Myocardial ischemia with left ventricular outflow obstruction

We report an unusual case of a 32-year old man who was treated for a hypertrophic obstructive cardiomyopathy (HOCM) with a DDD pacing with short AV delay reduction in the past. Without prior notice the patient developed ventricular fibrillation and an invasive cardiac diagnostic was performed, which revealed a myocardial bridging around of the left anterior descending artery (LAD). We suspected ischemia that could be either related to LAD artery compression or perfusion abnormalities due to AV delay reduction with related to diastolic dysfunction

Spontaneous rupture of the left pulmonary artery - caused by long-term steroid use?

We describe a 71-year-old woman with spontaneous rupture of the left pulmonary artery. She was admitted with pulselessness of her left arm and lack of sensibility in her left arm and leg. Echocardiography and thoracic CT did not confirm aortic dissection. CT only showed hematoma around the descending aorta. She underwent left-sided thoracotomy. Intraoperatively, a rupture of the left pulmonary artery without any evidence of an aneurysm was found. Potentially predisposing factors for this rupture were long-term use of steroids due to COPD and her age. (C) 2003 Elsevier B.V. All rights reserved

Subthreshold test pulses versus low energy shock delivery to estimate high energy lead impedance in implanted cardioverter defibrillator patients

The high energy lead impedance is valuable for detecting lead failure in ICDs, but until recently shock delivery was necessary for high energy impedance measurement. This study compared the use of subthreshold test pulses and low energy test shocks to estimate the high energy impedance. Immediately after implantation of Ventak Prizm ICDs in 29 patients, the lead impedance was measured with five subthreshold (0.4 muJ) test pulses, 5 low energy (1.1 J) shocks, and two to three high energy (16 +/- 4.5 J) shocks. The mean impedances measured using high energy shocks, low energy shocks, and subthreshold pulses were 42.0 +/- 7.3 Omega, 46.5 +/- 8.1 Omega, and 42.4 +/- 7.1 Omega, respectively. The impedances measured using high and low energy shocks differed significantly (P < 0.0001), while those obtained by high energy shocks and low energy pulses did not (P = 0.63). According to-the Pearson correlation coefficient, the impedance measurements with subthreshold pulses and low energy shocks were both closely correlated (P < 0.0001) with impedance values determined with high energy shocks. However, while the impedance values tended to be higher when measured with low energy shocks, the concordance correlation coefficient (c) was higher for subthreshold test pulse versus high energy shock (c = 0.92) than for low versus high energy shock (c = 0.73). Furthermore, the intraindividual variability of impedance measurements was lower with subthreshold pulse measurements than with low energy shocks. Compared with low energy shocks, impedance measurement with subthreshold pulses has higher reproducibility and a higher correlation with the impedance obtained by high energy shock delivery. Safe and painless high energy impedance estimation with subthreshold pulses might, therefore, help to detect ICD lead failure during routine follow-up

Risk and Outcome after Simultaneous Carotid Surgery and Cardiac Surgery: Single Centre Experience

Objective. Carotid artery stenosis in patients undergoing open-heart surgery may increase risk and deteriorate outcome. The aim of the study was the analysis of risks and outcome after simultaneous carotid and cardiac surgery. Methods. We retrospectively reviewed the medical records of 100 consecutive patients who underwent simultaneous carotid surgery and open-heart surgery during a 5-year period (from 2006 to 2010). Seventy patients were male and 30 female; the mean age was 70.9±7.9 years (median: 71.8 years). Seventy-three patients underwent coronary bypass grafting (CABG), 18 patients combined CABG and valve procedures, 7 patients CABG combined with other procedures, and 3 patients isolated valve surgery. More than half of patients had had bilateral carotid artery pathology (n=51) including contralateral carotid artery occlusion in 12 cases. Results. Carotid artery patch plasty was performed in 71 patients and eversion technique in 29. In 75 cases an intraluminal shunt was used. Thirty-day mortality rate was 7% due to cardiac complications (n=5), metabolic disturbance (n=1), and diffuse cerebral embolism (n=1). There were no carotid surgery-related deaths. Postoperatively, transient cerebral ischemia occurred in one patient and stroke with mild permanent neurological deficit (Rankin level 2) in another patient. Conclusion. Simultaneous carotid artery surgery and open-heart surgery have low risk. The underlying cardiac disease influences outcome

Impact of Adjunct Femoral Patch Reconstruction on Graft Patency after Below the Knee Popliteal Bypass Implantation

Introduction: Acknowledging the superior long term patency of infrainguinal saphenous bypass to distal popliteal artery, debate continues regarding the choice of alternative conduits and possible surgical adjuncts to improve inflow and graft salvage. The objective of this retrospective study was to determine the effectiveness of proximal anastomotic patch as adjunct to open surgical below the knee popliteal revascularization.Material and Methods: In a series of 132 distal popliteal bypass operations 63 non-reversed vein, 18 in situ vein and 51 Omniflow bypass conduits were used. Proximal anastomotic patch was applied in overall 28 patients: 19% in the non-reversed (12 patients), 50% in the in situ group (9 patients) and 13.7% in the Omniflow group (7 patients).Results: The reintervention rate was 7.9% in the non-reversed, 33.3% in the in situ and 31.4% in the Omniflow group. The most often complication was the proximal anastomotic stenosis (5.3%), followed by bleeding (3%), infection (1.5%) and distal anastomotic stenosis (1.5%). Patch reconstruction did not decrease incidence of reoperation (21.4% vs. 21.2% in the non-patch group), nor significantly influence bleeding, infection or thrombosis, however it reduced the overall rate of proximal anastomosis stenosis (0% vs. 6.7%, p=) and significantly improved patency rate at 3 years in the in situ group compared to the non-patch group (100% vs. 55.6%, p=0.02).</p