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Mayooran N, Sherif A, Koulouroudias M, Gnanalingham S, Ahmed Saleh WU, Tan S, Boulemden A, Szafranek A. Surgical resection of primary intracardiac sarcomas and outcomes: A review of case reports over 20 years. Indian J Thorac Cardiovasc Surg 2024; 40:213-218. [PMID: 38389783 PMCID: PMC10879044 DOI: 10.1007/s12055-023-01618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 02/24/2024] Open
Abstract
Objective A quarter of all cardiac tumors are malignant, and most (~ 95%) are sarcomas. It is the most aggressive malignant cardiac tumor carrying the worst prognosis. Tumor involvement with the vital intracardiac structures makes it difficult for complete surgical resection. We aimed to study the role of complete surgical resection and its importance in long-term outcomes. Methods We analyzed published literature from 2002 to 2022 using PubMed. Cases reported adult, intracardiac sarcomas, and received surgical resections were included. We reviewed 132 published case reports, including and analyzed the following variables: demographics, clinical presentations, diagnostic imaging modality, the extent of surgical resection, pathological diagnosis, tumor location, postoperative chemo-radiation therapy, and follow-up (including re-operation, local and distant recurrence). Results A total of 135 patients are included from 132 articles. The mean age was 46.69 (18-86) and 76 patients were females. The main complaints were dyspnea (70%) and chest pain (32%). Performed investigations were transthoracic echocardiography (TTE) in 114/135 (84%), computer tomography (CT) scan 89/135 (66%), trans-esophageal echocardiography (TOE) 22%, and cardiac magnetic resonance imaging (MRI) 29%. The most common location was the atrium (left 46%, right 30%). Complete surgical resection was performed in 91 cases (67%), and frozen section was performed in 62 patients (43 positives). Incomplete resections were in 42 cases. Patients who underwent complete surgical resection had mean survival of 14.58 months and median of 10.5 months, compared to incomplete resection patients with 9.12 months and 6.5 months respectively. Conclusion Our review shows complete surgical resection results in better short- and long-term outcomes in intracardiac sarcoma patients. Furthermore, combining chemo-radiotherapy has additional benefits towards long-term survival.
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Affiliation(s)
- Nithiananthan Mayooran
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
- Nottingham University Hospital, Nottingham, UK
| | - A. Sherif
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - M. Koulouroudias
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | | | - W. U. Ahmed Saleh
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - S. Tan
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - A. Boulemden
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - A. Szafranek
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
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Abstract
Pericardial malignant mesothelioma (MM) is a rare tumour which accounts for about 1% of all mesotheliomas, 4% of the primary heart and pericardial tumours. It carries an extremely poor prognosis, with a reported overall survival of less than 6 months. Clinical symptoms and signs are frequently nonspecific, and the diagnosis is usually made after surgery or at autopsy. We report a case of a 72 years old woman with primary pericardial malignant mesothelioma involving the right atrium. Nine months following surgery, the patient is alive with good performance status.
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Affiliation(s)
- G. Apicella
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - A. Boulemden
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - A. Citarella
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - R. Sushma
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - A. Szafranek
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
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Hey C, Balasubramanian S, Szafranek A, Caruana E. Inpatient wait for urgent cardiac surgery: The patients’ perspective. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Desperak P, Trzeciak P, Cislak A, Szafranek A, Lekston A, Gasior M. P899The absorbed dose is not related to neoplasm diagnosis in patients with stable angina diagnosed with coronary angiography - insights from the PRESAGE registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Desperak P, Hawranek M, Gasior P, Cislak A, Gierlotka M, Szafranek A, Lekston A, Gasior M. P4675Comparison of multivessel percutaneous coronary intervention with coronary artery bypass grafting for patients with severe coronary artery disease and non-ST-segment elevation acute coronary syndromes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hawranek M, Desperak P, Gasior P, Cislak A, Pres D, Szafranek A, Lekston A, Gasior M. P4676Early and long-term outcomes of complete versus incomplete revascularization with percutaneous coronary intervention in patients with multivessel coronary artery disease and non-ST-elevation ACS. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Szafranek A, Podila SR, Al-Khyatt W, Kulatilake EN. Aseptic mediastinal cyst caused by BioGlue 7 months after cardiac surgery. J Thorac Cardiovasc Surg 2006; 131:1202-3. [PMID: 16678625 DOI: 10.1016/j.jtcvs.2005.12.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2005] [Revised: 11/26/2005] [Accepted: 12/09/2005] [Indexed: 11/25/2022]
Affiliation(s)
- A Szafranek
- Department of Cardiac Surgery, University Hospital of Wales, Cardiff, United Kingdom.
