Cardiac metastasis of liposarcoma

The authors describe a retroperitoneal liposarcoma with secondary involvement of the left ventricle. Therapy has been disappointing, and is guided by the nature of the primary tumor, previous therapy, extent of metastatic spread, and feasibility of cardiac resection. In selected patients whose primary tumor is well-controlled and progressing slowly, with no evidence of widespread disease, resection of the cardiac metastases can be performed when technically feasible.     

Diagnostic value of the biochemical composition of pericardial effusions in patients undergoing pericardiocentesis

In contrast to pleural effusion or ascites, there are few data regarding the chemical and cell-count parameters of pericardial effusions (PEs) to aid diagnosis. In the present work, all patients who underwent pericardiocentesis during a 9-year period (1995 to 2004) at a tertiary hospital and who had available fluid laboratory results were retrospectively identified. Causes of PE were diagnosed using predetermined criteria. The results of pericardial fluid biochemical and hematologic tests were compared with blood test results and analyzed to identify cut-off points that could distinguish among the various causes or among various groups of causes. Of 173 patients who underwent pericardiocentesis in the study period, 120 had available fluid laboratory results, and these patients constituted the study population. The most common causes of PE were neoplastic, idiopathic, and effusion related to acute pericarditis (accounting for 42, 22, and 17 of 120 patients, respectively). Most fluids (118 of 120) would have been classified as exudates by adopting Light's pleural effusion criteria. Moreover, in all parameters examined, there was a considerable overlap of test results among the different pericardial disorders. Thus, no biochemical or cell-count parameter was found useful at reasonable accuracy for differentiating among the individual causes or among various groups of pericardial disorders. In conclusion, most PEs are exudates. The analysis of pericardial fluid biochemical and cell-count composition is generally not helpful for the diagnosis of most PEs.     

Irradiation of Fresh Whole Blood for Prevention of Transfusion-Associated Graft-versus-Host Disease Does Not Impair Platelet Function and Clinical Hemostasis after Open Heart Surgery

Since our previous studies suggested that the transfusion of 1 unit fresh whole blood (FWB) after cardiopulmonary bypass (CPB) using a bubble oxygenator may provide hemostatic benefit equivalent to 8–10 units of platelet concentrates, we have routinely used FWB at the termination of CPB. Two patients who received FWB and developed transfusion-associated graft-versus-host disease (TA-GVHD) prompted us to investigate the effect of irradiation of FWB on platelet and clinical hemostasis. Twenty-four patients were randomized to receive either 1 unit FWB (12 patients), or 1 unit irradiated FWB (IrFWB, 1,500 cGy, 12 patients) after CPB. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope and graded from 1 to 4 (from poor to excellent aggregation), was similar in both groups preoperatively [3.3±0.9 (FWB) and 3.5±0.5 (Ir FWB)], and at the end of CPB [1.8±1.2 (FWB) and 1.9±0.9 (IrFWB)]. Platelet aggregation was similar after transfusion of FWB (3.0±1.0) and after IrFWB (3.2±0.8), as was the increase in platelet count. Twenty-four hours total postoperative bleeding was similar (560±420 and 523±236 ml for FWB and IrFWB, respectively). We conclude that irradiation of FWB for prevention of TA-GVHD does not impair platelet aggregating capacity, and can be used when blood is donated by the patient's next of kin.     

Fresh blood units contain large potent platelets that improve hemostasis after open heart operations.

Twenty units of fresh whole blood were separated into fresh packed red blood cells (PC) and platelet-rich plasma (PRP) and were transfused to 40 patients immediately after coronary bypass grafting. Patients were preoperatively randomized to receive either PRP (group A, 20 patients) or PC (group B, 20 patients). Platelet number in the PRP group was greater, but not significantly greater, than in the PC group (7.5 +/- 3 versus 5.9 +/- 2.2 x 10(10); p = not significant). However, mean platelet volume in the PC group was significantly greater (8.75 +/- 1.1 versus 6 +/- 0.7 fL). Postoperatively, group A patients bled more than group B (566 +/- 164 versus 327 +/- 41 mL; p less than 0.01) and received more red blood cell units (2.7 +/- 1.2 versus 1.6 +/- 0.7 U; p less than 0.05) and a larger number of blood products (5.9 +/- 3.7 versus 2.6 +/- 1.2 U; p less than 0.05). Transfusion of PRP to group A increased platelet count from 128 +/- 20 to 148 +/- 110 x 10(9)/L; however, platelet functions did not improve. Administration of PC to group B increased platelet count from 139 +/- 22 to 156 +/- 23 x 10(9)/L, improved platelet aggregation (with collagen from 33% +/- 20% to 53% +/- 23%, with epinephrine from 36% +/- 24% to 51% +/- 20%; p less than 0.05), and corrected the prolonged bleeding time. The results suggest that the improved hemostasis observed after fresh whole blood administration is related to the large, potent platelets that remained in the PC and were not separated to the PRP during standard platelet concentrate preparation.     

Accessory Mitral Valve Tissue: A Case Report and an Updated Review of Literature

Abstract Accessory mitral valve tissue is an unusual congenital cardiac anomaly and a rare cause responsible for left ventricular outflow tract obstruction. An 18‐year‐old patient was referred to this hospital due to an occasionally noted heart murmur in a medical examination. Echocardiography facilitated the diagnosis of accessory mitral valve tissue. To relieve the left ventricular outflow tract obstruction, an operation including resection of the accessory mitral valve tissue, implantation of artificial chordae tendineae, and mitral valve annuloplasty was performed successfully. Postoperative echocardiography showed a complete relief of the mitral valve leaflets and a wide patent left ventricular outflow tract. However, transient ischemic attack and Horner's syndrome complicated the patient early postoperatively. He was administered with a high dose of aspirin, and he recovered shortly. Surgical removal is mandatory insomuch as a definite diagnosis of accessory mitral valve tissue with left ventricular outflow tract obstruction is established. A prophylactic treatment should be applied to the patients with accessory mitral valve tissue in virtue of their susceptibility to neurological events.     

Amplatzer Vascular Plug: expanding the applications spectrum

The Amplatzer Vascular Plug is a new embolization device which has been used in different vascular anomalies, especially by cardiologists in the cardiac and pulmonary circulations. It is underused by interventional radiologists. We used this device in three different vascular conditions, which we present here.