Synchronous cardiac myxoma and colorectal cancer: a case report.

The occurrence of synchronous but unrelated cardiac and colorectal tumors is extremely rare. We present the case of a 56-year-old man who had a left atrial cardiac myxoma that nearly obstructed the mitral valve outflow tract and an unrelated, synchronous colorectal-vesicle carcinoma that nearly obstructed the lumen of the intestine. The patient underwent emergency resection of the cardiac mass under cardiopulmonary bypass and underwent successful resection of the colorectal mass 2 weeks later Two years after these operations, the patient is well with no recurrence of either tumor Synchronous tumors, particularly when one of them involves the heart, require aggressive surgical treatment at multiple sites in order for the patient to survive.

Isolated right ventricular outflow tract mass presenting as hemoptysis.

Infective endocarditis presenting as an isolated right ventricular outflow tract mass is rare. We report a 34-year-old man with no history of congenital heart defect or intravenous drug abuse who presented with hemoptysis and fevers. Diagnostic workup revealed isolated right ventricular outflow tract vegetation. Despite aggressive antibiotic treatment for endocarditis, he developed septic emboli and acute respiratory distress. He was taken to the operating room for successful resection of the ventricular mass.

Indwelling catheter-induced right ventricular rupture.

We describe a case of a 68-year-old man who, because of postoperative mediastinitis, underwent a multiple muscle flap closure of the mediastinum. A chronic indwelling catheter led to erosion and rupture of the anterior wall of the right ventricle. The near exsanguinating hemorrhage was corrected under circulatory arrest. A pericardial patch repair was performed with good results.

Combined carotid endarterectomy and coronary artery bypass grafting in asymptomatic carotid artery stenosis.

The role of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) in patients with severe asymptomatic carotid artery disease and concurrent symptomatic coronary artery disease is controversial. The objective of this report is to investigate the safety of combined CEA/CABG. The medical records of 30 patients who underwent combined CEA/CABG for coexistent asymptomatic carotid and symptomatic coronary artery occlusive disease were reviewed. All patients were scheduled for either elective or urgent myocardial revascularization due to their symptomatic coronary artery disease. Color-flow duplex scanning identified internal carotid artery stenosis of 80 to 99 per cent in 28 patients (93%) and 50 to 79 per cent in 2 patients (7%). Seventeen patients (57%) were male. The mean age was 64 +/- 10 years (range, 42-84 years). Contralateral internal carotid artery occlusion was present in four patients. Severe left main coronary artery disease was present in 12 patients (40%) and 7 patients (23%) had an ejection fraction of less than 50 per cent. There were no perioperative deaths or strokes. One patient suffered a myocardial infarction on postoperative day 1. This study demonstrates the safety of combined CEA/CABG for coexistent coronary and asymptomatic carotid disease. Using this surgical approach for critical coexistent disease may minimize the incidence of perioperative cerebrovascular complications in patients undergoing CABG.

Chest wall implantation of lung cancer after thin-needle aspiration biopsy.

Percutaneous aspirational biopsy of intrathoracic lesions has become a popular technique. One of the rarest complications is that of implantation of malignant cells within the needle tract and subsequent development of a chest wall mass. A case of chest wall implantation of adenocarcinoma of the lung after thin-needle biopsy is reported. The lesion was successfully treated with radical full-thickness excision of the chest wall and immediate reconstruction with a large rectus abdominis musculocutaneous flap.

Should aortography be used routinely in the elective management of abdominal aortic aneurysm?

Until recently aortography was performed routinely for elective abdominal aortic aneurysm at our institution. A death resulting from this procedure prompted us to evaluate this policy by a retrospective study of 105 elective aneurysm patients. These studies identified 21 renal artery stenoses, 2 renal artery aneurysms, 2 cases of multiple renal arteries, 8 celiac stenoses, 6 superior mesenteric artery stenoses or occlusions, and a number of peripheral occlusive processes and associated iliac aneurysms. However, the impact of these findings on surgical management was limited to six renal artery reconstructions: one for reimplantation of a renal artery arising from the aneurysm, one for serious hypertension, and four in normotensive patients with severe arterial stenosis. No celiac or mesenteric reconstructions were undertaken, and no visceral complications ensured. In only one patient, the one with renal artery reimplantation, was the angiographic information unsuspected and significant for operative management. This did not appear to justify the risk and expense involved in routine preoperative aortography.