OBJECTIVES:To compare the independent and combined effects of anaemia and red blood cell transfusion on late survival after isolated coronary artery bypass grafting. METHODS:Retrospective analysis of 5243 consecutive patients undergoing primary isolated coronary artery bypass grafting, performed from 2000 to 2015, in a Portuguese Academic Hospital. We identified 1649 patients with preoperative anaemia (A+) and 1422 patients who received a perioperative transfusion (T+)-the 4 possible combinations allowed for the creation of 4 subgroups (A-/T-, A-/T+, A+/T- and A+/T+). The primary endpoint was all-cause mortality at 10 years. We employed inverse probability weighting to control for confounding variables. RESULTS:Thirty-one percent of the patients had preoperative anaemia, and 27.0% had at least one packed red blood cell transfusion. Inverse probability weighting was effective in eliminating differences in all significant baseline characteristics. The primary endpoint of all-cause mortality at 10 years occurred in 568 patients (20.5%) in the A-/T- group, as compared with 204 (24.4%) in the A-/T+ group (hazard ratio, 1.14; 95% confidence interval, 1.00 to 1.31; P = 0.053), 358 (33.8%) in the A+/T- group (hazard ratio, 1.53; 95% confidence interval, 1.38 to 1.71; P < 0.001), 254 (43.6%) in the A+/T+ group (hazard ratio, 2.25; 95% confidence interval, 1.97 to 2.56; P < 0.001). CONCLUSIONS:This longitudinal, population-level study emphasizes the adverse long-term outcomes of preoperative anaemia and perioperative red blood cell transfusion. It stresses the importance of an evidence-based, multimodal and multidisciplinary approach to conserving blood resources and optimizing outcomes in patients at high risk for transfusion.

OBJECTIVES Patients with severe coronary artery disease who undergo coronary artery bypass grafting consistently demonstrate that continued smoking after surgery increases late mortality rates. Smoking may exert its harmful effects through the ongoing chronic process of atherosclerotic progression both in the grafts and the native system. However, it is not clear whether cardiac mortality is primary and solely responsible for the inferior late survival of current smokers. METHODS In this retrospective analysis, we included all consecutive patients undergoing primary isolated coronary artery bypass surgery from 1 January 2000 to 30 September 2015 in an Academic Hospital in Northern Portugal. The predictive or independent variable was the patients' smoking history status, a categorical variable with 3 levels: non-smoker (the comparator), ex-smoker for >1 year (exposure 1) and current smoker (exposure 2). The primary end point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall and Fine and Gray subdistribution hazard models. RESULTS We identified 5242 eligible patients. Follow-up was 99.7% complete (with 17 patients lost to follow-up). The median follow-up time was 12.79 years (interquartile range, 9.51-16.60). Throughout the study, there were 2049 deaths (39.1%): 877 from cardiovascular causes (16.7%), 727 from noncardiovascular causes (13.9%) and 445 from unknown causes (8.5%). Ex-smokers had an identical long-term survival than non-smokers [hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.88, 1.12; P = 0.899]. Conversely, current smokers had a 24% increase in late mortality risk (HR 1.24; 95% CI 1.07, 1.44; P = 0.004) as compared to non-smokers. While the current smoker status increased the relative incidence of noncardiac death by 61% (HR 1.61; 95% CI 1.27, 2.05, P < 0.001), it did confer a 25% reduction in the relative incidence of cardiac death (HR 0.75; 95% CI 0.59, 0.97; P = 0.025). CONCLUSIONS Whereas ex-smokers have an identical long-term survival to non-smokers, current smokers exhibit an increase in late all-cause mortality risk at the expense of an increased relative incidence of noncardiac death. By subtracting the inciting risk factor, smoking cessation reduces the relative incidence of cardiac death.

