Autotrasplante cardiaco en el tratamiento quirúrgico de tumores cardiacos primarios: Caso clínico / Heart autotrasplantation for the treatment of a rhabdomyosarcoma of the left ventricle: Report of one case

Background: Heart autotrasplantation is an exceptional surgical technique used in the treatment of uncontrolled cardiac arrhythmias and primary unresectable cardiac tumors. We report a 28-year-old male with a rhabdomyosarcoma of the left ventricle, localized in the lateral and posterior wall, which involved the mitral valve and circumflex artery. After a complete study ruling out dissemination of the tumor, the patient was operated. Surgical exploration determined the unresectabilility of the tumor with the heart in situ. Therefore, the heart was explanted, preserving the right atrium and coronary sinus for re-implantation. Fifty percent of the mitral valve and the circumflex artery from its origin, were resected due to tumor infiltration. The heart was reconstructed with bovine pericardium and a mechanical valve was implanted in the mitral position. Afterward, the heart was implanted again following the same sequence as in bicaval transplantation, followed by a double bypass grafting to the distal circumflex territory. The patient had no significant complications and after nine months of follow up, there was no evidence of local recurrence. In the fourth postoperative month, a subcutaneous mass in the left thigh that was considered a metastasis without histological confirmation appeared. The lesion disappeared with radio and chemotherapy.

Disección aórtica tipo A: Resultados operatorios y seguimiento a mediano plazo / Surgical results among 100 patients with type A aortic dissection: Retrospective review

Background: Tipe A aortic dissection involves the ascending aorta and has high mortality rates without surgical treatment. Aim: To report the results of surgical treatment of type A aortic dissection. Material and Methods: Retrospective review of medical records of 100 patients aged 17 to 78 years (73 percent males) operated between January 2000 and August 2008, for type A aortic dissection. Follow up was performed with telephone interviews and review of national death records. Results: Eighty three percent of patients had an acute dissection. Operative mortality was 27 and 20 percent for patients with acute and chronic dissection, respectively. Mortality was 50 percent among patients aged 70 years or more, compared with 21 percent among their younger counterparts, The most common complication was bleeding that required a new surgical procedure in 18 percent of patients. Actuarial survival was 70 percent at five years. Cardiovascular problems caused the death of two of the nine patients that died during follow up. Conclusions: Surgical mortality among patients with type A aortic dissection was higher among patients with acute episodes and those aged 70 years or more.