Native mitral valve endocarditis due to Rhizobium Radiobacter - first case report.

Rhizobium Radiobacter (RR) has rarely been associated with human infection, mainly sepsis or bacteremia, and an unique case of prosthetic aortic endocarditis has been reported. We present a case of native mitral valve endocarditis to RR, to our knowledge the first clinical report of such infection.

[New clinical aspects of cardiac myxomas: a clinical and pathological reappraisal].

Unlabelled: Easy access to echocardiography and its extensive and repeated use (as is the case in Portugal) now facilitates the early diagnosis of cardiac myxoma (CM).

Objective: To re-evaluate the clinical and pathological profile of CM under current diagnostic conditions.

Methods: We performed a retrospective study of 40 patients consecutively referred for surgery (between January 2003 and January 2010) with a histologically-confirmed diagnosis of CM - 26 female (F) and 14 male (M), with a mean age of 64±12 years (range 12-81; 53% over 65, 43% over 70); 39 patients were operated (one was not operable due to major neurological deficit).

[Left ventricular aneurysm and differential diagnosis with pseudoaneurysm].

Left ventricular aneurysm and pseudoaneurysm are two complications of myocardial infarction in which the role of imaging is paramount. The authors describe a case of a true aneurysm of the posterior wall, for which cardiac magnetic resonance was useful, although only intra-operative assessment confirmed the diagnosis.

[Elevated HDL is the main negative risk factor for coronary artery disease in the elderly patient with calcific aortic valve disease].

Unlabelled: In spite of high prevalences of hypertension and hypercholesterolemia, the majority of elderly patients admitted for aortic valve surgery due to calcific aortic valve disease (CAVD) do not have significant coronary artery disease (CAD).

Objective: To evaluate the lipid profile (LP) of patients undergoing surgery for CAVD and to correlate this with coronary angiographic data and prior cardiovascular risk factor profile.

Methods: This was a prospective observational cohort study of 264 consecutive patients aged >59 years (mean 72), 126 men (48%) and 138 women (52%).

[Hemangioma of the right ventricular outflow tract, clinical report].

Cardiac hemangiomas are a rare benign primary tumor with an estimated incidence of no more than 10% of cases of primary cardiac tumors. They can arise in any location but most of them occur predominantly in the right ventricle. Heart hemangiomas are usually asymptomatic and accidentally diagnosed by imaging methods such as echocardiography or nuclear magnetic resonance; however they can cause symptoms resulting from obstruction of blood flow, interference with the heart valves, arrhythmias or embolization.

[Rupture of a bronchial artery aneurysm - a rare case of non-traumatic hemothorax].

Bronchial circulation is a vascular territory rarely involved by pathology, with a few cases reported in the literature. The authors describe the clinical case of a bronchial artery aneurysm rupture, complicated by hemothorax, that required immediate surgery for effective control. The main features of the available knowledge about this rare entidy are analysed and discussed.

[Images in cardiology after clinical observation - aortic dissection in Marfan syndrome].

Introduction: Stanford type A aortic dissection is a rare phenomenon with high short-term mortality and clinical manifestations that can make differential diagnosis a lengthy process requiring several diagnostic examinations.

Objectives: Based on a case report, the aim is to highlight the importance of physical examination in the initial management of these patients and of rapid access to a surgical center. A brief review follows on the diagnosis and treatment of ascending aortic dissection, and its specific nature in Marfan syndrome.

[Influence of coronary revascularization on chronic ischemic stunning of the conduction system of the heart].

Unlabelled: About one fourth of patients (pts) with coronary artery disease (CAD) referred for coronary bypass surgery (CABG) exhibits some kind of intraventricular conduction defect (IVCD).

Objective: To assess CABG influence on the behavior of intraventricular conduction in pts submitted to CABG.

Material And Methods: Prospective study of 504 pts with severe CAD (3-vessel and/or left main trunk disease), divided in 2 groups (Gr) - GrA, composed of 252 pts with on-pump CABG, and GrB, with 252 pts submitted to off-pump CABG - whose pts were matched for age, gender, angiographic data, additive Euroscore, prior myocardial infarction, diabetes and hypertension.

[Control of postoperative hemorrhage in isolated coronary bypass surgery: comparison of tranexamic acid effects in off-pump surgery with aprotinin effects in conventional surgery].

Unlabelled: In spite of the strong criticism elicited thereafter, the results of a multicentric study on the consequences of several perioperative anti-hemorrhagic strategies in cardiac surgery, published five years ago, led to the aprotinin (Aprot) withdrawal from the market and its progressive replacement by tranexamic acid (TrAc) in many surgical departments.

Objective: To evaluate the hemostatic effects and clinical consequences of TrAc use or non-use in off-pump coronary bypass surgery (CABG) and compare them with those of Aprot use or non-use in conventional (conv) CABG.

Material And Methods: Retrospective analysis of 2 groups (Gr) of patients (pts): GrA - 252 pts undergoing isolated conv CABG (GrA1 - 185 pts submitted to an intra-operative full-dose Aprot protocol; GrA2 - 67 pts operated without Aprot); GrB - 383 pts undergoing isolated off-pump CABG (GrB1 - 136 pts submitted to an intra-operative low-dose TrAc protocol; GrB2 - 247 pts operated in absence of TrAc).

