From January 1968 to July 1983, 38 patients with an intracardiac myxoma underwent surgical excision of the tumor at our Institution. There were 15 males and 23 females, ranging in age from 17 to 68 years (mean 47.7). In all but 2 patients, the presence of an intracardiac myxoma was documented preoperatively by angiographic and/or echocardiographic study. The first 2 patients of this series were referred with the diagnosis of mitral stenosis, and the myxoma was an unexpected surgical finding. In 32 cases (84.2%) the myxoma was located in the left atrium, in 4 (10.5%) in the right atrium and in 2 (5.3%) in the right ventricle. Surgery was performed on an emergency basis in 36 patients. Two patients (5.2%) both with a left atrial myxoma, died after surgery: one died intraoperatively of hemorrhage and the other after one month of bowel infarction. Follow-up of the 36 survivors ranges from 3 months to 14.5 years (average 5.2 yr); all were controlled by means of clinical and echocardiographic investigations, and no evidence of tumor recurrence was detected. Surgery for intracardiac myxoma, which should be undertaken on an emergency basis, carries a low operative risk; excision of the tumor appears to be curative with no recurrences at long-term follow-up; non-invasive tools are of the utmost importance in both the preoperative assessment and follow-up of these patients.

The present report reviews our experience with 12 cases of delayed cardiac tamponade following open heart surgery, which occurred at various times after the seventh postoperative day (average 19 days). In each case the diagnosis was made on clinical grounds, supported by the radiographic findings in all, and confirmed by echocardiography in 4. Pericardial effusion was serous in 5 patients, sero-sanguineous in 3, sanguineous in 3, and purulent in one; it was most frequently caused by a postpericardiotomy syndrome (7 cases). A single pericardiocentesis was curative in 6 instances, while repeat procedures were required in 2 because of recurrence. A repeat median sternotomy was performed in 5 patients associated with pericardiocentesis, and a pericardiectomy in 2. Three patients died within one month from the initial operation; no recurrences have been noted so far in the long-term survivors. According to the results of the present investigation, early clinical recognition is considered the clue to a successful outcome. Sole pericardiocentesis is followed by immediate improvement of the patient's state, and is often curative, but recurrences may require other maneuvers for further fluid evacuation. Awareness of this possible complication may contribute to a decrease in the still high mortality rate associated with this condition.

Traumatic rupture of the aorta at the level of the arch is an exceptionally rare lesion (Charles et al, 1977 Radiographic studies showed a widened mediastinum and a fracture of the right tibia. As a traumatic rupture of the thoracic aorta was suspected he was transferred to our department, where an angiographic study was immediately performed. This showed a rupture of the aortic arch and defective filling of the brachiocephalic vessels ( fig 1).As the patient's condition was rapidly deteriorating, he was taken to the operating theatre, where a median sternotomy was performed. Cardiopulmonary bypass was available. After the pericardial sac had been opened, direct inspection showed a previously unsuspected retro-oesophageal position of the aortic arch, which was obviously the site of the laceration. The adventitia was still intact. The brachiocephalic vessels were abnormal in origin. The first branch of the arch was the left carotid artery, next arose the right carotid artery, and lastly the right subclavian artery originated from the posterior surface of the distal ascending aorta (fig 2).As it appeared impossible to reach the aortic tear through this approach, the sternum was closed and a left posterolateral thoracotomy in the

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