An unexpected left atrial cavernous hemangioma: the cardiac surgeon needs an optimal preoperative study!

An optimal preoperative evaluation is fundamental to the assessment of all patients undergoing cardiac surgery. We report the case of a male patient who underwent elective coronary artery bypass surgery, and intraoperative transesophageal echocardiography (TEE) revealed an unexpected left atrial cavernous hemangioma. The tumor was resected via a transatrial approach, and a definitive diagnosis was made after histological examination. This uncommon intra-atrial tumor (which accounts for approximately 2.8% of all benign cardiac neoplasms) was detected at the time of the operation as no basic echocardiography study had been performed on the patient during the process of diagnosing his coronary heart disease because of a suboptimal cardiological work-up. Most cardiac masses are discovered incidentally by imaging techniques; in this patient, transthoracic echocardiography could have aided in the preoperative study and enabled the cardiac surgeon to plan and perform the adequate surgical procedure beforehand. Intraoperative TEE should be used routinely in all patients undergoing cardiac surgery: the clinical information obtained in certain cases might have a direct impact on surgical decision-making and might therefore positively influence patient's outcome.

[Incidence and clinical impact of pulmonary homograft dysfunction after the Ross procedure]. / Incidencia e impacto clínico de la estenosis del homoinjerto pulmonar tras el procedimiento de Ross.

INTRODUCTION AND OBJECTIVES: We analyzed the incidence, risk factors and clinical impact of pulmonary homograft dysfunction after the Ross procedure in our patients. PATIENTS AND METHOD: All patients were evaluated at 3, 6 and 12 months, and annually thereafter. Patients with a transhomograft pressure gradient greater than 30 mmHg were referred for cardiac magnetic resonance imaging. RESULTS: At the end of the study, 9 patients (11.8%) showed a transhomograft pressure gradient >30 mmHg after a mean period of 15.3 months post-surgery. Mean transhomograft pressure gradient was 19.8 (16.2%) (range, 2-100 mmHg). All patients were in functional class I, except 2 who were in New York Heart Association class II with severe stenosis. These 2 patients were treated percutaneously with stent placement and no reoperation. No association was found between clinical outcome and sex, age or homograft diameter. We found a trend toward greater perioperative use of plasma, platelets and red cells in the group of patients in comparison to controls, although the difference was significant only for postoperative use of plasma (1.7 [3] vs 5.5 [5.3] units; P<0.05). Cardiac magnetic resonance imaging showed stenosis predominantly in the body of the homograft, whereas the valvular component itself remained competent. Right ventricular hypertrophy was mild or very mild in 7 patients and moderate in 2. CONCLUSIONS: The incidence of some degree of pulmonary homograft dysfunction after the Ross procedure was non-negligible, but its clinical impact seems to be slight. Patients with severe stenosis were treated successfully via a percutaneous approach. The use of blood products might be a risk factor for the development of this complication.

Incidencia e impacto clínico de la estenosis del homoinjerto pulmonar tras el procedimiento de Ross / Incidence and clinical impact of pulmonary homograft dysfunction after the Ross procedure

Introducción y objetivos. Estudiamos la incidencia, los factores de riesgo y el impacto clínico de la estenosis del homoinjerto pulmonar tras la intervención de Ross en nuestra serie clínica. Pacientes y método. El seguimiento se realizó a los 3, 6 y 12 meses, y después anualmente. Los pacientes con gradiente a través del homoinjerto pulmonar > 30 mmHg fueron sometidos a una resonancia magnética cardíaca. Resultados. De los 76 pacientes intervenidos, 9 (11,8 por ciento) presentaron un homoinjerto pulmonar > 30 mmHg una media de 15,3 meses después de la intervención. El gradiente medio fue de 19,8 ñ 16,2 mmHg (rango, 2-100). Todos los pacientes se encontraban en grado funcional I de la New York Heart Association excepto 2, que estaban en grado funcional II con estenosis severa y fueron tratados percutáneamente con stents, sin necesidad de reoperación. No encontramos asociación con el sexo, la edad ni el diámetro del homoinjerto. El uso de hemoderivados (hematíes, plasma y plaquetas) fue mayor en el grupo afectado que en el de control, si bien no alcanzó significación estadística, a excepción del uso de plasma en cuidados intensivos (1,7 ñ 3 frente a 5,5 ñ 5,3 unidades; p < 0,05). El estudio con resonancia magnética cardíaca demostró afección eminentemente del cuerpo de homoinjerto, con aparato valvular competente. La repercusión en el ventrículo derecho fue muy leve-leve (n = 7) o moderada (n = 2).Conclusiones. La incidencia de disfunción del homoinjerto pulmonar no es desdeñable, si bien el impacto clínico parece ser muy discreto y los casos severos se controlan satisfactoriamente de forma percutánea. El uso de hemoderivados podría ser un factor de riesgo para el desarrollo de esta complicación (AU)