[Intravascular leiomyomatosis presenting as a right atrial mass].

Introduction: Intravenous leiomyoma is a peculiar, rare tumour that originates from the myomatous uterus, grows into the lumina of veins and, through the inferior vena cava, may extend to the right heart cavity. The intracardial tumour causes severe cardiovascular symptoms and may be fatal.

Case Report: The symptoms of the 45-year-old woman consisted of chest discomfort, dizziness, and short periods of unconsciousness, which occurred during vacuum-cleaning when she bent forward.

[Surgical treatment of ascending aortic aneurysm].

Despite of its low incidence ascending aortic aneurysm is an extremely important disease due to its continuous life threatening feature. In spite of advanced diagnostic and surgical and anesthetic methods--developed in the last decade--aneurysm operations have high mortality rate particularly in cases of complications such as rupture or dissection (30-45%). Author discusses data of 55 patients operated on from 1994 to 2001.

[Analysis of the stable metabolite of endothelium-derived nitric oxide of internal mammary artery bypass grafts at the venous drainage system of the recipient coronary artery. Morphologic implications and consequences].

Introduction: The internal mammary artery's endothelium continuously produces nitric oxide in a large quantity resulting in local and downstream vasodilatation, inhibition of platelet aggregation and in the tunica media prevents smooth muscle cell proliferation.

Objective: The aim of this study was to measure the concentration of the internal mammary artery bypass graft's endothelium derived nitric oxide's stable metabolite, (nitrite) at the venous drainage site (great cardiac vein) of the recipient coronary artery (left anterior descending), and to prove that the change of the biochemical milieu provides morphological stability (vasodilation and lack of atherosclerosis) in the recipient coronary artery based on recoronarographies.

Method: Authors investigated the levels of endothelium derived nitric oxide in intraoperative settings of 50 off pump, partly heparinized coronary bypass surgery cases sampling from the internal mammary free cut end flow (81.

Complications due to abandoned noninfected pacemaker leads.

Noninfected unwanted pacemaker leads are usually abandoned since the reported complication rate related to them is low. We followed 60 patients with noninfected retained leads, and complication was observed in 12 (20%) of them. Lead migration occurred in 5 patients, skin erosion in 3 patients, venous thrombosis in 2 patients, and muscle stimulation in 2 patients.

[Successful new method for surgery of the postinfarctional left ventricular free wall rupture].

Authors discuss a history of a 78-years old male who suffered from left ventricular free wall rupture due to acute transmural myocardial infarction. Cardiac surgical intervention was carried out immediately after the ECHO examination which established the diagnosis. First time in Hungary authors used a sutureless technique to close the rupture and utilised double component glue and synthetic patch for this purpose.

Quantitative measurement of endothelium derived nitric oxide production of the internal mammary artery bypass graft during extracorporeal circulation.

Objective: This study was undertaken to determine the extent of endothelium derived nitric oxide (EDNO) production of the internal mammary artery (IMA) bypass graft and of the native coronary circulation by measuring its stable metabolite (NO2: nitrite) in different sampling sites: internal mammary free cut end flow, in the coronary sinus prior and after anastomosis completion, and to compare them to the nitrite level of the normal plasma.

Methods: Nitrite level was determined with fluoroscopy using 4 hydroxycoumarin nitrozation in 50 consecutive patient undergoing onpump myocardial revascularization.

Results: Nitrite levels in the normal plasma were found to be 31.

[Coronary revascularization on beating heart].

At authors clinic 563 coronary artery bypass graft procedures were done from 1. January 1998 to 15. September 1999.

[Clinical experience with surgical management of atrial myxoma].

Clinical data (symptoms, diagnostic tools, surgical and histological findings, postoperative course and present status) of 26 patients with cardiac myxomas were reviewed. All myxomas were of left atrial localization. The diagnosis was confirmed by cardiac catheterization and angiography (until late seventies) and echocardiography.

[Aortic regurgitation caused by quadri-cuspid aortic valve].

Authors report the surgical treatment of a rare malformation of the aortic valve associated with coronary artery stenosis. The aortic valve had a supernumerary cusp which was revealed intraoperatively. The supernumerary cusp appeared to be similar in size to the three other.

[Echocardiographic diagnosis of intermittent failure of a mitral valve prosthesis].