OBJECTIVES The aim of this sudy was to investigate the presence of an obesity paradox on the long-term mortality of patients undergoing primary isolated coronary artery bypass surgery and to uncover whether any discrepancy found could be attributable to cardiovascular or noncardiovascular causes.METHODS Retrospective analysis of 5242 consecutive patients with body mass index (BMI) over 18.5 kg/m2 undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary end point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall, and cause-specific hazard models, with BMI forced both as a categorical (using World Health Organization predefined cutoffs) and as a continuous variable.RESULTS Follow-up was 99.7% complete. The median follow-up time was 12.79 years (interquartile range, 9.51-16.61). The cumulative incidence functions failed to uncover any difference in 15-year all-cause (log-rank test, P = 0.400), cardiovascular (Gray's test, P = 0.996) and noncardiovascular mortality (Gray's test, P = 0.305) between BMI categories. Likewise, extensive multivariable-adjusted Cox regression and cause-specific hazards models failed to demonstrate in-between category differences, with BMI forced as a categorical variable. On the other hand, using BMI as a continuous variable, the model identified the optimal BMI as between 25.8 and 30.3 kg/m2 (nadir around 28.9 kg/m2), albeit this was dependent on the definition of the reference value.CONCLUSIONS In this longitudinal, population-level analysis of patients undergoing isolated primary coronary artery bypass grafting, we could not attest to any protective effect of obesity on long-term survival. In 2016, nearly 2 billion adults were overweight, of whom over 650 million were obese [1].

BACKGROUND AND OBJECTIVE:The introduction of off-pump coronary artery bypass surgery intended to overcome some of the conventional on-pump procedure limitations by avoiding potentially harmful adverse effects of extracorporeal circulation and aortic cross-clamping. However, the doubt remains on whether it is associated with worse long-term outcomes. To compare long-term survival in patients with multivessel ischemic heart disease undergoing off-pump versus on-pump coronary artery bypass grafting.METHODS:Retrospective analysis of 4788 consecutive patients undergoing primary isolated multivessel coronary artery bypass grafting surgery, performed from 2000 to 2015, in Northern Portugal. Among the study population, we identified 1616 and 3172 patients that underwent off-pump and on-pump coronary artery grafting, respectively. We employed a propensity-score-based overlap weighting (OW) algorithm to restrict confounding by indication. The primary endpoint was all-cause mortality at 10 years.RESULTS:The mean age of the study population was 63.9 (±9.8) years, and 951 (19.9%) were females. OW was effective in eliminating differences in all major baseline characteristics. Follow-up was 100% complete. The median follow-up time was 12.80 (9.62, 16.62) years. The primary endpoint of all-cause mortality at 10 years occurred in 431 patients (26.7%) in the off-pump group, as compared with 863 (27.2%) in the on-pump group (hazard ratio, 0.93; 95% confidence interval, 0.83-1.04; p = .196).CONCLUSIONS:In this longitudinal, population-level comparison of off-pump versus on-pump coronary artery bypass surgery for treating multivessel coronary artery disease, the primary outcome of long-term mortality was identical among both patients' groups.

BackgroundSeveral of the most extensively used risk prediction tools for coronary artery bypass grafting outcomes include female sex as an independent risk factor for postoperative outcomes. It is not clear whether this putative increased surgical risk impacts long-term survival. This study aimed to assess sex differences in 10-year all-cause mortality.MethodsRetrospective analysis of 5340 consecutive patients undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary endpoint was all-cause mortality at ten years. We employed an overlap weighting algorithm to minimize confounding. Its target population highlights patients with the most overlap in their observed characteristics, and its corresponding estimand is the average treatment effect in the overlap population.ResultsWe identified that 5340 patients underwent isolated CABG: 1104 (20.7%) were female, and 4236 (79.3%) were male. Sixteen patients were lost to follow-up (0.3%). The median follow-up time was 12.79 (IQR, 9.52-16.66) years: 12.68 (IQR, 9.48-16.54) years for the male patient group and 13.13 (IQR, 9.75-16.98) years for the female patient group. The primary endpoint of all-cause mortality at ten years occurred in 1106 patients (26.1%) in the male patient group, compared with 315 (28.5%) in the female patient group. The unweighted survival analysis for both groups reveals the worst long-term prognosis for the female cohort (hazard ratio, 1.22; 95% CI, 1.10 to 1.35; p < 0.001), while in the overlap weighted survival analysis, such long-term difference in prognosis disappears (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; p = 0.693).ConclusionIn this longitudinal, population-level analysis of patients undergoing primary, isolated CABG, we demonstrated that the female sex is not associated with increased long-term all-cause mortality compared to their male counterparts. Thus, sex should not influence the undertaking of an adequate revascularization strategy.

