Left ventricular outflow tract obstruction due to a left ventricular myxoma: a case report and review of the literature.

A 17-year-old-man who presented with syncope, had a left ventricular (LV) myxoma causing left ventricular outflow tract obstruction. The tumor was removed through left ventriculotomy using conventional cardiopulmonary bypass with good result. There have been 47 cases of LV myxoma reported in the world literature since 1957. Most of them are symptomatic (92.7%). Systemic embolism is the most common manifestation (50%) and often leads to death. The surgical removal should be performed urgently. Resection of the mass with limited normal tissue surrounding its pedicle is recommended. There are only three recurrences and five operative deaths.

Successful implantation of transvenous automatic implantable cardioverter defibrillator (AICD): the first case report in Thailand.

We successfully implanted transvenously the AICD in a case of sudden cardiac arrest survivor. Though the device is very expensive, it is useful in some selected cases. With its diagnostic capabilities, the device may be useful in elucidating the underlying mechanism of Lai Tai.

Intraoperative transesophageal echocardiography: preliminary experience at Siriraj hospital.

In order to evaluate the result of intraoperative TEE monitoring for cardiothoracic surgery, 113 patients were involved in this study. They included 65 males and 48 females, with an average age of 48.8 +/- 16.6 years, ranging from 10 to 74 years. The pre-operative diagnoses consisted of 41.6 per cent coronary artery disease, 34.5 per cent valvular disease, 12.4 per cent congenital heart disease, 8 per cent aortic aneurysm or aortic dissection, and 3.5 per cent of miscellaneous. The TEE appeared to provide accurate information by beating to changes in the left ventricular preload and contractility in all patients. The severity of valvular dysfunction, intracardiac air/mass, Swan Ganz catheter position, sites of congenital heart defect and aortic dissection were either assessed or reconfirmed during the operation. The ease of TEE technique was satisfactory, since unsuccessful attempt was observed in only 1.8 per cent. One patient died from rupture of thoracic aortic dissection which was related to TEE probe insertion. These data suggest the favorable result of intraoperative TEE as a valuable tool for monitoring in cardiothoracic surgery. Although the technique is simple, special precaution must be observed for patients suffering from acute aortic dissection.

Leiomyomas of the lower respiratory tract: a case report.

A rare case of leiomyoma of the left main bronchus in a 16-year-old female has been reported. Of the pulmonary leiomyomas reported, 18.3 per cent were found in the trachea, 33.8 per cent in the bronchi and 47.9 per cent in the parenchyma. Bronchial lesions tend to produce symptoms due to partial or complete obstruction of the affected bronchus, whereas, over 90 per cent of parenchymal lesions which are more common in women, are asymptomatic and usually discovered on routine chest radiographs. Tracheal lesions may present as bronchial asthma. The correct diagnosis is not usually made until the lesion has been resected. However, early and correct diagnosis may be made in suspicious cases by histological examination of bronchoscopic biopsy specimens or frozen section material obtained at thoracotomy. The surgical approach to these tumors is conservative but lobectomy or pneumonectomy is often necessary because of secondary pulmonary destruction.