Recurrent left atrial myxoma.

Based on statistics from the UK, the incidence of myxoma is about 1:1,000,000/year. Three recent cases of recurrent myxoma are reported, one where excision was probably incomplete, one where tumour implantation may have occurred and one where a mesenchymal sarcoma was misinterpreted histologically. The relative importance of these three factors in recurrence of cardiac tumours after surgical excision is discussed.

Secundum atrial septal defect repair: long-term surgical outcome and the problem of late mitral regurgitation.

This study examines the clinical and surgical outcome of a group of 55 patients (mean age 33 years) with secundum atrial septal defect who underwent surgical repair of this defect between 1981 and 1990. A group of 25 of these patients underwent late echocardiographic follow-up. Fifty-two patients underwent repair by direct suturing and three by patch closure.

Propionibacterium acnes causing an aortic root abscess.

A case of endocarditis caused by Propionibacterium acnes associated with an aortic root abscess is presented. This supports the current opinion that aortic root abscesses are not necessarily associated with microorganisms of high virulence.

Pedunculated left ventricular thrombus--report of two cases.

In two patients presenting with myocardial infarction, one with a subendocardial infarction and the second patient with a classic Q wave infarction, pedunculated left ventricular thrombi were detected in the course of subsequent routine cardiac catheterization. Both patients underwent successful surgical thrombectomy.

Aortic root complications of infective endocarditis--influence on surgical outcome.

Fifty cases of aortic valve endocarditis during a 6-year period between 1982 and 1988 were reviewed. Twenty-three (46%) had aortic root complications by way of aortic root abscess or mycotic aneurysm in the perivalvular area. Patients with root complications were grouped into the aortic root abscess (ARA) group and those without into a non root abscess (NARA) group.

Aminoglycoside toxicity following antibiotic prophylaxis in cardiac surgery.

We have reviewed experience with aminoglycosides in cardiac surgical prophylaxis from 1984 to 1989. In the first two years, prospectively randomized trials (517 patients) allowed comparison of tobramycin (three-day course) with a non-toxic antibiotic, teicoplanin. A significant excess rise in serum creatinine was present at the end of the first postoperative week in patients given tobramycin (165 vs 149 patients, 95% CI 3-17 microM.

Low energy level internal defibrillation during cardiopulmonary bypass.

Low energy level internal direct current shocks were used to defibrillate the hearts of 168 patients during procedures performed on cardiopulmonary bypass. In all cases, the core temperature was greater than 32 degrees C and care was taken to correct hypokalaemia and acid-base balance prior to defibrillation. In 78 patients (46%), defibrillation required 2 joules or less, and in 139 (82.

Should the temperature chart influence management in cardiac operations? Result of a prospective study in 314 patients.

The body temperature is measured routinely and carefully charted in our own and presumably all units. Pyrexia is normal after bypass and is discounted on the basis of clinical experience in the first few days. If this pyrexia persists, a search for infection may be instigated and discharge from the hospital may be delayed.

Demonstration of the ascending aorta in infective endocarditis by intravenous digital subtraction angiography.

Four patients with infective endocarditis were examined by digital subtraction angiography immediately before operation. In three a root abscess was suspected and the remaining patient was believed to have a false aneurysm at an infected aortic cannulation site. In all the cases digital subtraction angiography showed the structure in several projections and confirmed the presence of a cavity.

Long term clinical outcome of coronary surgery and assessment of the benefit obtained with postoperative aspirin and dipyridamole.

Three hundred and twenty patients originally entered into a randomised study to assess the effect of aspirin and dipyridamole on the patency of coronary bypass grafts one year after operation were clinically reassessed a mean of 6.6 years (range 4.3-8.

Contamination of blood during cardiopulmonary bypass: the effect of antibiotic prophylaxis.

Despite antibiotic prophylaxis in cardiac surgery, gram-positive bacteria can be isolated in up to 10% of intraoperative blood cultures. During a prospective randomized trial, blood was collected from the oxygenator at the end of bypass in 58 patients given teicoplanin and in 60 others given flucloxacillin and tobramycin. Coagulase-negative staphylococci were cultured from 16 patients given teicoplanin but in only four cases after flucloxacillin and tobramycin (Fisher's exact test, P = 0.