Abstract OBJECTIVES As definitive data from randomized controlled trials comparing the effect on long-term survival of using single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting are not yet available, observational studies allow for long-term follow-up in large and representative populations, which might complement the information potentially derived from randomized trials. To compare long-term survival in patients under 70 years of age undergoing SIMA or BIMA grafting. METHODS Retrospective analysis of 3384 consecutive patients under 70 years undergoing primary isolated coronary artery bypass grafting, performed from 2000 to 2015, in a Portuguese level III Hospital. We identified 2176 and 1208 patients from the study population who underwent SIMA and BIMA grafting, respectively. The primary end point was all-cause mortality at 10 years. We employed inverse probability weighting to restrict confounding by indication. RESULTS The mean age of the study population was 59.4 (± 7.6) years, and 567 (16.8%) were females. Inverse probability weighting was effective in eliminating differences in all significant baseline characteristics. Follow-up was 99.88% complete. The median follow-up time was 12.82 (interquartile range, 9.65, 16.74) years: the primary end point of all-cause mortality at 10 years occurred in 463 patients (21.3%) and 166 (13.7%) in the SIMA and BIMA grafting groups, respectively (hazard ratio, 0.78; 95% confidence interval, 0.66–0.92; P = 0.004). CONCLUSIONS Bilateral internal mammary grafting is associated with lower long-term mortality than single internal mammary grafting. Moreover, this survival benefit comes at no increased perioperative morbidity or mortality cost.

OBJECTIVES:Our objective was to examine the results of ECMO post cardiotomy in Centro Hospitalar Universitário S. João (CHUSJ).METHODS:Between 2011 and 2019, 13 patients were cannulated for refractory cardiogenic shock post-cardiotomy; 8 (61,5%) male and 5 (38,5%) female. Patients under 18 years old were excluded. Data was collected from hospital archives concerning preoperative comorbidities, open-heart surgery procedure, dates of ECMO cannulation and decannulation, postoperative complications, hospital mortality and cause of death. Follow-up was obtained by review of the last outpatient observation. The outcomes investigated were hospital mortality and survival at 12, 36 and 60 months.RESULTS:After a median ECMO-VA therapy of 6 days (1-16 days), 7 (53,8%) patients were successfully decannulated; from these 2 succumbed from stroke and septic shock, one is still in intermediate care convalescing steadily and 4 were discharged. Overall 8 (61,5%) patients died. 5 (38,5%) survived, 4 were discharged home and 1 is still in intermediate care. Survival (after discharge) at 12, 36 and 60 months was respectively 25%, 16,7% and 8,3%. Regarding postoperative complications, reoperation for bleeding was necessary in 5 (38.5%), stroke was diagnosed in 2 (15,4%), dialysis in 6 (46,2%), leg ischemia affected 5 (38,5%) and mediastinitis occurred in 1 (7,7%).CONCLUSIONS:VA ECMO saves a life in each three patients suffering from refractory cardiogenic shock after cardiac surgery. Despite risks associated with advanced cardiopulmonary support, survivors maintain good health condition.

Aneurysms of the innominate artery are rare, representing only 3% of all aneurysms of the supra-aortic trunks. Early treatment of these aneurysms is recommended in order to prevent the occurrence of rupture and/or embolization to the brain or peripheral circulation. The authors report the case of an asymptomatic patient, with an aneurysm of the brachiocephalic trunk with 3.2 cm of greatest diameter, associated to ectasia of the right subclavian artery and common carotid double kinking. A bypass was performed from the ascending aorta to the carotid and subclavian arteries using a Dacron bifurcated prosthesis, through median sternotomy and right supraclavicular approach, to exclude the aneurysm. A review of the literature is made and the clinical features and surgical treatment of such aneurysms are described and discussed.

