Gary Fermanis

Treatment of Intravenous Leiomyomatosis with Cardiac Extension following Incomplete Resection.

Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.

Thoracic cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy for pseudomyxoma peritonei.

Pleural dissemination of pseudomyxoma peritonei (PMP) is considered an advanced/terminal disease. We review our experience with thoracic cytoreductive surgery (CRS) and intraoperative hyperthermic intrathoracic chemotherapy (HITHOC) for the treatment of pleural recurrence of PMP following previous intraabdominal surgery.

Dissection of the Ascending Aorta: A Late Complication of Coronary Artery Bypass Grafting

Acute dissection of the ascending aorta as a late complication of coronary artery bypass grafting has been rarely reported. We report a case of a 61 year-old man in whom acute dissection of the ascending aorta developed 2 years after coronary artery bypass grafting. The ascending aorta was replaced with a Dacron graft, and an island of the aortic wall, on which previous proximal anastomoses had been placed, was implanted into the Dacron graft successfully.

Successful repair of a ruptured postinfarct pseudoaneurysm of the left ventricle

We report a case of a 60-year-old woman who underwent emergency surgical repair of a ruptured pseudoaneurysm of the left ventricle 10 days after acute myocardial infarction. The repair consisted of oversewing the rupture (2 cm long) on the posterior wall under cardiopulmonary bypass. The patient made a satisfactory recovery.

Early stenosis of Medtronic Mosaic bioprosthesis in the aortic position

The Medtronic Mosaic valve (Medtronic, Inc, Minneapolis, Minn) is a third-generation stented porcine bioprosthesis combining physiologic fixation and a-amino-oleic acid antimineralization treatment to improve hemodynamic performance and durability. Despite encouraging short-term and midterm clinical results, however, there has been a heightened interest in the safety and efficacy of this device after a recent case series study of early valve failure resulting from an unknown cause. We present here 2 case reports of early structural valve dysfunction after implantation of the Mosaic valve in the aortic position.

Cytoreductive surgery and heated intrathoracic chemotherapy for thoracic extension of Pseudomyxoma peritonei

Background: Thoracic extension of Pseudomyxoma peritonei can occur via trans-diaphragmatic spread of abdominal disease. Cytoreductive surgery with intraoperative intrapleural chemotherapy may prolong survival in an otherwise terminal condition. We evaluate the long-term outcomes of patients undergoing thoracic cytoreductive surgery and intrathoracic intraoperative chemotherapy for pleural extension of Pseudomyxoma peritonei. Methods: All patients who underwent thoracic cytoreductive surgery and heated intrathoracic chemotherapy for thoracic spread of PMP were identified from our prospectively compiled registry. Peri operative outcomes were reviewed and long term results were obtained from follow up and correspondence from other specialists. Long-term mortality was calculated from follow-up data. Results: There were three men and three women. The median age at thoracic surgery was 49.7 years. All patients had undergone previous abdominal surgery for pseudomyxoma. Time from initial cytoreductive surgery to thoracic recurrence ranged from 12.1 to 135 months. There was no perioperative mortality. Follow up range was 8 – 132 months. There were no cases of thoracic disease recurrence following complete thoracic cytoreduction. 5 and 10-year survival was 80% and 40% respectively. Conclusions: Complete cytoreduction and heated intrathoracic intraoperative chemotherapy can provide long-term disease free and overall survival for patients with thoracic recurrence of pseudomyxoma peritonei.