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Jasinski MJ, Ulbrych P, Kolowca M, Szafranek A, Baron J, Wos S. Early Regional Assessment of LV Mass Regression and Function after Stentless Valve Replacement: Comparative Randomized Study. Heart Surg Forum 2004; 7:E462-5; discussion E462-5. [PMID: 15799926 DOI: 10.1532/hsf98.20041096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Early regional performance and hypertrophy regression after stentless aortic valve replacement are still incompletely characterized. We compared early postoperative changes of segmental thickness and function after stentless and stented aortic valve replacement as assessed by cardiac magnetic resonance (CMR). In 16 patients randomly assigned to stented (Mosaic, 8 patients) and stentless (Freestyle, 8 patients) groups, 4 parallel short-axis images at the level of the apex (slice 4), midventricle (slices 2-3), and mitral valve (slice 1) were obtained with a 1.5 T CMR scanner (Magnetom Sonata, Siemens) before and 1 month after surgery. Cine images were obtained using an echo gradient sequence. Left ventricle mass was calculated as the difference between the left ventricular end-diastolic volume at the epicardial and endocardial borders multiplied by a myocardium density factor (1.05). Each slice was divided into 8 segments (octants) from anterior (octant I-II) to septal (octant V-VIII). A total of 32 segments encompassed the entire heart. From each of these elements end diastolic thickness and systolic function (fractional thickening) were calculated. In stentless valves significant reduction of septal octant thickness on the midventricular slice was noted. There was no difference in regional systolic function-segment thickening. In stented valves no segmental thickness changes were observed. In stentless valves there was early postoperative thickness reduction of septal segments at the midventricular level. However, this finding did not coincide with changes in segmental function.
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Affiliation(s)
- M J Jasinski
- 2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
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Iwko J, Namysłowski G, Czecior E, Szafranek A. [Hearing aid fitting in children treated at the Phoniatric Outpatient Clinic in Zabrze in years 1986-1990]. Otolaryngol Pol 1999; 52:713-7. [PMID: 10064992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The purpose of this study was to evaluate the hearing aid fitting of 179 regularly controlled, hearing-disabled children from the Silesian area, first time admitted to Phoniatric Outpatient Clinic in Zabrze in years 1986-1990. The mean age of provision of a hearing aid was high. Children were supplied with hearing aids at mean age of 4,9 years (losses > 60 dB) and of 9,3 years (losses < or = 60 dB). There was a delay from 8,4 up to 12,5 months (losses < or = 60 dB) between the age of fitting and the issue of the hearing aid. It was also stated that the total amount of children wearing their aids binaurally decreased significantly from 118 to 74 during 5 years' period. As for the utilisation of hearing aids, prevalence of full-time users (57.9%) was demonstrated in confrontation to non-users (5.6%).
