Michael J Bentley

Biatrial myxoma: a rare cardiac tumor.

A previously healthy 48-year-old man presented to the hospital with a transient ischemic attack. Echocardiography revealed a large left atrial tumor with a second tumor in the right atrium. Surgical excision revealed a large left atrial myxoma with extension through the interatrial septum into the right atrium.

Successful cardiac transplantation with methanol or carbon monoxide-poisoned donors.

BACKGROUND Patients succumbing to methanol or carbon monoxide poisoning are usually rejected for heart donation. Increasing demand for donors has lead to the expansion of acceptance criteria and increased use of the marginal donor. METHODS We transplanted hearts from donors who had had methanol intoxication in three cases and carbon monoxide exposure in two cases. Standard donor evaluation criteria and transplantation techniques were used. RESULTS All of the transplants were successful. Three of the recipients required significant inotropic support for a few days postoperatively; however, all of the hearts functioned well over the intermediate and long term. Two recipients (1 from each group) died of complications other than heart failure (1.5 and 2 years postoperatively). CONCLUSIONS Successful heart transplantation can be achieved using the hearts from patients succumbing to methanol or carbon monoxide poisoning. Routine evaluation of cardiac function and myocardial damage is adequate for screening these donors. Hearts from methanol-poisoning victims may require longer inotropic support postoperatively before complete recovery, but can provide excellent long-term function and results.

Recurrent Aortic Dissection After Orthotopic Heart Transplantation

A patient with Marfans syndrome and previous Bentall repair for aortic dissection required orthotopic cardiac transplantation for end-stage cardiomyopathy. Postoperatively he suffered recurrent aortic dissection involving the transverse and descending aorta leading to tracheal and esophageal compression. He underwent successful surgical replacement of his ascending aorta, transverse arch, and descending aorta.

Anomalous right coronary artery originating from the left main coronary artery

A 54-year-old man with no cardiac history presented with exertional angina. Cardiac catheterization revealed an anomalous right coronary artery originating from the left main coronary artery with external compression during its course between the aorta and the pulmonary artery. He was successfully managed with surgical reimplantation of the right coronary artery into the aorta.

Asymptomatic pseudoaneurysm of the ascending aorta diagnosed due to accompanying infection of a right atrial embolus

We present a case of a large pseudoaneurysm of the ascending aorta, originating from the purse-string suture of the cardioplegia line which was essentially asymptomatic but was diagnosed during patient follow up for fever and elevated white blood count of unknown origin. During intraoperative transesophageal echocardiography, a free floating tumor was localized in his right atrium which after removal appeared to be an infected embolus with excessive neutrophils and monocytoid cells interspersed with cell debris and fibrin. Material send for culture was positive for streptococci, whereas tissues cultures from the pseudoaneurysm were essentially negative. To our knowledge, this is the first report of an asymptomatic, non-infected aortic pseudoaneurysm which was accidentally diagnosed due to concomitant infection of an deep venous thrombus which had embolized into the right atrium.