Right atrial angiosarcoma with severe biventricular dysfunction and massive pericardial effusion.

This paper presents the case of a 35 year-old woman with symptoms of heart failure from the last month. A physical examination at admission showed paleness, dyspnea, peripheral edema and fatigue. In a two-dimensional echocardiography and transesophageal echocardiography, normal thickness but severe left and right ventricular dysfunction with severe pericardial effusion and thickened pericardium were found. In the enlarged right atrium, an oval-shaped structure was found with features of continuity with lateral right atrial wall and also a bulging of the structure through the orifice of the tricuspid valve to the right ventricle. In the echocardiography, we did not saw any blocking of the tricuspid valve or the inflow from inferior vena cava (IVC) or superior vena cava (SVC) or coronary sinus. On the basis of the echocardiography examination and clinical presentation, tentative diagnosis of the right atrium myxoma was made. A coronary angiography revealed normal coronary arteries and no feeding of tumor by branch of right coronary artery (RCA). Surgical removal of the tumor was performed without complication. The histopathological examination confirmed the diagnosis of angiosarcoma. In the follow-up echocardiography carried out after three months, severe left ventricular (LV) and right ventricular (RV) dysfunction continued and was demonstrated. Magnetic resonance imaging revealed no lymphadenopathy or re-growth of the tumor in the mediastinum or pericardium.

Low dose aprotinin increases mortality and morbidity in coronary artery bypass surgery(*).

BACKGROUND: The low dose aprotinin consistently reduces blood and transfusion requirement in adults during cardiac surgical procedures but its effectiveness in some ethnical groups were debated and controversy about its effect on mortality and morbidity precludes its routine use. This study was designated to determine whether a low dose of aprotinin causes more mortality and morbidity when used after coronary artery bypass grafting (CABG) surgery. METHODS: In a clinical trial study, 380 patients in placebo and 273 patients in aprotinin group were enrolled. A test dose before skin incision and 2 million kallikrein inactivation units (KIU) during initiation of cardiopulmonary bypass (CPB) were given to patients. Differences in quantity of blood transfusion, morbidity and mortality were analyzed. Multivariable analysis was performed to determine risk factors for mortality. RESULTS: Decreased blood product transfusions and increased rate of morbidity were found in the aprotinin group. Independent predictors for increased number of transfusion were aspirin continued before operation and small body mass index (BMI) but there was a significant difference in mortality and morbidity between two groups. CONCLUSIONS: In patients undergoing CABG procedure, low dose aprotinin is effective in attenuating post bypass coagulopathy and decreasing blood product use, but it increases morbidity.

A comparative study of cardioprotective effect of three anesthetic agents by measuring serum level of troponin-T after coronary artery bypass grafting.

BACKGROUND: Cardiac surgery is associated with some degree of myocardial injury. Preconditioning first described in 1986 was pharmacologic and non- pharmacologic. Among the long list of anesthetic drugs, isoflurane as an inhaling agent along with midazolam and propofol as injectable substances have been documented to confer some preconditioning effects on myocardium. OBJECTIVES: In this study cardiac Troponin T (cTnT) ,as a reliable marker, was used for evaluating myocardial injury. METHODS: This prospective double blind study was comprised of 60 patients scheduled for CABG and were randomly assigned into three groups who received infusion of propofol or midazolam or isoflorane. Surgical procedures and anesthetics were similar for 3 groups. cTnT measured preoperatively and at 12, 24 and 36hr after arrival in ICU. RESULTS: There were no statistically significant differences in mean cTnT levels between three groups in the preoperative period and 12-24 hours after arrival in ICU. However, mean cTnT in 3 groups at 36 hours after arrival in ICU were different (P< 0.013) and cTnT level was significantly higher in midazolam group (P<0.001) and lowest in isoflurane group (P=0.002). CONCLUSION: There were significant differences on cTnT levels between anesthetic groups of isofluran, midazolam and propofol at 36 hr after surgery. Preconditioning effect of isoflurane was higher than the other two groups.