Cardiac myxoma Mansoura experience, results of 17 cases

The study was conducted to evaluate our surgical results and operative outcome after complete excision of cardiac myxoma. This retrospective study was conducted in the Department of Cardiothoracic Surgery, Mansoura University Hospital from march 1996 to January 2007, the study involved 17 patients with intracardiac myxoma for whom excision was done. All patients were subjected to full history taking, clinical examination, routine laboratory and EGG examination. Echocardiography was performed preoperatively, prior to discharge and after a mean duration of 8.47 +/- 2.72 months postoperatively. Seventeen patients of cardiac myxoma were surgically treated. The mean patient age was 37.82 +/- 9.4 years and there was 9 [52.9%] male patients and 8 [47.1%] female patients. The most common preoperative symptom was dyspnea occurring in 7 [41.2%] patients. The mean interval from the onset of symptoms to surgery was 8.29 +/- 4.98 months. The tumor was in the left atrium in 15 [88.3%] patients, in the right atrium in one [5.9%] patient and bilateral myxoma was present in one [5.9%] patient. The heart was approached via median sternotomy in all cases, left atriotomy was done in 15 [88.2%] patients, right atriotomy in one [5.9%] patient while bilateral approach was used in one [5.9%] patient. The tumour was excised completely in all cases and the defective area was repaired directly in 11 [64.7%] cases, and with pericardial patch in 6 [35.3%] cases. The mean cardiopulmonary bypass and aortic cross clamp times were 38.3 +/- 2.36 and 26.4 +/- 2.1 minutes respectively. There was one [5.9%] case hospital mortality due to fatal arrhythmia and 2 [11.8%] cases morbidity in the form of pneumonia and superficial wound infection. All patients underwent echocardiography prior to discharge and at a mean follow up period of 8.47 +/- 2.72 months postoperatively. All survival 16 [94.1%] patients showed no evidence of tumour recurrence clinically or on echocardiographic examination, also ECG abnormalities that were present before surgery had disappeared. In conclusion, in our study there was no recurrence of myxoma after complete excision so surgical excision in considered to be the curative method for treatment of cardiac myxoma that quickly relieves symptoms and must be done early after diagnosis

Closed mitral valvotomy in patients with rheumatic mitral stenosis and associated aortic regurge

This work comprised 300 patients with tight mitral stenosis [MS] who underwent closed mitral valvotomy [CMV] operation and subdivided into two main subgroups: Subgroup A with MS and without associated aortic regurge [AR] [MS group] and comprised 100 patients and subgroup B with MS and associated AR [MS-AR group] and comprised 200 patients [130 patients had AR grade up to I/IV and 70 had AR grade ranged from >1/IV to II/IV; 180 patients had normal preoperative left ventricular, LV, dimensions and 20 patients had mild increased LV dimensions] [end systolic diameter, ESD, up to 4.2 cm and end diastolic diameter, EDD, up to 6.2 cm]. All patients were subjected to CMV operation, preoperatively and postoperatively [within three months, one year and three years]; clinical and Doppler echocardiographs evaluation. The study concluded that CMV operative can be done safely for patients with tight MS and associated AR up to grade II/IV and even among those patients having mild increased LV dimensions [ESD up to 4.2 cm and EDD up to 6.2 cm]. A longer follow up period [up to ten years] was recommended for these patients to evaluate the rate of the progression of AR and the need of AV replacement among them

Blood groups and risks from oral contrceptive pills

This study evaluated the abnormal lipid metabolism related to OCs usage among women with different ABO blood groups. It comprised 204 healthy women regularly using OCs for more than 1 year [56 group A, 52 group B, 24 group AB and 72 group O], as well as 82 healthy women not receiving any hormonal contraception or therapy [21 group A, 20 group B, 11 group AB and 30 group O]. The abnormal lipid changes related to OCs usage [elevated serum triglyceride, total cholesterol and LDL- chol] was found more among women with blood group A and B and no significant changes was found among women with blood group AB and only increase in serum triglycerides was found among women with blood group O. Although the altered lipid metabolism among women with blood group B, AB and O showed no relation to the estrogen content of pills, the lipid abnormalities among women with blood group A was related to the estrogen content of pills. It is advisable to estimate serum lipids for women with blood group A and B before using OCs and annually when using the pills. Women with blood group A should not receive the 50 mug estrogen containing pills. In absence of known contraindications, women with blood group AB and O could use any OCs preparation as a contraceptive method

