M. Neligan

Atrial myxoma: National incidence, diagnosis and surgical management

Despite being the most common benign intracardiac tumour with an excellent prognosis after surgical excision the incidence of atrial myxoma (except at autopsy) is unknown. We reviewed all patients admitted to the National Cardiac Surgery Unit (n=26) with an atrial myxoma over a fifteen year period (1977–1991) to compile national incidence data and assess pre-operative diagnosis, management, surgical technique, and outcome. Preoperative symptoms were: congestive cardiac failure (12 patients), embolism (8 patients), constitutional (3 patients), asymptomatic (2 patients) and tachyarrhythmia (1 patient). The diagnosis was confirmed by 2D echocardiography alone in thirteen patients and by a combination of echocardiography and angiography in thirteen patients. At operation the site of the tumour was left atrial in 24 patients and bi-atrial in two patients. All cases were confirmed by histology. All patients made a good post-operative recovery, although one patient survived a pulmonary embolus and one patient developed a deep venous thrombosis. There has been one late death (five months after surgery) from a cerebrovascular accident. Serial echocardiography has revealed one recurrence to date (8 years after surgery). The surgical incidence of these tumours in the Republic of Ireland over the study period was 0.5 atrial myxomas/million population/year. Although rare atrial myxomas are the most important cardiac tumours to diagnose as the results from surgery are excellent.

The effects of cardiopulmonary bypass on immune mechanisms of man

SummaryImmunological functions were evaluated in a group of six male patients undergoing elective cardiopulmonary bypass.The investigations included differential white cell count, immunoglobulins IgG, IgM, and IgA, complement components C4 and C3, C-Reactive protein (CRP), neutrophil chemotaxis and neutrophil phagocytotic and microcidal capacities. All the studies were carried out pre-operatively, per-operatively and post-operatively, except neutrophil chemotaxis which was measured preoperatively and post-operatively only.The results show that significant neutrophilia occurred post-operatively. The immunoglobulin levels dropped significantly per-operatively (P<0.001). The complement levels dropped per-operatively (C3-P<0.05, C4-P<0.05), CRP rose dramatically post-operatively (P< 0.001).The neutrophil phagocytotic and microcardial remained normal and the neutrophil chemotactic studies revealed the presence of a serum inhibitor of chemotaxis present in the post-operative phase (P<0.05).These results demonstrate that the effects of cardiopulmonary bypass on immune responses are balanced; the neutrophilia and normal neutrophil phagocytosis and microcidal capacities countered the inhibited chemotaxis and the fall in immunoglobulin and complement levels.

Cardiac constriction due to malignant disease of the pericardium

SummaryTwo patients with pericardial constriction due to tumour are described. The tumour consisted of a lymphoma in both cases. Tumour is not an uncommon cause of pericardial constriction; it was responsible for 6% of a consecutive series of 34 cases seen at the Mater Misericordiae Hospital. Treatment may provide satisfactory relief of symptoms, at least in the short-term.

Experience with the abramslucas inductively coupled cardiac pacemaker

SummaryA SERIES of forty-six patients treated with the Abrams-Lucas inductively coupled pacemaker for periods up to three years is described. There have been three deaths in the series only one of which is thought to have been linked to the pacemaking process. The incidence of complications has been low and of the type associated with any endocardial pacing system, i.e. early catheter displacement and infection of the implanted parts. No internal component has had to be replaced for malfunction or breakage. This is a safe, reliable, simple, inexpensive long term pacemaking system for use in patients who do not require a demand apparatus. The patients must be carefully selected as not everyone is capable of managing the system.

A national review of surgically treated traumatic aortic transections

ConclusionSurgical treatment of BTRA results in excellent immediate and long-term outcome. However, with an estimated 20% of RTA mortalities having BTRA, and approximately 10% surviving until hospitalisation, the authors should have seen approximately 105 acute cases, instead of the 29. A high index of clinical suspicion is essential to ensure optimal outcome following this catastrophic injury.

Diffuse tracheo-bronchial amyloidosis

SummaryTWO cases of this uncommon condition which presented to our cardiothoracic service are described. The diagnosis in each case was established at bronchoscopy. One case in a young female is the youngest person with the condition yet described and only the seventh such case so far noted in a woman. The other case occurred in association with a squamous cell carcinoma of the bronchus. A discussion of the condition is included.