- Email: [email protected]
Papillary Fibroelastomas and Other Cardiac Tumors Should Be Resected on an Urgent Basis
756
CORRESPONDENCE
marked anastomosis between the radial and ulnar arteries, which confirms the presence of a collateral supply to the hand [2]. This suggests that the majority of patients should be eligible for radial artery harvesting, as the incidence of major vascular disease in upper limb arteries is low [3]. Our main concern with the protocol of Dr Csiki and colleagues is that results from their technique may not directly translate into clinical outcome measures, and thus, a significantly higher proportion of patients (those with false-negative results) will be denied the potential benefits of arterial revascularization, even before the costs of the tests are considered. In our study [4], we used the Allen test in combination with forearm arterial duplex ultrasonography to optimize the safe use of the radial artery. Using clinical outcome measures, we safely harvested the radial artery in 99% (285/287) of patients undergoing total arterial revascularization. In our experience, we have safely harvested the radial artery in well over 500 patients without any major complications. The combination of clinical assessment and duplex ultrasonography provides a simple and cost-effective method of examining the radial artery and the collateral circulation to the hand. These methods of assessment are readily available and therefore can be adopted by the vast majority of centers undertaking radial artery harvesting. Yasir Abu-Omar, MRCS Shafi Mussa, MRCS David P. Taggart, FRCS Department of Cardiothoracic Surgery John Radcliffe Hospital Headley Way Headington, Oxford OX3 9DU, UK e-mail: [email protected] [email protected]
References
MISCELLANEOUS
1. Tatoulis J, Buxton BF, Fuller JA. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg 1998;66:714 –20. 2. Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF. Surgical implications of variations in hand collateral circulation: anatomy revisited. J Thorac Cardiovasc Surg 2001;122:682–6. 3. Kane-ToddHall SM, Taggart SP, Clements-Jewery H, Roskell
© 2005 by The Society of Thoracic Surgeons Published by Elsevier Inc
Ann Thorac Surg 2005;79:749 –56
DE. Pre-existing vascular disease in the radial artery and other coronary artery bypass conduits. Eur J Med Res 1999;4: 11–4. 4. Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP. Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. Ann Thorac Surg 2004;77:116 –9.
Papillary Fibroelastomas and Other Cardiac Tumors Should Be Resected on an Urgent Basis To the Editor: Koolbergen and associates reported [1] a well presented case of a papillary fibroelastoma of the aortic valve. Nevertheless, the words elective surgery in the title of their short report are misleading, and we emphasize that urgent resection of these cardiac tumors should be performed. We [2, 3] recommend resection within 2 days after diagnosis. For other cardiac tumors and atrial myxomas, tumor embolization while the patient is waiting for operation has been documented [4]. Torsten Bossert, MD Jan F. Gummert, MD, PhD Friedrich Mohr, MD, PhD Department of Cardiac Surgery University of Leipzig Strumpellstr 39 Leipzig D-04289, Germany e-mail: [email protected]
References 1. Koolbergen DR, Voigt P, Kolowca M, Smit VTHBM, Somer ST, Dion RA. Elective surgery for fibroelastoma of the aortic valve. Ann Thorac Surg 2004;77:725. 2. Bossert T, Krakor R, Garbade J, Mohr FW. Fibroelastoma of the aortic valve causing drop attack. Eur J Cardiothorac Surg 2003;24:639. 3. Bossert T, Diegeler A, Spyrantis N, Mohr FW. Papillary fibroelastoma of the aortic valve with temporary occlusion of the left coronary ostium. J Heart Valve Disease 2000;9:842–3. 4. Nkere UU, Pugsley WB. Time relationships in the diagnosis and treatment of left-atrial myxoma. Thorac Cardiovasc Surg 1993;41:301–3.
0003-4975/05/$30.00
CORRESPONDENCE
marked anastomosis between the radial and ulnar arteries, which confirms the presence of a collateral supply to the hand [2]. This suggests that the majority of patients should be eligible for radial artery harvesting, as the incidence of major vascular disease in upper limb arteries is low [3]. Our main concern with the protocol of Dr Csiki and colleagues is that results from their technique may not directly translate into clinical outcome measures, and thus, a significantly higher proportion of patients (those with false-negative results) will be denied the potential benefits of arterial revascularization, even before the costs of the tests are considered. In our study [4], we used the Allen test in combination with forearm arterial duplex ultrasonography to optimize the safe use of the radial artery. Using clinical outcome measures, we safely harvested the radial artery in 99% (285/287) of patients undergoing total arterial revascularization. In our experience, we have safely harvested the radial artery in well over 500 patients without any major complications. The combination of clinical assessment and duplex ultrasonography provides a simple and cost-effective method of examining the radial artery and the collateral circulation to the hand. These methods of assessment are readily available and therefore can be adopted by the vast majority of centers undertaking radial artery harvesting. Yasir Abu-Omar, MRCS Shafi Mussa, MRCS David P. Taggart, FRCS Department of Cardiothoracic Surgery John Radcliffe Hospital Headley Way Headington, Oxford OX3 9DU, UK e-mail: [email protected] [email protected]
References
MISCELLANEOUS
1. Tatoulis J, Buxton BF, Fuller JA. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg 1998;66:714 –20. 2. Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF. Surgical implications of variations in hand collateral circulation: anatomy revisited. J Thorac Cardiovasc Surg 2001;122:682–6. 3. Kane-ToddHall SM, Taggart SP, Clements-Jewery H, Roskell
© 2005 by The Society of Thoracic Surgeons Published by Elsevier Inc
Ann Thorac Surg 2005;79:749 –56
DE. Pre-existing vascular disease in the radial artery and other coronary artery bypass conduits. Eur J Med Res 1999;4: 11–4. 4. Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP. Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. Ann Thorac Surg 2004;77:116 –9.
Papillary Fibroelastomas and Other Cardiac Tumors Should Be Resected on an Urgent Basis To the Editor: Koolbergen and associates reported [1] a well presented case of a papillary fibroelastoma of the aortic valve. Nevertheless, the words elective surgery in the title of their short report are misleading, and we emphasize that urgent resection of these cardiac tumors should be performed. We [2, 3] recommend resection within 2 days after diagnosis. For other cardiac tumors and atrial myxomas, tumor embolization while the patient is waiting for operation has been documented [4]. Torsten Bossert, MD Jan F. Gummert, MD, PhD Friedrich Mohr, MD, PhD Department of Cardiac Surgery University of Leipzig Strumpellstr 39 Leipzig D-04289, Germany e-mail: [email protected]
References 1. Koolbergen DR, Voigt P, Kolowca M, Smit VTHBM, Somer ST, Dion RA. Elective surgery for fibroelastoma of the aortic valve. Ann Thorac Surg 2004;77:725. 2. Bossert T, Krakor R, Garbade J, Mohr FW. Fibroelastoma of the aortic valve causing drop attack. Eur J Cardiothorac Surg 2003;24:639. 3. Bossert T, Diegeler A, Spyrantis N, Mohr FW. Papillary fibroelastoma of the aortic valve with temporary occlusion of the left coronary ostium. J Heart Valve Disease 2000;9:842–3. 4. Nkere UU, Pugsley WB. Time relationships in the diagnosis and treatment of left-atrial myxoma. Thorac Cardiovasc Surg 1993;41:301–3.
0003-4975/05/$30.00