Primary synovial sarcoma of the heart. A clinicopathologic study of one case and review of the literature.

Primary synovial sarcomas of the heart are aggressive and extremely rare tumors. Only thirteen cases have been reported previously. We report the fourteenth case and review the previous ones. Our patient is a 45 year-old man who presented with congestive heart failure, which was related to a right atrial pedunculated tumor. The tumor was resected completely and the patient has remained disease-free after 5 years. The histopathologic examination and immunohistochemistry study confirmed the diagnosis. Thirteen cases are reported in the literature (11 men, 2 women) with a median age of 37.38 years (13 to 53 years). Most of the tumors occur in the right side (in 8 cases) particularly in the right atrium (in 5 cases). Ten patients died, seven within one year of diagnosis. However, in our case, the patient is still alive and free of disease.

[Congenital coronary aneurysm. Report of two cases]. / Anevrysmes coronaires congenitaux. A propos de deux observations.

Congenital coronary aneurysms are an unusual anatomical entity. Their prognosis appears to be particularly dependent on the presence or absence of aneurysm thrombosis. We report two cases of congenital coronary aneurysms, diagnosed in one case after myocardial infarction. The two patients were treated successfully by an exclusion of the aneurysm and coronary bypass. The aim of this study is to discuss the clinical features, prognosis and management of this disease.

Hydatid cyst of the heart and pericardium.

Between 1977 and 1988, six young patients (average 22 years) underwent surgery for cardiac echinococcosis. Three had a single cyst and the others had multiple cysts which ruptured into the pericardium. The diagnosis was always confirmed by cross-sectional echocardiography and cardiac angiography. Surgery was always performed through median sternotomy using cardiopulmonary bypass. Morbidity and mortality were nil and late results were satisfactory.

Closed mitral valvotomy in pregnancy--a study of seven cases.

Between 1977 and 1987, seven pregnant women (mean age 28 years) had closed mitral valvotomy through a left lateral thoracotomy during their first (3 cases), second (2 cases) or third (2 cases) trimester. Surgery was necessary either because of acute heart failure with pulmonary edema not responding to medical treatment (4 cases) or to prevent the complications of severe mitral stenosis affecting either the mother or the fetus in three patients with desired pregnancies. There were neither maternal nor fetal deaths. The only complication was bleeding from a low insertion of the placenta identified in the early postoperative period in one patient that required a caesarean section, which produced a normal baby. Six pregnancies continued until term with uneventful delivery and produced normal children. We conclude that closed mitral valvotomy is a simple and a low risk procedure in pregnant women. It prevents complications of severe mitral stenosis occurring in either the mother or the fetus during pregnancy and delivery.

[Recurrent post-infarction ventricular tachycardias. Treatment combining circular ventriculotomy, myocardial revascularization and aneurysmal plication]. / Tachycardies ventriculaires récidivantes post-infarctus. Traitement associant ventriculotomie circulaire, revascularisation myocardique et plicature anévrysmale.

The efficacy of encircling endocardial ventriculotomy (EEV) with treatment of recurrent persistent post-infarction VT has been established. The relative simplicity of the operation has enables it to be easily integrated into the surgical therapeutic arsenal for the treatment of coronary artery disease and its complications. Several electrophysiological studies have clearly demonstrated the origin of reentry pathways in the border zone of the aneurysm so that peroperative mapping can be dispensed with except in special cases. Sixteen patients with post-infarction LV aneurysm causing recurrent VT resistant to antiarrhythmic therapy for over 3 months were operated between January 1979 and June 1983. The average age was 51 years, range 36 to 70 years. The causal myocardial infarction dated from 3 months to 22 years; the site of infarction was anterior in 12 cases (anteroseptal 5 cases), posterior in 3 cases and circumferential in 1 case. Surgery was performed under cardiopulmonary bypass and comprised EEV in the border zone of the aneurysm without prior mapping studies. A myocardial revascularisation procedure was associated in 10 cases (aortocoronary saphenous vein bypass) with single grafts in 4 patients. Thirteen patients also underwent plicature of the aneurysm to remodel the ventricular cavity. There was one death in the immediate postoperative period due to a low output state (6.25%). The 15 survivors have been followed up for 1 to 45 months during which period 3 deaths occurred, on at the 2nd month due to cardiac failure and 2 sudden deaths at the 5th and 22nd months. These 2 patients had not had recurrences of their arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Open-heart surgery in patients over 65 years of age. Lesions encountered and immediate postoperative mortality]. / La chirurgie à coeur ouvert chez les sujets de plus de 65 ans. Lésions rencontrées et mortalité post-opératoire immédiate.

Open heart surgery after 65 is more and more frequent (16% of our surgical cases). Between January 1971 and December 1982, 8 425 open heart operations were performed in this Department, 1 377 of them in patients over 65. Most were cases of aortic valvulitis (620), and calcific aortic stenosis in particular, but also dystrophic aortic insufficiency; 217 patients underwent surgery for mitral valvulitis (rheumatic or dystrophic in origin) and 84 for involvement of more than one valve. Of the 2 440 patients with coronary lesions who underwent surgery, 255 were over 65; beyond this age, a higher rate of association between coronary lesions and valvular disease was found (167 patients undergoing surgery). Surgical mortality (during the first postoperative month) was higher after 65: 11.1% in patients with valve disease, and 11.4% in those with coronary artery disease, whereas in patients under 65 the figures were 6.5% and 4% respectively. On the other hand, in those undergoing surgery for combined valve and coronary disease, mortality over 65 was hardly any higher than under 65 (13.7% as against 10.4%). This justifies screening for coronary artery disease in any candidate for valve surgery aged over 65. These results were achieved thanks to some technical and anaesthetic precautions, and though they may be less satisfactory than those for younger patients, they justify such surgery for all lesions that threaten survival in the short term.