Three cases are reported who had intermittent diastolic jamming of a mitral tilting disc valve. The clinical presentation of this unfrequent but catastrophic early postoperative complication was different in all cases: the first patient presented with heart failure, the third patient had loss of consciousness with enuresis and the second patient was asymptomatic at the time of the diagnosis. Electromechanical dissociation was first suspected by clinical examination in 2 cases but it was confirmed in all 3 cases by 2 dimensional and Doppler echocardiography.

[Repair of an electrode breakage in a permanent pacemaker by internal bypassing].

A possible complication of the definitive pacemaker therapy is the fracture on the electrode which usually needs new electrode replacement. A new method is discussed as the electrical fault caused by fracture is resolved by internally bypassing the broken part of the electrode with a guide-wire. This method is more simple and economical and quicker than the electrode replacement and provides more safety for the patients.

[Dual-chamber rate responsive cardiac pacing].

The authors describe in this report their first experience with the implantation of a rate responsive, dual chamber pacemaker. They emphasize the advantages of this type of pacemakers: the maintenance of AV-synchrony and the rate increase in response to exercise. Meanwhile they call attention on the complexity of the ECG interpretation.

Modification of atrioventricular node transmission properties by intraoperative neodymium-YAG laser photocoagulation in dogs.

The purpose of this study was to test the feasibility of neodymium-yttrium-aluminum-garnet (Nd-YAG) laser photocoagulation of the atrioventricular (AV) node to control the ventricular rate during rapid atrial rhythms without creating AV block. In 12 dogs on normothermic cardiopulmonary bypass, short laser pulses were delivered to an area between the coronary sinus orifice and the site of the most proximally recorded His deflection until second degree AV block occurred at a paced atrial rate of 200 beats/min. Long-term effects on AV node function were followed up for 3 months.

[Coronary revascularization in post-infarction patients].

Authors report the type of revascularization, the result of noninvasive and invasive investigations carried out 6-9 months after surgery, improvement of functional status of 56 postinfarction patients with recurrent angina pectoris. They conclude, that recoronarography performed in 12 patients revealed diminished patency rate compared to the estimated predictive one, especially in those, where complete revascularization was considered to have been carried out. Ejection fraction, wall motion score by ventriculography and echocardiography did not seem to improve significantly.

Observations with Paxirasol nasal spray therapy following open heart operations.

The effect of Paxirasol nasal spray (EGIS) has been examined in 25 patients following open heart surgery. In 18 of the patients increased secretion, in 7 crusting due to dryness of mucosa were observed as accompanying symptoms. These symptoms ceased in response to Paxirasol therapy, in the former cases within one week, in the latter ones within two weeks.

Coronary artery revascularization after myocardial infarction.

Authors report on the revascularization resulted by noninvasive and invasive interferences carried out 6-9 months after surgery and on the improvement of functional status of 56 postinfarction patients with recurrent angina pectoris. They conclude that recoronarography performed in 12 patients revealed diminished patency rate as compared to the estimated rate, especially in those cases, where complete revascularization was considered to have been carried out. Ejection fraction, wall motion score by ventriculography and echocardiography did not seem to improve significantly.

[Surgical management of aneurysm of the ascending aorta associated with aortic valve insufficiency].

Out of 318 aortic valve replacements performed between July 1, 1984 and June 30, 1989, aneurysm of the ascending aorta was found in 17 cases. In 7 of these cases employment of conduit was required due to the dimension of the aneurysm. In 5 cases they performed Bentall procedure: aortic valve replacement combined with conduit of the ascending aorta with the replantation of the coronaries.

Endocavital cooling in intraoperative myocardial protection during extracorporeal circulation.

The possible protective effect of endocavital cooling with a balloon left ventricular vent was studied by post cross clamp time rhythm, ECG, DC shock need, dynamics of temperature changes in the interventricular septum, and positive inotropic support requirement in 60 extracorporeal operations (18 aortic valve replacement, 26 aortocoronary bypass and 16 combined procedures) performed by the same team of surgeons with an identical technique and anaesthetic protocol. The results were compared to the data of 60 similar procedures carried out earlier by the same team but without the balloon technique. We conclude that endocavital cooling may have certain additive effects to chemical cardioplegia, especially in cases with left ventricular hypertrophy, multiple coronary stenoses, and in combined procedures.