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Affiliation(s)
- J Iwko
- II Katedra i Klinika Laryngologii Slaskiej AM w Zabrzu
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Abstract
BACKGROUND The role of the ECG in evaluating reperfusion status after thrombolytic treatment in acute myocardial infarction is not clear. Dramatic ST segment changes have been observed during recanalization of an infarct-related artery, but ST criteria have not been definitively established for prediction of coronary artery patency. Differences in ST segment changes in relation to infarct localization have not been evaluated, and further investigation is required into reciprocal ST depression, which provides information independent from ST elevation. Therefore, the aim of this study was to evaluate how early changes in ST segment elevations and depressions predict vessel patency after fibrinolysis for patients with anterior and inferior/lateral infarcts. METHODS AND RESULTS Two hundred patients with a Pardee wave in the ECG and chest pain of less than 6 h duration were given thrombolytic treatment. The result of the therapy was assessed simultaneously with coronary angiography. Patients were divided into two groups: I (50 patients) without recanalization (TIMI grade 0, 1 or 2), and II (150 patients) with successful recanalization (TIMI grade 3). Before and after therapy, analysis of the 12 lead ECG included maximum ST elevation measurement (H1, H2 respectively), the sum of ST elevations (sigma H1, sigma H2), the sum of ST segment depressions (sigma h1, sigma h2), and the ratios of ST segment changes (R1 = H2:H1, R2 = sigma H2:sigma H1, R3 = sigma h2:sigma h1). The mean interval from the first to the second ECG was 3.5 +/- 1 h. Successive values of R1 and R2 were examined to find that which best distinguished between the two groups. The best values for prediction of reperfusion were: (1) For anterior wall infarct [table: see text] (2) For inferior and lateral infarct [table: see text] In 13 patients with a complete right or left bundle branch block in the first or second ECG, the result of treatment was predicted in 11 patients using criteria for factor R1 and in 12 patients using criteria for R2. Analysis of ST segment depressions revealed a significant correlation between normalization of ST segment depressions and elevations (R3 vs R1: r = 0.60, P < 0.05; R3 vs R2 r = 0.59, P < 0.05). Multivariate discriminant analysis showed an independent value of R3 for discrimination between the two groups, but only in patients with inferior/lateral infarcts. The overall accuracy of the common algorithm in predicting reperfusion was significantly better in patients with inferior/lateral infarcts (Chi2 test, P = 0.0078). When separate algorithms were used, there was no significant difference between patients with anterior or inferior/lateral infarcts because of the significant improvement in prediction of reperfusion in patients with anterior infarcts (McNemar's test: P = 0.041). CONCLUSIONS We conclude that analysis of ST segments on the standard 12-lead ECG offers valuable help in the early identification of successful recanalization of infarct-related arteries after thrombolytic therapy in patients with acute myocardial infarction. Use of the ratio of ST segment normalization according to the separate criteria for anterior and inferior/lateral infarcts gives the test a high sensitivity and specificity, even in the presence of interventricular conduction disturbances.
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Affiliation(s)
- P Buszman
- Silesian Center of Cardiology, Zabrze, Poland
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Pasyk S, Wojnicz R, Szafranek A, Zielińska T, Krupa H. [Cardiomyopathy in diabetes. Ultrastructural examinations]. Kardiol Pol 1993; 39:439-45; discussion 446. [PMID: 8289430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The functional and morphological changes in myocardium of diabetic patients is caused by diabetic macroangiopathy, diabetic microangiopathy, autonomic neuropathy and metabolic disorders. Mechanism of these changes in the course of diabetes is not fully known. To determine whether there are myocardial ultrastructure differences between patients with diabetic cardiomyopathy (normal coronary angiograms) and diabetic patients with coronary artery disease, electron microscopy examination were performed of 70 sections received from seven biopsied patients (1F, 6M), average age 53 years (range: 42-60) with diabetes type II WHO (group A) without clinical evidence of prior coronary artery disease and hypertension, and 100 sections from 10 patients (2F, 8M), average age 54 years (range: 42-65) with diabetes and coronary atherosclerosis. These patients had clinical evidence of heart failure and were submitted to bypass-graft operations (group B). Endomyocardial biopsy tissues were obtained from the right ventricle without complications either during or after the procedure. Obtained biopsy specimens were fixed in 3% glutaraldehyde stabilized with 1M cacodylate buffer at pH 7.4, postfixed in 1% OsO4 on cacodylate buffer. The materials were then dehydrated and embedded in epon. The Irvin-Fischer test for statistical analysis was used. A p value < 0.05 was considered significant. The presence of focal mild loss of myofibrils (+) was statistically more frequent in the patients in A group (p < 0.05). It was found in 86% (6/7) of cases in A group, while in the B group was observed in 20% of (2/10) cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Pasyk
- Wojewódzkiego Ośrodka Kardiologii, Zabrzu
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