Benign Metastasizing Leiomyoma in the Heart of a 45-Year-Old Woman.

We report a rare case of benign metastasizing leiomyoma in the heart of a 45-year-old woman 2 years after a uterine leiomyoma had been discovered during hysterectomy. Computed tomograms at presentation showed a large mixed cystic mass in the pelvis and bilateral lung nodules suggestive of metastatic disease. A large cardiac mass, attached to the chordae of the tricuspid valve and later shown to be histopathologically consistent with uterine leiomyoma, was successfully resected through a right atriotomy. This case suggests that benign metastasizing leiomyoma should be considered in the differential diagnosis of right-sided cardiac tumors.

Late follow-up of patients submitted to total cavopulmonary derivation: clinical aspects, reinterventions, and complications interfering in morbidity

Abstract Objective: To identify main complications in outpatient follow-up, as well as factors before or during operation that may interfere in patient's evolution. Methods: Retrospective study of patients submitted to total cavopulmonary shunt with extracardiac conduit from 2000 to 2014 at the Hospital do Coração (São Paulo, Brazil) and who underwent clinical follow-up at this institution. Results: One hundred and fifty surgeries were performed and 59 patients maintained outpatient follow-up. The mean age of these patients at the time of surgery was 4.45 years (median of 45 months) and 70.2% of them were males. Among the patients undergoing outpatient follow-up, postoperative time at evaluation ranged from 10 days to 145 months; 30 (50.8%) patients had single left ventricle and 29 (49.2%) had single right ventricle (48.2% of these presented with hypoplastic left heart syndrome [HLHS]). Patients with single left ventricle had a higher percentage of reintervention-free survival, but without statistically significant difference. 40% of the patients had no complications and 35% of them presented with thrombosis at some point in the follow-up period, with ventricular dysfunction being the second most frequently found complication (15% of cases), mainly among patients with single right ventricle morphology (P=0.04). Between the patients currently under follow-up, 20 (35%) of them had been evaluated by ultrasonography and had some degree of hepatic congestion and/or hepatomegaly. 16.7% of the patients with such alteration had HLHS (P=0.057). Conclusion: Except for the right ventricular morphology, no other factor has been shown to interfere in late evolution after total cavopulmonary shunt.

Left Ventricular Reconstruction for Postinfarction Left Ventricular Aneurysm: Review of Surgical Techniques.

Different surgical techniques, each with its own advantages and disadvantages, have been used to reverse adverse left ventricular remodeling due to postinfarction left ventricular aneurysm. The most appropriate surgical technique depends on the location and size of the aneurysm and the scarred tissue, the patient's preoperative characteristics, and surgeon preference. This review covers the reconstructive surgical techniques for postinfarction left ventricular aneurysm.

The outcomes of superior cavopulmonary connection operation: a single center experience

Abstract Introduction: The superior cavopulmonary connection operation is one of the stages of the palliative surgical management for patients with functionally single ventricle. After surviving this stage, the patients are potential candidates for the final palliative procedure: the Fontan operation. Objectives: This study aimed to analyze the outcomes of superior cavopulmonary connection operations in our center and to identify factors affecting the survival and the progression to Fontan stage. Methods: The outcomes of 161 patients were retrospectively analyzed after undergoing superior cavopulmonary connection operation in our center between 2005 and 2015. Results: The early mortality rate was 2.5%. Five (3.1%) patients underwent takedown of the superior cavopulmonary connection. The rate of exclusion from the Fontan stage was 8.3%. Statistical analysis revealed that elevated mean pulmonary artery pressure preoperatively and the prior palliation with pulmonary artery banding were risk factors for both early mortality and takedown; however, the age, the morphology of the single ventricle and the type of operation were not considered risk factors. Conclusion: The superior cavopulmonary connection operation can be performed with low rate mortality and morbidity; however, the elevated mean pulmonary artery pressure preoperatively and the prior pulmonary artery banding are associated with poor outcomes.

Myxoma of the left ventricle.

This report concerns a 69-year-old woman who presented with an asymptomatic myxoma in the left ventricle. The tumor was successfully excised. We provide a very brief review of 72 other published cases of surgically treated left ventricular myxoma.

Spontaneous remission of ruptured intramyocardial hematoma detected upon serial multidetector computed tomography.

Intramyocardial hematoma is a rare sequela of percutaneous coronary intervention after acute myocardial infarction. Clinical outcomes of intramyocardial hematoma vary from asymptomatic remission to cardiac death. Close follow-up is imperative. Herein, we report the case of a 69-year-old man who had sustained an acute inferior myocardial infarction. During primary percutaneous coronary intervention to the occluded right coronary artery, an intramyocardial hematoma developed and immediately ruptured into the right ventricle. Because the patient remained hemodynamically stable, a conservative approach was taken. Follow-up with serial multidetector computed tomographic imaging elucidated the course and extent of the hematoma and clearly revealed the healing process. After 1 year, this method of imaging showed complete remission of the hematoma. To the best of our knowledge, this is the 1st use of serial multidetector computed tomography to document the remission of an intramyocardial hematoma that ruptured after complicated percutaneous coronary intervention. We believe that multidetector computed tomography is useful in tracing the natural history of intramyocardial hematomas.

Delayed left ventricular free-wall rupture after cardiac sarcoma resection.

We report the case of a 38-year-old woman who underwent cardiac sarcoma resection and presented later with spontaneous left ventricular free-wall rupture. The original tumor resection required autotransplantation and a transmitral approach, including partial resection of the inner left ventricular wall. Although the patient did well postoperatively, 3 weeks later she developed a large pericardial effusion with tamponade. Intraoperatively, a portion of the left ventricular free wall ruptured and required repair with a Dacron patch. The patient recovered and was discharged from the hospital 3 weeks later. To our knowledge, this is the 1st reported case of spontaneous ventricular rupture after the resection of a cardiac tumor.