Seventy-five primary sarcomas of the heart were classified by histologic appearance as angiosarcoma (26 cases), undifferentiated sarcoma (18 cases), osteosarcoma (9 cases), fibrosarcoma (6 cases), malignant fibrous histiocytoma (6 cases), leiomyosarcoma (4 cases), myxosarcoma (3 cases), synovial sarcoma (2 cases), and neurofi-brosarcoma (1 case). The ages of the patients ranged from 1 to 75 years at the time of presentation (mean, 39 years). Angiosarcomas were predominantly right-sided and osteosarcomas left-sided. Forty patients treated surgically were examined, and survival correlated with clinical and histologic parameters. The survival rate was poor, with a mean of 11 months and median of 6 months. By univariate analysis, the survival rate was more favorable for patients with tumors located on the left side of the heart, without necrosis, with a low mitotic count, and without metastasis at diagnosis. Survival rates were better in patients receiving chemotherapy and radiation therapy. Age, gender, presence of differentiation, and histologic type did not affect prognosis. By multivariate analysis, a low level of mitotic activity and any therapy were the only significant factors affecting survival rate. Immunostaining with commercially available antisera was useful in the diagnosis of sarcoma but not in subclassification of 19 tumors so tested. Although the prognosis for patients with cardiac sarcomas is dismal, histologic grading is useful in predicting outcome, as has been shown for soft tissue sarcomas of other sites.

Primary sarcomas of the heart.

Traumatic aortic rupture: Twenty-year metaanalysis of mortality and risk of paraplegia

Primary cardiac tumors: early and late results of surgical treatment in 91 patients

Primary cardiac neoplasms: early and late results of surgical treatment in 42 patients

In summary, BAI is a lethal result of severe blunt trauma. It should be considered in all patients who sustained injury by a deceleration or acceleration mechanism, especially in the face of physical or radiographic findings suggestive of mediastinal injury. Angiography remains the "gold standard" for diagnosis, although CT scanning is taking more of a role, especially for screening. Diagnosis should be followed by prompt surgical repair using some method of distal perfusion to minimize renal and spinal cord ischemia. If prompt repair is not feasible because of other injuries or comorbidities, medical control of blood pressure is warranted in the interim.

https://www.east.org/Content/documents/practicemanagementguidelines/aortic-blunt-injury-diagnosis-and-management.pdf

Guidelines for the diagnosis and management of blunt aortic injury: an EAST Practice Management Guidelines Work Group.

During a 10-year period 21 patients were treated for tumors of the heart, including 19 myxomas, one fibroma, and one sarcoma The latter two cases are presented separately, and the 19 myxomas are analyzed together An unusual association of left-sided myxoma with mitral valve abnormalities was found In the surgical group (18 patients) there were no deaths and one case of postoperative cerebrovascular accident (CVA) with residual sequelae during a mean follow-up of 55 months The results show the good prognosis of patients operated upon for myxomas of the heart and that there is no need for routine full-thickness excision of the septum in its treatment

Primary tumors of the heart: a rewarding challenge.

In 41 of 220 consecutive patients who had a coronary artery bypass operation between July 1973 and March 1974 the operation was for acute coronary insufficiency (recurrent chest pain with transient electrocardiographic changes persisting after admission to hospital). Their mean age was 54 (range 33-70 years). Eleven patients had had angina before, 14 had had at least one myocardial infarction, and 16 presented de novo. Eight of the latter 16 patients required only a single graft, usually to the left anterior descending artery, a significantly greater number than the two of the other 25 patients (P less than 0.01). Fourteen of these 16 patients had normal ventricular contraction, a significantly higher proportion than the 13 of the remaining 25 (p less than 0.05). No collaterals were seen in any of the 10 with single-vessel disease, which was significantly fewer than five out of 18 with double- and nine out of 13 with triple-vessel disease (P less than 0.005). Patients with rapidly developing obstruction, especially in the proximal left anterior descending artery, may not have time to develop collaterals, present acutely with good ventricular function, and may be particularly at risk. There was no operative mortality. The patients had a perioperative myocardial infarction, and there was one late death. At follow-up averaging 9-7 months (range 5-14 months) 32 (80%) patients were angina-free, no myocardial infarctions had occurred, and 85% were fully employed. Urgent coronary artery bypass grafting is a safe and effective treatment for acute coronary insufficiency.

https://heart.bmj.com/content/heartjnl/37/10/1053.full.pdf

Acute coronary insufficiency. An urgent surgical condition.

Ten patients with rupture of the aortic isthmus due to blunt trauma were subjected to early surgical intervention with nine survivors (mortality 10%). A high degree of suspicion is necessary in order to make an early diagnosis. Left atrium (LA) to femoral artery (FA) bypass using systemic heparinization was used in all cases and bypass instituted before the aorta was prepared for clamping. Advantages of LA to FA bypass are as follows: (a) Technically easy; (b) Better control of patient during preparation of the aorta for clamping; (c) Provides the surgeon with more time to perform a safe operation.

J Wood

Papers

Primary tumors of the heart: a rewarding challenge.

Acute coronary insufficiency. An urgent surgical condition.

Early surgical repair in traumatic rupture of the thoracic aorta (report of 9 cases and review of the current concepts).