Doppler estimation of left ventricular filling pressures in patients with mitral valve disease.

Background: Conventional Doppler measurements have limitations in the prediction of left atrial pressure (LAP) in patients with mitral valve disease (MVD), given the confounding effect of valve area, left ventricular (LV) relaxation, and stiffness. However, the time interval between the onset of early diastolic mitral inflow velocity (E) and annular early diastolic velocity (Ea) by tissue Doppler imaging (TDI), T(E-Ea), which is well related to the time constant of LV relaxation (tau) in canine and clinical studies, is not subject to these variables. We therefore undertook this study to test its usefulness in a patient population.

Stentless bioprosthetic aortic valve replacement after a homograft root replacement: Toronto SPV implantation after a homograft root.

Stentless bioprosthetic valves for the aortic position offer excellent hemodynamic characteristics, making them an attractive choice ahead of other valve prostheses. We present a unique case in which a patient underwent aortic valve replacement with a stentless porcine valve and mitral valve repair for severe aortic and mitral regurgitation 1 year after a homograft root replacement for acute aortic endocarditis. The rationale for our approach is outlined in the context of current surgical trends.

Heparin-induced thrombocytopenia associated with bilateral adrenal hemorrhage after coronary artery bypass surgery.

Heparin-induced thrombocytopenia (HIT) is a well-recognized syndrome associated with thrombosis and multiple potential clinical sequelae. We report a case of bilateral adrenal hemorrhage, a known but rare complication of heparin-induced thrombocytopenia complicating a routine coronary artery bypass surgery. Thrombocytopenia, abdominal pain, and signs of adrenal insufficiency in the context of heparin treatment should raise suspicion of this unusual complication.

Autotransplantation for central non-small-cell lung cancer in a patient with poor pulmonary function.

Lung resection is the standard therapy for non-small-cell lung cancer confined to the lung. The extent of pulmonary resection is dictated by the location and extent of the tumor and the patient's physiologic ability to tolerate resection. We present the case of a patient who had a large non-small-cell tumor of the lung that involved the right main stem bronchus and the adjacent pulmonary artery; poor pulmonary function precluded a pneumonectomy.

Loss of C. elegans BBS-7 and BBS-8 protein function results in cilia defects and compromised intraflagellar transport.

Bardet-Biedl syndrome (BBS) is a genetically heterogeneous developmental disorder whose molecular basis is largely unknown. Here, we show that mutations in the Caenorhabditis elegans bbs-7 and bbs-8 genes cause structural and functional defects in cilia. C.

Status of mitral valve surgery.

Purpose Of Review: To review the evolution of mitral valve repair and outline currently favored repair techniques.

Recent Findings: Chordal replacement with polytetrafluoroethylene sutures is an accepted and reproducible technique for repair of the anterior leaflet. Most posterior leaflet problems can be addressed with either a quadrangular resection or a sliding repair.

Surgical outcome in 85 patients with primary cardiac tumors.

Background: We present a large, single institution experience with adult cardiac tumors and address factors affecting outcome.

Methods: A retrospective review was made of all patients who underwent surgery for primary cardiac tumors from April 1975 through August 2002.

Results: Eighty-five patients (33 male and 52 female) with a mean age of 54 years were identified with follow-up available for 80 (94%) patients.

Endoscopic vein harvesting in cardiac surgery.

Purpose Of Review: Endoscopic vein harvesting (EVH) is a relatively new technique, developed to help minimize morbidities associated with traditional harvesting techniques. Wound dehiscence, recurrent cellulitis, hematomas, neuropathies, and impaired mobility are often experienced by patients who have undergone open harvest techniques.

Recent Findings: Use of this developing technique has been hindered due to the skill required to perform this task and time constraints that are often encountered in the operating room.

A loop technique for the safe, secure, and convenient fixation of subclavian central venous catheters to the chest wall.

Central venous catheters are placed frequently at our institution. Residents are taught the technique of subclavian line placement starting in their first year of training. Frequently the teaching stops once the line is in the vein.

A combined modality approach to recurrent cardiac sarcoma resulting in a prolonged remission: a case report.

