Atrial myxoma related myocardial infarction: Case report and review of the literature

Atrial myxomas are the commonest primary cardiac tumors and usually affect the left atrium. Patients with atrial myxomas present with intracardiac obstruction, embolization to the pulmonary and systemic circulation, or constitutional symptoms

The coronary arteries' involvement in myxomatous embolization, although rare, has been described to cause acute myocardial infarction [AMI]

We report a case of atrial myxoma associated MI and present the clinical and echocardiographic features of this presentation followed by review of the English literature for the association of atrial myxomas and acute myocardial infarctions [AMI]

Expectant management of premature rupture of membranes remote from term

To evaluate maternal and neonatal outcomes of singleton pregnancies complicated by PROM from 16 to 28 weeks gestation, and exposed to conservative management, in a local at Ibn Sina College of Medicine, hospital in Jeddah, Saudia Arabia. When PROM occurred and fetuses were at viable gestational age, pregnant patients were managed aggressively with tocolytic therapy, antenatal corticosteroids and antibiotic therapy. The relevant data related to the maternal and neonatal outcomes as well as maternal and neonatal morbidity were recorded and evaluated. During the study period, there were 4,665 deliveries, and 44 women admitted to the hospital with PROM at 16-28 weeks of gestation. Two women were excluded from the study, one of whom developed chorioamnionitis and the other experienced prolapsed fetal parts outside the vagina. Eight cases [19%] of PROM occurred in women at 16-19 weeks gestation, 14 cases [33.33%] occurred at 19-24 weeks gestation, and 20 cases [47.6%] occurred at 24-28 weeks gestation. Among the 42 pregnant patients, there were 23 [54.7%] still births and 5 [11.9%] neonatal deaths, resulting in a total death rate of 66.66%. Therefore the perinatal survival rate was 33.33%. The survival rate based on gestational age at the onset of PROM was "nil" at 16-24 weeks gestation [4 cases early neonatal deaths and 18 cases were still births]. The survival rate at 24-28 weeks gestation was 70% [14 out of 20]. There was no maternal mortality, however, four women [9.5%] experienced puerpural endometritis. One patient receive blood transfusion for a significant blood loss after a curettage to remove retained placenta. Among the surviving newborn infants, 100% had respiratory distress syndrome; 2 of them [14.2%] developed pneumothorax, and 8 [57.1%] experienced apnea. Intraventricular hemorrhage occurred in one case [7.1%] as did necrotizing enterocolitis. Three cases [21.4%] developed neonatal sepsis and 6 [42.8%] suffered from anemia. Physicians should council their patients thoroughly and well in advance with regard to the poor outcomes and the potential complications for neonates anticipated after this type of delivery. Aggressive expectant management does not seem to increase maternal morbidity

Early results of total arterial revascularization in comparison to conventional coronary artery bypass

The issue of total arterial revascularization as opposed to conventional coronary artery bypass grafting, using the left internal mammary artery and venous conduits, remains controversial. In this study, we aim to compare both methods in regards to outcome, and short term follow-up. Group I: Forty patients [male 37; female 3; mean age 60 years] underwent CABG using arterial grafts only [left and right internal mammary arteries, and left and right radial arteries]. Data collected were compared with another forty patients [Group II] [male 36; female 4; mean age 65] who were revascularized by conventional CABG using the left internal mammary artery and venous conduits. Patients with single vessel disease, preoperative renal or hepatic dysfunction, or associated cardiac procedures were excluded from the study. There was no statistically significant difference between the groups with respect to systemic hypertension [67.5%], insulin dependent diabetes [6.3%], non-insulin dependent diabetes [25%], hypercholesterolemia [72%], prevalence of three-vessel disease [90%] and left main stenotic lesion [10%], or preoperative ejection fraction [44%].Operative technique and myocardial preservation was similar in both groups. The mean number of grafted vessels per patient was three grafts. All patients were totally revascularized, defined as bypass of all significant lesions with more than 70% stenosis. In all patients in Group II, the left internal mammary artery was anastomosed to the left anterior descending artery, and saphenous vein conduits to the remaining stenosed vessels. In Group I, total arterial revascularization was achieved using the internal mammary. There was no statistically significant difference between both groups regarding early post operative events, inotropic requirements, use of intra-aortic balloon pump, reinterventions for bleeding, wound problems, or stroke. Group I:One patient showed manifestations of postoperative infarction [2.5%]. There were no early mortalities. One patient died five months post-operatively from perforated peptic ulcer. Five patients were studied postoperatively [8 to 24 months] by coronary angiography revealing graft stenosis in a single free right internal mammary artery conduit, and one radial artery conduit. Group II: Three patients showed manifestations of postoperative infarction [7.5%]. There were two early mortalities from heart failure. Five patients were studied postoperatively [8 to 24 months] by coronary angiography revealing graft stenosis in three venous conduits. In this short-term study, there was no significant difference between total arterial revascularization in CABG, and conventional CABG using the left internal mammary artery and venous conduits, in respect to early outcome and graft patency