Cardiopulmonary bypass for anesthetic management anterior medistinal teratoma: Case report.

INTRODUCTION AND IMPORTANCE: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. CASE PRESENTATION: Here we describe the anesthetic management of an 18-year-old woman with a mature teratoma who presented with progressive exertional dyspnea that was aggravated in the supine position in the operating room. After tracheal intubation, the tidal volume decreased, airway pressure increased, and pet CO2 grew beyond 105 mmHg without oxygen desaturation, prompting a femoro-femoral cardio-pulmonary bypass. CLINICAL DISCUSSION: Cardio-pulmonary bypass (CPB) can facilitate tumor dissection by safely deflating the lungs and retracting the heart, enhancing exposure and reducing risks of hemodynamic or respiratory complications. However, systemic heparinization may increase complications, necessitating a preoperative risk assessment. CONCLUSION: Preoperative management of large mediastinal masses requires careful attention to tumor anatomical details and relationships with surrounding structures. Preoperative preparation includes multimodality imaging and multidisciplinary team discussions to assess MMS risk, requiring specialized center management.

Case report and analysis of the literature on sarcomatous mesothelioma of the left atrium.

INTRODUCTION AND IMPORTANCE: Primary intracardiac malignant mesothelioma is an extremely uncommon condition with a terrible prognosis. Because of its rarity, there have been extremely few examples described in the literature. CASE PRESENTATION: We are reporting the instance of a 44-year-old lady who was referred to the department of cardiology for worsening dyspnea, palpitations, and a recent syncopal episode. On examination, the patient had signs of global heart failure. Cardiac imaging showed a tissue mass infiltrating the atrioventricular sulcus at the mitral valve level, responsible for severe mitral stenosis. Pleural effusion without an intrapleural mass was also noted. Urgent surgery was performed, including excision of the tumor mass, mechanical replacement of the mitral valve, and tricuspid plasty. The anatomo-pathological study concluded in cardiac mesothelioma. The patient was transferred back to the cardiology department 9 months after surgery due to severe left heart failure. TTE and TOE were performed and revealed tumor recurrence responsible for severe mitral stenosis. The course was marked by the onset of cardiogenic shock refractory to treatment, followed by the death of the patient. The case we are reporting seems to be the initial instance documented as exclusively primary intracardiac mesothelioma especially its lack of association with any other pleural sarcomatoid mesothelioma or asbestos exposure. CLINICAL DISCUSSION: In cases where a large atrial tumor is present, prompt surgical intervention is recommended to mitigate the risk of catastrophic embolization or valve orifice obstruction. The objective of surgical intervention is to excise the entire neoplasm with sufficient surrounding tissue, a feat that is infrequently achievable. Palliative debulking may be a beneficial intervention for patients who do not necessitate complete resection, particularly those experiencing relevant or rapidly escalating symptoms. Cardiac transplantation remains a viable option in the event of an unresectable malignant tumor. CONCLUSION: The short-term prognosis is poor. Surgical treatment remains the best treatment for this type of tumor. Total excision should be considered, but may not be feasible in all cases. Adjuvant chemotherapy may be considered.

Neonatal cardiogenic shock revealing obstructive cardiac Hibernoma: case report.

BACKGROUND: Cardiac Hibernomas are very rare benign tumors and usually remain asymptomatic. Neonatal cardiogenic shock due to cardiac tumors is extremely very rare. Until this date a few cases of cardiac hibernoma have been reported in the literature. Transthoracic echocardiography help in the differential diagnosis, but the definitive diagnosis is histological. The management strategy is not clearly codified. The Aim is to report and discuss the clinical features of a cardiac Hibernoma and review the relevant literature. CASE PRESENTATION: We describe a case of a 2-day-old Caucasian full-term male neonate admitted in neonate intensive care with cardiogenic shock, having fluid resuscitation and inotropic drugs. Ventilatory support was started immediately with the subsequent reestablishment of normal blood pressure. Then he was transferred to the echocardiography laboratory. Transthoracic echocardiography showed two echogenic masses in the right atrium and right ventricle. The masses were extended to the pulmonary trunk. Pulmonary artery flow measurements showed the presence of pulmonary and tricuspid obstruction. Surgery was rapidly considered since the baby was hemodynamically unstable. Intraoperative evaluation showed a mass embedded in the interventricular septum that occupy the right ventricular cavity and the right atrium. The tumor involved also the chordae of the tricuspid. Partial resection was done. Tricuspid valve repair was performed by construction of new chordae from the autologous pericardium. The specimen was sent for histopathological analysis. The baby died immediately after surgery. Histological examination of the surgical specimen revealed clear multivacuolated cells filled with lipid droplets and granular intense eosinophilic cytoplasm which confirms the diagnosis of Hibernoma. CONCLUSION: Cardiac Hibernomas are rare benign tumors. The prognosis and treatment strategy is closely dependent on the location, initial clinical presentation and possible complications. The prognosis can be unfavorable if the tumor was obstructive and infiltrate the myocardium.

Surgical Management and Outcomes of Cardiac and Great Vessels Echinococcosis: A 16-Year Experience.

BACKGROUND: Cardiac involvement is an uncommon presentation of hydatid disease. In this study, we aim to analyze the experience of surgical treatment of cardiac and great vessels echinococcosis in our cardiovascular and thoracic surgery department. METHODS: Through a 16-year period, from 2000 to 2015, 27 patients underwent surgery for cardiac and great vessels hydatid disease. The clinical, operative, and postoperative data were analyzed through this retrospective and descriptive study. RESULTS: Most of our patients came from a rural area. The most common symptom was chest pain. The diagnosis was mainly made by transthoracic echocardiography, which has shown the right ventricle as the most frequent location of the disease. All patients received surgical treatment under cardiopulmonary bypass, and only six surgeries were performed without cross-clamping the aorta. Inhospital mortality rate was 7.4%. CONCLUSIONS: Cardiac hydatidosis is a rare but potentially serious condition whose treatment is mainly surgical even for asymptomatic patients owing to its possible fatal complications. The surgery outcomes are usually satisfactory. Follow-up examinations are highly recommended to detect recurrences.