OBJECTIVES:Analysis of the early results and long term outcome after the modified Bentall operation with a mechanical prosthesis in a single Institution, emphasizing the use of the aortic index in elective procedures to assist the difficult decision of replacing the ascending aorta in patients with aortic valve disease.METHODS:Prospective study of 126 consecutive patients operated in a 16 year period. In 82 patients (65%) the surgeries were performed electively but the remaining 44 patients were operated urgently for acute aortic dissection or acute bacterial endocarditis. Total follow-up time was 519.96 patient-years. Time related analyses, including freedom from event analysis, were calculated with the Product Limited Method of Kaplan and Meier and tested with the Log-Rank and Cox Regression tests.RESULTS:Early mortality was 7.9% for the entire cohort. There was no mortality on elective primary operations. The aortic index was computed in 93% of the elective procedures, ranging between 1.9 and 6.9 cm2/ m2. For all patients, survival at 15 years was 67.3% and freedom from local complications requiring reoperation was 95.6 % at same time.CONCLUSIONS:The modified Bentall operation can be performed with low mortality and morbidity in selected patients and an exceptionally low rate of local complications in the long term. The aortic index is a valuable tool to help cardiac surgeons to decide when to replace a dilated ascending aorta.

Abstract  Aims: We reviewed the long‐term survival, autonomy, and quality of life (QoL) of elderly patients undergoing aortic valve replacement (AVR). Methods: Records of patients ≥75 years old that underwent AVR from 2002 to 2006 were retrospectively analyzed. Functional status was classified with Barthel Index (BI). QoL was presumed as the self‐perception of well‐being after AVR. Independent predictors of mortality were identified using the Cox proportional hazards model. Results: We included 114 patients, with a mean age of 78.5 ± 2.5 years. Seventy (59.8%) patients were females. Mean additive and logistic EuroSCORE were 7 ± 2 and 9 ± 7, respectively. Follow‐up on vital status was achieved for 113 (99.1%) patients after a mean period of 47.2 ± 23.4 months. Twenty‐seven (23.7%) patients died (including three operative deaths). Survival up to one, three, and five years of follow‐up was 94.4%, 86.7%, and 76.1%, respectively. Multivariate analysis showed that pulmonary hypertension and diabetes were independent predictors of all‐cause mortality. Information on BI score and QoL was obtained for 77 (89.5%) and patients. Among those, 69 (89.6%) were autonomous according to BI and 72 (93.5%) considered having had an improvement in QoL. Conclusion: Patients ≥75 years old undergoing AVR presented good medium‐term survival. Predictors of an adverse outcome were significant pulmonary hypertension and diabetes. At follow‐up, most achieved improvement of QoL and remained autonomous. These results stress that excellent long‐term outcomes with AVR can be achieved in appropriately selected elderly patients. (J Card Surg 2012;27:20–23)

