Successful Surgical Treatment of an Aggressive Pelvic Angiomyxoma With Intracardiac Extension.

We present a case of an intravenous tumor with extension into the right atrium and right ventricle of the heart. Pelvic angiomyxoma is a rare benign tumor, which in this case carried a significant operative risk due to its extension. The patient initially presented with suspected caval and intracardiac thrombus, but unsuccessful treatment led to further investigations. The tumor was extensively dissected from the right atrium, suprarenal vena cava, and left iliac vein on cardiopulmonary bypass and deep hypothermic circulatory arrest. Affected gynecological organs were removed. The patient recovered uneventfully and received hormonal therapy postoperatively.

A 6-Year Single-Center Experience of Intra-aortic Balloon Pump Treatment--Retrospective Analysis of 223 Patients.

OBJECTIVES: This study describes the long-term survival (1 year) of patients after intra-aortic balloon pump (IAPB) treatment. DESIGN: A single-center, retrospective registry study. SETTING: Single university hospital intensive care unit. PARTICIPANTS: Participants included 223 consecutive patients who received intra-aortic balloon pump (IABP) treatment between January 1, 2005, and December 31, 2010 (203 cardiac surgical patients [7.8% of all cardiac surgical patients] and 20 conservative medical patients). INTERVENTIONS: IABP treatment was used as an adjunct therapy for severe hemodynamic compromise perioperatively in cardiac surgery and in hemodynamic shock of other etiology. MEASUREMENTS AND MAIN RESULTS: Mean age of patients was 66±10 years. The 30-day mortality was 22.1% for surgical patients and 37.8% for conservative medical patients. The 1-year mortality was 24.5% for surgical patients and 55% for conservative medical patients. There were 14 (6.3%) major complications related to IABP treatment that required operative treatment. The 1-year survival for patients surviving the initial 30 days after coronary artery bypass grafting was 95.2%. Independent predictors of 1-year mortality (Cox regression) were age, previous cardiac surgery, critical preoperative state, and conservative medical treatment. Timing (preoperative, intraoperative, postoperative) of IABP treatment did not predict survival. CONCLUSIONS: IABP treatment was safe with few serious complications. Timing of IABP placement was not related to survival. Survival at 1-year follow-up was excellent after an initially high mortality for cardiac surgical patients treated for hemodynamic compromise with aortic counterpulsation.

[Thoracoscopic ablation of atrial fibrillation]. / Eteisvärinän torakoskooppinen ablaatiohoito.

Atrial fibrillation is often a disabling arrhythmia which can be alleviated by ablation procedures. The cornerstone procedure pulmonary vein isolation is generally performed using a transvenous approach transseptally. Endocardial technique can cause as complications arterial embolisation, pulmonary vein stenosis and oesophageal damage. Endocardial isolation has to be repeated often without predictable outcome. Pulmonary vein isolation can be performed with beating heart also mini-invasively in a thoracoscopic way. The procedure is suggested to be combined with ganglionated plexus ablation and resection of left atrial appendage. The results of both endocardial and epicardial isolation of pulmonary veins (hybrid therapy) have been promising. These two techniques are not competing with each other but are complementary. The epicardial procedure has more complications and the choice of therapy line should be considered carefully.

Left-sided diaphragmatic and pericardial ruptures with subluxation of the heart after blunt trauma.

We present a rare case of individual but simultaneous rupture of the left pericardium and diaphragm in a patient with multiple blunt trauma. Skeletal trauma was repaired uneventfully with internal plate fixation. Diaphragmatic rupture was suspected and diagnosed 13 days from the initial trauma when the patient exhibited chest pain, dyspnea, and nausea. Intraoperatively, a pericardial rupture was discovered along with subluxation of the heart and repaired with a mesh.

Microwave Ablation in Mitral Valve Surgery for Atrial Fibrillation (MAMA).

Objective: Microwave ablation in conjunction with open heart surgery is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). In patients assigned for isolated mitral valve surgery no prospective randomized trial has reported its efficacy. Methods: 70 patients with longlasting AF where included from 5 different centres. They were randomly assigned to mitral valve surgery and atrial microwave ablation or mitral valve surgery alone. Results: Out of 70 randomized, 66 and 64 patients were available for evaluation at 6 and 12 months. At 12 months SR was restored and preserved in 71.0 % in the ablation group vs 36.4 % in the control group (P=0.006), corresponding figures at 6 months was 62.5 % vs 26.5 % (P=0.003). The 30-day mortality rate was 1.4 %, with one death in the ablation group vs zero deaths in the control group. At 12 months the mortality rate was 7,1 % (Ablation n=3 vs Control n=2). No significant differences existed between the groups with regard to the overall rate of serious adverse events (SAE) during the perioperative period or at the end of the study. 16 % of patients randomized to ablation were on antiarrhytmic drugs compared to 6 % in the control group after 1 year (p=0.22). Conclusion: Microwave ablation of left and right atrium in conjunction with mitral valve surgery is safe and effectively restores sinus rhythm in patients with longlasting AF as compared to mitral valve surgery alone.

Thoracoscopic microwave ablation of atrial fibrillation.

The aim of the study was to assess the safety and efficacy of thoracoscopic microwave ablation in treating atrial fibrillation (AF). AF predisposes to embolic complications and may cause heart failure. The treatment of AF is still challenging in spite of the promising results of endocardial radiofrequency approach. The present study is a follow-up study of 22 patients (mean age 45 years, range 21-59) with disabling paroxysmal (n=10) or persistent (n=12) AF who underwent a thoracoscopic microwave isolation of pulmonary veins. The patients had a lone AF. All the patients had suffered from severely disabling AF for >1 year (range 1-16 years) without any response to antiarrhythmic medication. The patients have been followed-up on an average of 11 months (range 3-22 months). During the follow-up, 13 (60%) patients have become asymptomatic without any documentation of AF since at least two months, six (27%) patients with anti-arrhythmic medication have clinically improved. Because of major intrathoracic bleeding and because of liver damage the thoracoscopy wound had to be expanded to open thoracotomy in two patients. Thoracoscopic AF microwave ablation seems to be a promising alternative to endocardial ablation in the treatment of highly symptomatic paroxysmal and persistent AF.