Pulmonary haemodynamic changes after injection sclerotherapy in patients with bilharzial pulmonary hypertension

This work aimed to evaluate the incidence of bilharzial pulmonary hypertension [PH] in patients with ruptured esophageal varices, as well as the value of variceal injection as a therapeutic modality and its effects on pulmonary hemodynamic, among patients with bilharzial PH. Out of 3000 patients with ruptured esophageal varices, 18 only were found to have associated bilharzial. Patients with ruptured varices and bilharzial PH were subjected to emergency sclerotherapy to control bleeding, repeated sclerotherapy to produce variceal obliteration and electrocardiographic as well as Doppler echocardiographic evaluations and estimation of mean pulmonary artery pressure [MPAP] for 3 times [before initial sclerotherapy, 1 week after control of bleeding and 1 week after complete variceal obliteration]. Injection sclerotherapy had resulted in non- significant changes in all the studied electrocardiographic and Doppler echocardiographic parameters among our patients with bilharzial PH. It had resulted also in non significant lowering in MPAP among them

study of autonomic functions in patients with mitral valve prolapse

This work was performed to evaluate autonomic functions by cardiovascular reflexes among patients with mitral valve prolapse [MVP]. It comprised 45 patients [16 males and 29 females] with MVP diagnosed on clinical and echocardiographic basis. Twenty-three normal individuals [7 males and 16 females] with matched sex, age, weight, height and body mass index were taken as a control group. Abnormal autonomic functions had been observed in the MVP patients in the form of parasympathetic dysfunction and inappropriate [imbalance] sympathetic response to different stress in the form of hyperactive early response and hypoactive response on sustained stress and this autonomic imbalance was not related to age or sex but could be related to the severity of MVP. The degree of autonomic affection [quantitative defect] was related to the presence of symptoms among the studied MVP patients. The symptomatology of MVP was not related to sex, severity of MVP, but it was related to the younger age group

Enkephalins and tolerance to cardiovascular effects of caffeine

The present study comprised 22 patients [10 with essential hypertension and 12 with ischemic heart disease] who were 10 chronic coffee and/or tea healthy drinkers and 10 caffeine-naive individuals. All were given a boostering dose of caffeine [250 mg] and were subjected to treadmill exercise ECG testing and 2D-echocardiographic study before and after the boostering dose. Their caffeine and enkephalins serum levels were also determined before and after the treadmill exercise ECG testing. The results of the study showed that the chronic coffee and/or tea drinkers whether they were patients or healthy individuals were tolerant to the cardiovascular effects of caffeine in moderate doses and the enkephalins may have a role in the development of this tolerance

Incidence of organic tricuspid valve affection among rheumatic valvular heart diseases

Among the 545 patients with rheumatic valvular affection evaluated by Doppler Echocardiography; 56 were to have associated organic TV affection [10.28%]. They were 307 females of whom 29 have associated TV organic affection [9.4%] and 238 males of whom 27 have associated organic TV affection [11.34%].The echocardiographic features refIecting organic TV affection found among our studied cases were refIecting thickening [100%]; dooming [78.0%]; prolapse [12.5%]; calcification [3.75%]; subvalvular chordal thickening [19.86%] and restricted valve mobility[9.55%]. Associated organic tricuspid valve was found to be more prevelent among cases with combined aortic and mitral valve lesions [13.3%] especially those suffering from double mitral and aortic valve lesions [19.05%] as well as among those with isolated mitral stenosis [11.42%]. Tricuspid regurge was found in [10.28%] among the studied cases [9.4%among males and 11.34% among females]. Tricuspid stenosis was found in only 7.5% [in 7.6% among males and in 1.5% among females]. Significant TS was found in 2.75%; [in 3.5% among males and 2.0% among females]. There is no sex difference for the prevelance of organic TV affection among our studied rheumatic valvular heart cases; however, Significant TS is more common in males than females. In conclusion; Rheumatic TV disease is common in association with other valvular affection, it never occur as an isolated condition; TS always associated with TR. There is a high incidence of organic TV disease among males with rheumatic valvular lesion than females which requires further studies and analysis