HomeCirculationVol. 124, No. 17Accessory Mitral Valve With Cordal Attachments to Mitral and Aortic Valves Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessBrief ReportPDF/EPUBAccessory Mitral Valve With Cordal Attachments to Mitral and Aortic ValvesAn Unusual Cause of Left Ventricular Outflow Tract Obstruction and Both Mitral and Aortic Insufficiencies António Gaspar, Jorge Almeida, Benjamim Marinho, Vítor Monteiro, Armando Abreu and Paulo Pinho António GasparAntónio Gaspar From the Department of Cardiology, Hospital of Braga, Braga, Portugal (A.G.); and the Department of Cardiothoracic Surgery, Hospital of S. João, Oporto, Portugal (J.A., B.M., V.M., A.A., P.P.). , Jorge AlmeidaJorge Almeida From the Department of Cardiology, Hospital of Braga, Braga, Portugal (A.G.); and the Department of Cardiothoracic Surgery, Hospital of S. João, Oporto, Portugal (J.A., B.M., V.M., A.A., P.P.). , Benjamim MarinhoBenjamim Marinho From the Department of Cardiology, Hospital of Braga, Braga, Portugal (A.G.); and the Department of Cardiothoracic Surgery, Hospital of S. João, Oporto, Portugal (J.A., B.M., V.M., A.A., P.P.). , Vítor MonteiroVítor Monteiro From the Department of Cardiology, Hospital of Braga, Braga, Portugal (A.G.); and the Department of Cardiothoracic Surgery, Hospital of S. João, Oporto, Portugal (J.A., B.M., V.M., A.A., P.P.). , Armando AbreuArmando Abreu From the Department of Cardiology, Hospital of Braga, Braga, Portugal (A.G.); and the Department of Cardiothoracic Surgery, Hospital of S. João, Oporto, Portugal (J.A., B.M., V.M., A.A., P.P.). and Paulo PinhoPaulo Pinho From the Department of Cardiology, Hospital of Braga, Braga, Portugal (A.G.); and the Department of Cardiothoracic Surgery, Hospital of S. João, Oporto, Portugal (J.A., B.M., V.M., A.A., P.P.). Originally published25 Oct 2011https://doi.org/10.1161/CIRCULATIONAHA.111.021030Circulation. 2011;124:e434–e436We introduce the case of a 72-year-old woman referred with exertional dyspnea and chest pain. On clinical examination, a grade III/VI harsh systolic murmur radiating to the neck was audible. Transthoracic echocardiography showed a structure attached to the proximal left ventricular outflow tract (LVOT) causing significant obstruction (maximum and median gradients of 55 and 33 mm Hg, respectively), which led to the initial diagnosis of subaortic membrane (Figure 1A and 1B; Movie I in the online-only Data Supplement). Transesophageal echocardiography allowed the visualization of a mobile structure in the proximal left ventricular outflow tract, with cordal attachments to the subvalvular mitral apparatus and apparently to an aortic cuspid, conditioning severe mitral and moderate aortic insufficiencies (Figure 1C and1D; Movie II in the online-only Data Supplement). These findings were consistent with the diagnosis of accessory mitral valve tissue (AMVT). Coronary angiography revealed normal coronary arteries. Intraoperative three-dimensional echocardiography confirmed the presence of AMVT in the proximal left ventricular outflow tract and better delineated the cordal attachment to the aortic valve (Figure 1E and 1F; Movies III and IV in the online-only Data Supplement).Download figureDownload PowerPointFigure 1. A, Preoperative transthoracic echocardiography (apical 5-chamber view) showing an obstruction of the proximal LVOT (double arrow) associated with flow acceleration. B, Continuous Doppler measurement at the proximal LVOT showing instantaneous and mean gradients of 55 and 33 mm Hg, respectively. C, Preoperative transesophageal echocardiography (midesophageal long-axis view) showing AMVT (double arrow) in the proximal LVOT, with cordal attachments to the subvalvular mitral apparatus and apparently to an aortic cuspid (single arrow). D, Preoperative transesophageal echocardiography (midesophageal long-axis view) with color Doppler showing flow acceleration at the proximal LVOT. E, Three-dimensional echocardiography showing AMVT (double arrow) in the proximal LVOT with the mitral valve just below (viewed from the left ventricle side). F, Three-dimensional echocardiography showing AMVT (double arrow) in the proximal LVOT (cross-sectioned in its long axis) with a cordal attachment to an aortic cuspid (single arrow). LVOT indicates left ventricular outflow tract; AMVT, accessory mitral valve tissue.The patient underwent cardiopulmonary bypass. The ascending aorta was opened and the aortic valve inspected. The aortic insufficiency was due to cordal tissue coming from the AMVT and attached to the left coronary leaflet (Figure 2A). All the leaflets were thickened with a myxoid appearance. Left atriotomy was performed to directly inspect the mitral valve. The accessory tissue was attached to the anterior leaflet of the mitral valve, and through cords, to both the