Primary left atrial fibrosarcoma

An elderly female with refractory cardiovascular symptoms due to functional mitral stenosis secondary to a primary left atrial fibrosarcoma is described. The symptoms are often nonspecific and most of the patients present first time with hemodynamic compromise. A high index of suspicion is essential for the early diagnosis of these highly malignant cardiac tumors because of their rarity, a wide spectrum of nonspecific symptoms and poor survival.     

Subcutaneous metastasis of an atrial myxoma? Case report and literature review

A 25 year old woman developed 2 subcutaneous myxomas one month after removal of an atrial myxoma. The pathogenesis of this event is discussed. Special attention was given to distinction between true myxomas and myxoid sarcomas as well as to myxomatous diathesis, caused by a widespread, genetically determined specific abnormality of certain mesenchymal cells (Swiss-syndrome). With all aspects considered, this appears to be the best interpretation of the case under review.     

The role of left atrial receptors in the diuretic response to left atrial distension

1. The diuretic response to distension of the whole left atrium caused by obstruction of the mitral orifice has been compared with the effects of distension (by means of small balloons) of the left pulmonary vein/left atrial junctions.

2. Distension of the pulmonary vein/atrial junctions caused an increase in heart rate and a diuresis similar to but smaller than that caused by mitral obstruction.

3. Section of both ansae subclaviae prevented the increase in heart rate produced by distension of the pulmonary vein/left atrial junctions but had little effect on the diuretic response either to pulmonary vein distension or to mitral obstruction.

4. A diuretic response to mitral obstruction could be demonstrated after all nerves from the lungs had been cut but not after the vagus nerves had been cut at levels likely to interrupt the majority of afferent fibres from left atrial receptors.

5. The results support the view that stimulation of left atrial receptors is a major factor in the production of a diuretic response to mitral obstruction.

     

Thrombosis and infarction of the left atrial appendage in an infant: a case report

A case of thrombosed and infarcted left atrial appendage is presented. These findings occurred in a 28-day-old infant who died of pneumonia due to Hemophilus influenzae. Congenital abnormalities of the atrial appendages including hypoplasia, right and left isomerism and juxtapositions, and aneurysmal dilatations with and without pericardial defects are relatively uncommon. Acquired defects are also uncommon, and are often iatrogenic in nature. This report describes the case of a thrombosed and infarcted left atrial appendage in a 28-day-old infant.     

Morphology of the left atrial appendage

Background: When examining the left atrial appendage by transesophageal echocardiography, differences in size and shape of the left atrial appendage are to be observed. The study was carried out with the aim of investigating the morphology of the left atrial appendage and to find associations with pathologic cardiac findings. Methods and results: In 220 cases (106 female, 114 male, mean age 72 ± 13 years) a cast of the left atrial appendage was made after the post mortem examination by using synthetic resin. In 198 cases an ECG was available (sinus rhythm n = 143, atrial fibrillation n = 55). The casts were described in respect to course and ramifications of the principal axis. The casts were measured concerning orifice diameters, outline, and volume. Most frequently (42%) the course of the principal axis was angulated below 100°. More than five ramifications of the principal axis were found in 56% of the casts. The volume ranged from 770–19,270 mm³ (mean 5,220 ± 3,041). When comparing the clinical and autopsy-data of the patients with the morphology of the casts, associations could be found between the volume of the casts and atrial fibrillation (7,060 mm³ as compared to 4,645 mm³ in sinus rhythm, P < 0.01), left ventricular hypertrophy (5,740 mm³ as compared to 4,639 mm³ without hypertrophy, P < 0.01), myocardial scars (5,923 mm³ as compared to 4,891 mm³ without scars, P < 0.05), closed foramen ovale (5,515 mm³ as compared to 4,037 mm³ with patent foramen ovale, P < 0.01), and left atrial appendage thrombi (8,566 mm³ as compared to 5,027 mm³ without thrombi, P < 0.01). Conclusion: Left atrial appendages are formations greatly varying in volume and shape. This variability should be considered when interpreting images of the left atrial appendage, and in particular when diagnosing thrombi. © 1995 Wiley-Liss, Inc.     

Localization of transforming growth factor-alpha in human appendageal tumors.

Transforming growth factor-alpha (TGF alpha) is a potent mitogen for epithelial cells that has been localized to normal human appendageal epithelia. To further understand the role of TGF alpha in human appendages, we examined TGF alpha expression immunohistochemically in 17 types of human appendageal tumors differentiating toward hair follicles, eccrine, apocrine, and sebaceous glands. In order of decreasing degrees of differentiation, tumors could be divided into hyperplasias, adenomas, benign epitheliomas, and primordial epitheliomas. Using an antibody that recognizes primarily the 6-kd and 13-kd forms of TGF alpha, TGF alpha immunostaining in 16 of 17 tumor types analyzed was found to follow a similar pattern, with expression in hyperplasias greater than adenomas greater than benign epitheliomas greater than primordial epitheliomas. Within a given tumor, TGF alpha expression also correlated well with the known differentiation state of the tumor cell types. The results suggest that TGF alpha expression is directly correlated with the differentiation state of hair follicle, eccrine, apocrine, and sebaceous tumors in human skin, and raises the possibility that TGF alpha may play a role in the differentiation of appendageal epithelia.     