Staphylococcus epidermidis as a cause of postoperative wound infection after cardiac surgery: assessment of pathogenicity by a wound-scoring method.

Wound infection after clean surgery prolongs hospital stay but the organism most commonly isolated from wound discharge, Staphylococcus epidermidis, is often dismissed as a contaminant or commensal. The wounds of 517 patients were assessed, after cardiac surgery, by a wound-scoring method ('ASEPSIS') and a close comparison was made of the appearance and clinical outcome of 89 wounds, from which bacteria were isolated. There was no significant difference in the scores of 49 wounds, where S.

Antibiotic prophylaxis in cardiac surgery: a prospective comparison of two dosage regimens of teicoplanin with a combination of flucloxacillin and tobramycin.

Teicoplanin, a new glycopeptide antibiotic, has a serum half-life of 47 h and excellent activity against Gram-positive bacteria, including methicillin resistant staphylococci, making it a potentially useful drug for cardiac surgical prophylaxis. In two prospective randomized studies, we have compared it with a broad spectrum regimen of an aminoglycoside and flucloxacillin. In the first trial, teicoplanin (400 mg on induction of anaesthesia and 200 mg 24 h later), was compared with tobramycin (80 mg tds for three days) and flucloxacillin (500 mg qds for 5 days) in 314 patients.

Antibiotic prophylaxis in cardiac surgery: serum and tissue levels of teicoplanin, flucloxacillin and tobramycin.

In this study, the pharmacokinetics of teicoplanin have been studied in serum, fat and bone during and after cardiac surgery with two dose (400 and 200 mg) and three dose (400 mg each) regimens in a total of 49 patients. For comparison, 20 other patients, who had received a regimen of flucloxacillin (500 mg qds for five days) and tobramycin (1.5 mg/kg initially then 80 mg tds for three days), were similarly investigated.

The effect of antibiotic prophylaxis and topical antiseptics on the bacterial flora of the skin after cardiac surgery.

A controlled trial of antibiotic prophylaxis in cardiac surgery compared a two-dose regimen of teicoplanin with a longer conventional course of flucloxacillin and tobramycin. In 12 patients the susceptibility of the bacterial skin flora of four different sites to each of the three antibiotics was determined and the results are reported here. Less than 1% of the Gram-positive colonies showed reduced sensitivity to teicoplanin (MIC greater than or equal to 4 mg l-1).

Results of surgical repair for dissection of the ascending aorta.

Between 1970 and 1986, 40 patients had surgical treatment for dissection of the ascending aorta at the London Chest Hospital. The overall hospital mortality was 27.5%.

Urgent treatment for nonresectable, asphyxiating tracheal cylindroma.

A 22-year-old woman with an irresectable tracheal cylindroma asphyxiated during radiotherapy. Extracorporeal oxygenation was used to facilitate endotracheal resection and the insertion of a tracheobronchial stent.

Factors predisposing to wound infection in cardiac surgery. A prospective study of 517 patients.

Postoperative wound infection can greatly prolong hospital stay after cardiac surgery, so the identification of predisposing factors may help in prevention or early institution of treatment. Transfer of organisms from the leg to the sternum during coronary artery surgery has been proposed as a major additional cause of sepsis. The definition of wound infection is not standardised and therefore makes comparison between centres difficult.

Electrical properties and response to noradrenaline of individual heart cells isolated from human ventricular tissue.

The analysis of the electrical properties and response to catecholamines of cardiac tissue is greatly simplified by the use of single cell preparations. In this study individual cells isolated from human ventricular tissue were used to estimate cellular sarcolemmal resistance and capacitance and to record the time course of the response to ionophoretically applied noradrenaline. The mean input capacitance of the cells is consistent with a surface membrane area of approximately 15,000 micron2 if the specific membrane capacitance is 1 microF X cm-2.

Changes in plasma vasopressin concentration in association with coronary artery surgery or thymectomy.

Plasma vasopressin concentrations in 14 patients undergoing coronary artery surgery were compared with those in eight patients undergoing thymectomy. Vasopressin concentrations increased similarly in both groups on sternotomy. A second, and more marked increase was noted in the patients requiring cardiopulmonary bypass.