[Cardiac myxoma, diagnostic methods and curative surgery. Report of 5 cases]. / Mixoma cardiaco, metodos diagnósticos y cirugía curativa. Informe de 5 casos.

We report five patients with Myxomas of the left atrium studied by catheterization and/or Echocardiography between november 1976 and october 1978. Four patients were operated immediately with extracorporeal circulation which confirmed the diagnosis. The last patient died before surgical intervention due to a severe hepatorenal syndrome and extensive pulmonary infection. Another patient died postoperatively on the second day due to irreversible pulmonary hypertensión. The remaining three patients are asymptomatic (average 28 months after surgery). Reviewing the diagnostic methods, particularly the Echocardiogram, we found that it is a good diagnostic tool, making catheterization with the risks of myxomatous embolization unnecessary. Furthermore, the Echo facilitates simple and economic observation for the detection of relapses. Finally, broad and careful surgical management most be emphasized in order to avoid transoperative emboli, tumoral dissemination, and latent relapses, mediated by the greater use of filters and a broad resection of the implantation pedicule.

[Mitral valve replacement, results in 160 patients]. / Reemplazo valvular mitral, resultados en 160 pacientes.

The results of 163 mitral valve replacement from 160 patients since August 1972 til August 1977 are presented, this is the second communication in Mexico related to mechanical mitral prosthesis. 95 patients were females and 55 males. With ages from 8 to 57 years, average 34; the 13% were child or teenagers. In 67% there were a clear background of rheumatic fever; 50% cardiac insufficiency and 19% previous mitral surgery from 8 months to 12 years before. 94% were class III or IV (N.Y.H.A.) and only 6% in I or II. Surgery was indicated according symptoms and hemodynamic data, 98% were catheterized. 26 Starr-Edwards and 137 Bjork-Shiley prosthesis were implanted in mitral position; in 112 cases only the mitral valve was substituted, in 41 cases a tricuspid procedure was done and in another 10 cases the aortic valve was also changed. The postoperative complications were: arrhythmies 32%; low cardiac output in 21%; infections 9%. Operative mortality in the isolated mitral replacement was 12%; in those cases with mitral-aortic or mitro-tricuspic lesions have been 33% in the first three years and 25% in the last three years. The long-term follow-up in 130 survivors is 29 months; 81% of them are actually in class I, 16% in class II and 3% in class III. The literature is reviewed and the facts responsive for the improved results are analyzed; special importance is given to the temporal external cardiac pacing in the management of the postoperative arrhythmies. Mitral valve replacement is considered as a good palliative procedure to the functional and socio-economical long-term rehabilitation in the survivors.