The effects of left atrial and left ventricular cannulation on left ventricular function

A study in anesthetised dogs was undertaken to investigate the immediate effects of cannulation of the heart for left heart bypass on left ventricular function. Twenty-six mongrel dogs were studied. In the first group of 13 dogs (Group A), left atrial cannulation was performed through the atrial appendage and in the second group of 13 dogs (Group B), the left ventricular apex was also cannulated. Systemic blood pressure, heart rate, left atrial pressure, left ventricular end diastolic pressure and dP/dT showed no difference in left ventricular function between Groups A and B. Global ejection fraction (EF) measured by injection of technetium99m-labelled human serum albumen with gated left ventricular imaging, showed no significant difference between the two groups but analysis of the regional contribution to global EF in Group B dogs demonstrated a significant reduction in left ventricular function at the site of ventricular cannulation (P less than 0.05). These findings, together with other reported disadvantages of left ventricular cannulation, suggest that the left atrium is the preferred site for cannulation when left heart bypass is required. Many reports attest to the value of mechanical circulatory support in patients with ventricular dysfunction who cannot be weaned from cardiopulmonary bypass (2, 4, 10, 11, 15). Initial support is commonly provided by an intra-aortic balloon pump but, in more severe cases, use of a left ventricular assist device may be warranted. More recently, such devices have also been employed in the management of patients with cardiogenic shock refractory to medical therapy (10).(ABSTRACT TRUNCATED AT 250 WORDS)     

Spontaneous inversion of left atrial appendage.

Inversion of the left atrial appendage is a rare phenomenon and frequently occurs as a complication following cardiac operations. Spontaneous inversion is even rarer, and so far, only three cases have been reported. We report an additional case of spontaneous inversion in 4-month female with Down's syndrome, hypothyroidism, and complete atrioventricular canal defect.     

Successful treatment of left atrial auricular abscess

Mural endocarditis causing myocardial abscess without valvular involvement is very rare. We report an unusual case of left atrial auricular abscess which was successfully treated by surgical resection, treatment with antibiotics, and mediastinal irrigation. A 9-yr-old female patient with previous history of urinary tract infection was admitted because of persistent fever. Echocardiography and magnetic resonance imaging revealed massive pericardial effusion and a mass lesion at the left upper cardiac border. Pericardiocentesis isolated Staphylococcus aureus on culture. The patient underwent mass removal under cardiopulmonary bypass. The mass was located in the left atrial auricle with fibropurulent abscess formation inside. Postoperative mediastinal irrigation was performed using povidone iodine solution. Pathological examination of the mass showed organized thrombi with chronic fibrosing mural endocarditis.     

Chronic left atrial catheterisation in the rabbit

Summary A technique for chronic left atrial catheterisation in the rabbit is described and its advantages over other methods of access to the systemic circulation are discussed, particularly in relation to studies of cardiac output measurement and distribution. Evidence is presented which suggests that this procedure does not cause endocarditis and is followed by normal body growth and a rapid return to haemodynamic normality. Endothelialisation of the catheter within the atrium eliminates the risk of embolisation during implantation for several months. The uses of such a catheter in other areas of physiology are discussed.Supported by the National Kidney Research Fund, London.     

经食管超声心动图分析左心耳内部形态结构对左心耳封堵术的指导价值

目的:探讨经食管超声心动图（TEE）分析左心耳内部形态结构对左心耳封堵术的指导价值。方法:选取行左心耳封堵术患者110例,术前均给予TEE检查,分析左心耳开口最大径、梳状肌至开口距离等参数。结果:110例患者左心耳封堵术均成功,出现残余分流19例,无残余分流91例;手术时间17~80 min,平均手术时间（45.49±13.30） min;辐射量560~2 100 mGy,平均辐射量（980.50±112.40） mGy;曝光时间520~1 950 s,平均曝光时间（890.50±120.40） s;ACP封堵器尺寸18~33 mm,平均（25.50±2.50） mm;TEE所测左心耳开口最大径为（23.12±2.24）mm,小于ACP封堵器尺寸（P<0.05）;TEE所测左心耳开口最大径与ACP封堵器尺寸呈正相关（r=0.426, P<0.05）;手术时间<45 min和≥45 min患者左心耳开口最大径、左心耳深度及开口与深度比值比差异无统计学意义（P>0.05）;手术时间<45 min患者梳状肌到开口距离为（16.60±3.22） mm,明显大于手术时间≥45 min患者（P<0.05）;梳状肌到开口距离与手术时间呈负相关（r=-0.524, P<0.05）。结论:TEE分析左心耳内部形态结构对左心耳封堵术有一定指导价值,值得临床使用。