[The National Registry of Cardiac Tumors (the 1996-1997 report)]. / Registro Nacional de Tumores Cardíacos (memoria 1996-1997).

We presented the first report of the national database of heart tumors. We described the origin, development and goals reached during the years 1996 and 1997, the way the data was collected and the form used. The cases collected until 31st of December of 1997 include 165 tumors in 155 patients distributed all around the country. Age and gender distribution, way of diagnosis, morphologic classification, treatment and follow-up of this pathology is reported.

Surgical repair of double-outlet right atrium.

The case of a patient with abnormal position of the atrial septum resulting in a right atrium with two atrioventricular valves and a disconnected left atrium is presented. The left superior vena cava drained into the left atrium; the right superior vena cava and the coronary sinus were absent. The surgical technique for repair of this anomaly is described. A possible explanation of the embryopathogenesis of double-outlet right atrium is given. To our knowledge, this is the second case of double-outlet right atrium to be reported in the thoracic surgical literature.

Closure of the right atrioventricular valve in the modified Fontan operation for univentricular heart.

Surgical palliation of univentricular hearts by a modified Fontan operation has become a useful procedure for these complicated cases. Closure of the right atrioventricular valve is an important part of the operation. Patch closure has been the technique used by most surgeons. Heart block and dehiscence of the patch have been two common complications of this technique; both involve severe hemodynamic upset and often death to the patients in the early postoperative period. We closed the right atrioventricular valve by approximating the leaflets using pledgeted mattress sutures in two patients. Advantages of this type of closure are avoidance of the conduction system and secure closure of the valve.

Aspirin or Coumadin as the drug of choice for valve replacement with porcine bioprosthesis.

Eight hundred twenty-four patients who had cardiac valve replacement with a porcine bioprosthesis were given either Coumadin (sodium warfarin) or aspirin. No patient in sinus rhythm no matter what valve or valves were replaced had thromboembolism whether treated with Coumadin (124 patients) or aspirin (260 patients). One hundred fifty-one patients who had mitral valve replacement, were in atrial fibrillation, and were treated with Coumadin had seven embolic events (4.6%), while 135 similar patients treated with aspirin had five embolic events (3.7%). Fifty-one patients who had double-valve replacement, were in atrial fibrillation, and were treated with coumadin had three embolic episodes (5.9%), while 86 similar patients treated with aspirin had three embolic events (3.5%). No statistical difference was found in the incidence of thromboembolism between similar groups of patients whether treated with Coumadin or aspirin (p greater than 0.05). Hemorrhagic complications were higher and reached statistical significance (p less than 0.001) for the group treated with Coumadin. This study shows that aspirin prevents thromboembolic complications as well as Coumadin in patients having cardiac valve replacement with a bioprosthesis, and results in a lower rate of complications.

Early leaflet perforation as a cause of bioprosthetic dysfunction.

Of 699 patients with 900 bioprostheses, who lived longer than six months, three cases of early perforation of bioprosthetic leaflets are reported. In two cases the cut ends of the suture used for valve insertion had perforated the bioprosthetic cusps from repeated trauma. Insertion of the sutures in the periphery of the sewing ring and cutting the sutures flush with the knots should avoid this complication. The third case showed massive collagen breakdown with destruction of most of the cusp tissue. A possible explanation for such a massive early tissue breakdown could be an inadequate collagen fixation by glutaraldehyde.

Rupture of the tricuspid valve associated with disruption of De Vega's annuloplasty.

A case of sudden ruptured chordae tendineae of the tricuspid valve associated with failure of De Vega's tricuspid annuloplasty, 27 months after surgery, is reported. This is the first case to our knowledge of spontaneous ruptured chordae tendineae of the tricuspid valve reported in the literature.

Surgical treatment of annulo aortic ectasia. Experience in eight consecutive patients.

Eight patients with ectasia of the aortic annulus due to cystic degeneration of the media are presented. All patients were operated with a technique similar to the one described by Bentall and De Bono. Six patients had the aortic valve replaced by a bioprosthesis and two patients with a St. Jude Medical Valve Prosthesis. Manoeuvers to avoid anastomotic tension, adequate myocardial protection, and a careful control of postbypass blood pressure are described. There was no early or late mortality. Patients have been followed for a mean period of twelve months. Seven patients are in grade I of the N.Y.H.A., and one in grade II. Five patients studied postoperatively with cardiac catheterization and angiography showed normal ventricular function, normal prosthetic function and no aneurysm or pseudoaneurysm in any of the suture lines and with a good coronary anatomy.

Transaortic cannulation for balloon pumping in a "crowded aorta".

A technique for cannulating the ascending aorta or aortic arch to introduce a balloon catheter for intraortic balloon pumping is described. It is performed without the use of a partial occlusion clamp. This technique is useful when multiple anastomoses in the ascending aorta leave no room for the application of a vascular clamp. Three patients in whom this technique was used are reported.