Modified biatrial approach for the surgical excision of left atrial myxomas.

The biatrial approach generally has been accepted as the method for excision of atrial myxoma, having the advantages of identifying the site of attachment, inspection of the four cardiac chambers, and adequate irrigation. A technique that uses this approach, adding safety and completeness of removal of left atrial myxomas attached to the septum, is described.

Plasma endothelin-1 levels in adult patients undergoing coronary revascularization.

Cardiopulmonary bypass is thought to injure all endothelial cells, mainly by cell-to-cell interaction with activated granulocytes which, augmented by endothelin-1 (ET-1), enhance the generation of superoxide radicals. These radicals on the other hand, may sustain and prolong endothelial injury. In the present study, by means of a magnetic separation radioimmunoassay procedure, ET-1 levels were measured in 10 adult patients undergoing coronary artery bypass surgery, in 10 perioperative phases, in order to reconfirm and further elucidate the effect of cardiopulmonary bypass on endothelial secretion of ET-1. ET-1 levels before cardiopulmonary bypass showed a definite rising trend, especially after median sternotomy. After induction of cardiopulmonary bypass, ET-1 levels increased significantly compared with preoperative values (P < 0.01). ET-1 levels in stable angina patients during and after aortic cross-clamping were strongly and positively correlated with preoperative mean pulmonary artery pressure (r = 0.79, n = 7, P < 0.05 and r = 0.92, n = 7, P = 0.05) respectively. After the first hour in the intensive care unit, ET-1 levels in three patients with unstable angina were considerably higher than in those with stable angina, a fact that deserves further consideration and study.

Mitral valve replacement in a Jehovah's Witness with dextrocardia and situs solitus.

BACKGROUND AND AIMS OF THE STUDY: Dextrocardia with situs solitus and mitral valve insufficiency requiring surgical treatment is a rare presentation. Jehovah's Witnesses (JW), a specific religious group, deny any blood transfusion and for this reason the cardiac surgeon has to plan his operation well in advance, particularly in the case of adhesions from previous thoracic procedures. MATERIALS AND METHODS: A 50-year-old white female Jehovah's Witness with dextrocardia and situs solitus was referred for surgical treatment of massive mitral valve insufficiency of rheumatic etiology. Due to multiple adhesions from previous bilateral thoracotomies and the inverted position of the heart, cardiopulmonary bypass (CPB) was initiated with an aortic and a left common femoral vein cannulae. CPB was completed with an additional SVC cannula. The surgeon, having excellent exposure from the opposite side of the table, was able to perform a mitral valve replacement (MVR) with a 31 mm St. Jude Medical valve prosthesis, through a giant left atrium under moderate hypothermia and crystalloid cardioplegia. The operation was bloodless, with only two units of autotransfused blood being used with a postoperative hematocrit of 34%. RESULTS: The patient had an uneventful recovery and has been in NYHA class I for 24 months now. CONCLUSIONS: The case is presented for the safety of the approach, the excellent exposure from the left side in a dextrocardia case and the avoidance of blood transfusion in a Jehovah's patient.