ventricle and aortic valve (Figure 2B). The tissue was difficult to individualize from the original valve, and it was not possible to enucleate all the tissue in security to realize aortic and mitral valve reconstruction. Both the valves and the excess tissue were resected, and 2 bioprosthetic valves were implanted.Download figureDownload PowerPointFigure 2. A, After opening the ascending aorta, the inspection of the aortic valve showed cordal tissue (single arrow) coming from the AMVT and attached to the left coronary leaflet. B, Inspection through left atriotomy showed AMVT attached to the anterior leaflet of the mitral valve (single arrow). AMVT indicates accessory mitral valve tissue.AMVT is a rare congenital cardiac anomaly, in particular in adults, that was first described by Mclean et al.1 AMVT presents mostly with left ventricular outflow tract obstruction, usually being diagnosed in the first or second decade of life, with exercise intolerance, dyspnea, chest pain, and syncope as the main symptoms.1,2 Echocardiography, both transthoracic and transesophageal, has been widely recognized as the most valuable imaging technique for identification and characterization of this anomaly.3 It has been estimated to be present in 1 per 26 000 echocardiograms.4 Although little is known about the embryological mechanism of AMVT, it is thought to result from the abnormal development of endocardial cushion tissue.5 Direct and simultaneous involvement of both mitral and aortic valves, as in the present case, has been very rarely described.6DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.111.021030/-/DC1.Correspondence to António Gaspar, MD, Rua de Contumil, no. 1098, 4200-149 Porto, Portugal. E-mail [email protected]comReferences1. McLean LD, Culligan JA, Kane DJ. Subaortic stenosis due to accessory tissue on mitral valve. J Thorac Cardiovasc Surg. 1963; 45:382–387.CrossrefGoogle Scholar2. Prifti E, Bonacchi M, Bartolozzi F, Frati G, Leacche M, Vanini V. Postoperative outcome in patients with accessory mitral valve tissue. Med Sci Monit. 2003; 9:RA146–RA153.Google Scholar3. Alborilas ET, Tajik AJ, Puga PJ, Ritter DG, Seward JB. Accessory mitral valve tissue in association with discrete subaortic stenosis: a two-dimensional echocardiographic diagnosis. Echocardiography. 1985; 2:105–107.Google Scholar4. Rovner A, Thanigaraj S, Perez JE. Accessory mitral valve in an adult population: the role of echocardiography in diagnosis and management. J Am Soc Echocardiogr. 2005; 18:494–498.CrossrefMedlineGoogle Scholar5. Cremer H, Bechtelsheimer H, Helpap B. Forms and development of subvalvular aortic stenosis. Virchows Arch A Pathol Anat. 1972; 355:123–134.CrossrefMedlineGoogle Scholar6. Sono J, McKay R, Arnold R. Accessory mitral valve leaflet causing aortic regurgitation and left ventricular outflow tract obstruction. Case report and review of published reports. Br Heart J. 1988; 59:491–497.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Yetkin E, Cuglan B, Turhan H and Yalta K (2021) Accessory mitral valve tissue: anatomical and clinical perspectives, Cardiovascular Pathology, 10.1016/j.carpath.2020.107277, 50, (107277), Online publication date: 1-Jan-2021. Mikuš-Kuracinová K, Babál P and Kubíková E (2018) Left Ventricle Outflow Obstruction by Reverse-Oriented Tricuspid Semilunar Valve-Like Endocardial Duplicatures, Case Reports in Cardiology, 10.1155/2018/2403806, 2018, (1-4), . Zhu Y, Zhang X, Wang L and Guan X (2014) Fibrous Cyst of the Chordae Tendineae of the Mitral Valve: Echocardiographic Appearance and Literature Review, Echocardiography, 10.1111/echo.12750, 32:1, (174-177), Online publication date: 1-Jan-2015. October 25, 2011Vol 124, Issue 17 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.111.021030PMID: 22025642 Originally publishedOctober 25, 2011 PDF download Advertisement SubjectsCardiovascular SurgeryEchocardiography

We present a patient with dyspnea, cyanosis and presyncope during exercise related to intermittent obstruction of the right outflow tract by a myxoma of the right ventricle attached to the membranous interventricular septum by its pedicle. We also review the specific medical and surgical features of such tumors. Right ventricular myxomas are rare benign tumors and clinical manifestations depend mainly on size and site of attachment. They can cause obstructive events, and embolism is also possible. Both forms of clinical presentation are potentially fatal and surgical removal should be urgently scheduled. This is usually curative, although recurrences have been reported, generally when these tumors are part of the Carney complex. The best surgical approach is individualized, and transesophageal echocardiography is an important tool in the decision. In our case right atriotomy was considered the best option.