[Myocardial abscess of the right ventricle anterior wall].

The authors report the clinical case of a 63 old male, with a previous history of aortic mechanical replacement valve, who was admitted with fever, neutrophilic leukocytosis and c-reactive protein elevation. During admission Escherichia coli was cultured from blood, and the patient underwent repeated transthoracic and transesophageal echocardiograms, that did not reveal any abnormalities. Three weeks after admission, a new transesophageal echocardiogram showed an image suggestive of an aortic annular abscess.

[Left ventricle free wall rupture - a 10-year experience].

The left ventricle free wall rupture is one of the most serious and lethal complications associated to myocardial infarction.The most common treatment in our days consists in direct closure of the rupture with pericardium or synthetic material, applied with the help of histoacryl glue, without extracorporeal circulation.Between January 2000 and September 2010, 35 consecutive patients underwent operation for left ventricle free wall rupture at our hospital.

[Perioperative myocardial infarction in coronary bypass surgery: characterization of risk factors, clinical pictures and prognosis].

Unlabelled: Perioperative myocardial infarction ( POMI ) in cardiac surgery is an issue that deserves to be revisited.

Objective: To evaluate the risk factors, clinical characteristics and prognosis of POMI in high-risk patients ( pts ) undergoing coronary bypass surgery ( CABG ).

Material And Methods: Retrospective study of 694 pts undergoing isolated CABG - 252 pts with conventional CABG and 442 pts with off-pump CABG - and operated on by 4 surgeons largely experienced in both CABG modalities.

Impact of intraoperative transesophageal echocardiography in cardiac surgery: retrospective analysis of a series of 850 examinations.

Objective: To evaluate the impact of intraoperative transesophageal echocardiography (TEE) on surgical decisions patients undergoing cardiac surger in a Portuguese hospital.

Methods: The authors retrospectively analyzed a series of 850 examinations performed between 2003 and 2009 in patients who underwent different cardiac surgical procedures. Medical records and TEE reports were reviewed to determine whether new information was found and whether this changed the surgical plan.

[Advantages of off-pump coronary bypass surgery over conventional coronary bypass surgery].

Unlabelled: Comparison between off-pump coronary bypass surgery ( OP-CABG )and conventional CABG ( C-CABG ) remains a controversial issue.

Objective: To compare short and long term OP-CABG and C-CABG results in high-risk patients ( pts ), in absence of usual bias.

Material And Methods: A prospective observational study of 752 pts ( 252 pts with C-CABG and 500 with OP-CABG ) consecutively operated throughout 23 months by 4 surgeons largely experienced in both CABG modalities.

Impact of aortic dimensions and pulse pressure on late aneurysm formation in operated type A aortic dissection. A magnetic resonance imaging study.

Background: Patients operated on for type A aortic dissection remain at risk of long-term aneurysm development, the main cause for late death. The aim of this study was to identify early predictors for aneurysm formation at three-years after surgery.

Methods: A study group of 70 consecutive patients (52 +/- 10 years-old, 41 male), operated on for aortic dissection with replacement of the ascending segment, was evaluated prospectively for three-years.

[Cardiac papillary fibroelastoma].

Cardiac papillary fibroelastoma is a rare and histologically benign tumor. It is the most common valvular tumor and preferentially is found in the aortic valve (44% of the cases). They are typically smaller than 1 cm in diameter, and are characterized by having a fibrous core with elastic fibers, connective tissue and an endothelial lining.

[Ehlers-Danlos syndrome - a rare cause of spontaneous pneumothorax].

Ehlers-Danlos syndrome (cutis hyperelastica), is a group of connective tissue disorders characterized by abnormalities of the skin, ligaments and internal organs. It is a hereditary syndrome, usually with autossomal dominant inheritance; that primarily affects the collagen synthesis. The skin and blood vessels are extremely fragile and elastic.

[Results of Dor's endoventricular repair in the management of left ventricular aneurysms].

Introduction: Left ventricular aneurysms are serious long-term complications from acute myocardial infarction that produce hemodynamic alterations in the cardiac function.

Objective: The aim of this study is to evaluate the chirurgical and clinic results of the endoventricular patch repair of the akinetic or dyskinetic portions of the left ventricle.

Methods: From August 2002 to October 2005, 20 consecutive patients underwent surgical repair of left ventricular aneurysm using the endoventricular patch repair technique.

[Grawitz tumor with invasion of the inferior vena cava and right atrium: surgical management with a multidisciplinary team].

In this paper, the clinical condition of a 56 year old male patient is reported, with the diagnosis of renal cell carcinoma, complicated by a tumoral thrombus, extended from the renal vein into the vena cava and right atrium, who underwent surgical treatment. The operation consisted in the radical nephrectomy associated to the vena caval thrombectomy, under extracorporeal circulation, utilizing a multidisciplinary team composed by urologists, vascular and cardio-thoracic surgeons. The main features related to the diagnosis and surgical management of this case are described and discussed, according to data taken from the most recent publications of the literature on the subject.

[Surgery for volume reduction in chronic pulmonary obstructive disease].

Pulmonary emphysema is an insidious disease and severe symptoms may not develop for many years. Most patients die within two years after medical treatment has became ineffective. In 1993, J.