We report a case of cardiac fibrosarcoma that was treated with cardiac tumor resection, chemotherapy, cardiac explantation, tumor repeat resection, and autotransplantation followed by external beam irradiation. The patient was able to achieve clinical remission and remained disease free > 2 years after the initial diagnosis. This case report demonstrates that a sustained remission from cardiac sarcoma is possible with an aggressive combined modality approach.

Current thinking in stentless valve surgery.

Aortic valve replacement for aortic stenosis represents a tremendous achievement in the management of cardiac disease. However, despite 4 decades of use, the ideal substitute for the diseased aortic valve is still not agreed upon. Stentless aortic valves represent the optimum in hemodynamic performance.

Identification of hibernating myocardium with quantitative intravenous myocardial contrast echocardiography: comparison with dobutamine echocardiography and thallium-201 scintigraphy.

Background: There are currently no data on the accuracy of intravenous myocardial contrast echocardiography (MCE) in detecting myocardial hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl(201)) scintigraphy.

Methods And Results: Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl(201) tomography (n=16) before revascularization.

Outcomes in single versus bilateral internal thoracic artery grafting in coronary artery bypass surgery.

The authors analyzed the early outcomes in two groups of patients undergoing coronary artery bypass grafting (CABG) with single versus bilateral internal thoracic arteries (ITA) in their institution. One thousand sixty-nine patients underwent CABG with single or bilateral ITAs from 1990 to 2000. Of these patients, 911 (85.

Relation of tissue Doppler-derived myocardial velocities to serum levels and myocardial gene expression of tumor necrosis factor-alpha and inducible nitric oxide synthase in patients with ischemic cardiomyopathy having coronary artery bypass grafting.

We evaluated the relation of segmental and annular tissue Doppler (TD) velocities to serum levels and myocardial gene expression of tumor necrosis factor-alpha (TNF-alpha) and inducible nitric oxide (NOS2) in humans. Seven patients with coronary artery disease underwent echocardiographic examination including TD imaging, along with transmural endomyocardial biopsies (2 biopsies per patient for a total of 14 specimens) at the time of bypass surgery. The specimens were analyzed for the number of mRNA copies of TNF-alpha and NOS2.

Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction: implications for the assessment of myocardial hibernation.

Background: Myocardial contrast echocardiography (MCE) has been used to evaluate myocardial viability. There are no data, however, on the pathological determinants of myocardial perfusion by MCE in humans and the implications of such determinants.

Methods And Results: MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering.

Large cell neuroendocrine carcinoma: an unusual presentation.

Primary lung cancer presenting as a pulmonary artery mass is unusual. We describe such a presentation in a patient with a large cell neuroendocrine carcinoma of the lung, its evaluation, and its treatment.

Autotransplantation of the heart for primary cardiac malignancy: development and surgical technique.

Primary cardiac malignancy presents an unusual and difficult surgical challenge. Malignant tumors of the left atrium have proved problematic due to their posterior location and difficulty of surgical exposure. The technique of cardiac explantation, ex vivo resection and cardiac reconstruction, and reimplantation--the cardiac autotransplantation procedure--was developed to solve this anatomic problem.

Evidence for an active inflammatory process in the hibernating human myocardium.

Myocardial hibernation refers to a state of prolonged impairment of left ventricular function in the presence of coronary artery disease, which may be reversed by revascularization. In this study we present evidence for a local inflammatory reaction in hibernating myocardial segments from patients undergoing coronary revascularization. We obtained transmural myocardial biopsies guided by transesophageal echocardiography from patients with ischemic ventricular dysfunction undergoing bypass surgery.

Increased myocardial gene expression of tumor necrosis factor-alpha and nitric oxide synthase-2: a potential mechanism for depressed myocardial function in hibernating myocardium in humans.

Background: Whether cardioinhibitory cytokines are elevated in regions of hibernating myocardium and account in part for the depression in resting function is currently not known. Methods and Results- Thirteen patients with stable ischemic ventricular dysfunction scheduled for bypass surgery underwent preoperative dobutamine echocardiography (DE) and intraoperative myocardial biopsies. The numbers of copies of mRNA for the negatively inotropic cytokines tumor necrosis factor-alpha (TNF-alpha) and inducible nitric oxide synthase (NOS2) were quantified by reverse transcription-polymerase chain reaction.