Acquired internal mammary artery to pulmonary artery fistula following bypass surgery.

We report two patients with acquired fistulas between the internal mammary and pulmonary arteries after coronary bypass surgery. This is a rare complication of bypass surgery and may be a cause of recurrent angina postoperatively due to coronary artery steal. A table of all the cases reported in the literature is compiled.

Invasive electrophysiologic evaluation in octogenarians: is age a limiting factor?

To assess the indications, diagnostic yield, and incidence of complications of electrophysiologic testing in the elderly we reviewed our experience with 60 procedures in 45 patients aged > or = 80 years (range 80 to 92 years, mean age 83) undergoing full electrophysiologic evaluation in our laboratory over the past 7 years. The yield of inducible ventricular tachycardia (31%), supraventricular tachycardia (4%), and previously unsuspected conduction abnormalities significant enough to warrant permanent pacemaker implantation (9%), together with the low incidence of complications (1 patient had a deep venous thrombosis and femoral artery pseudoaneurysm, representing an incidence of 2.2% of patients undergoing studies or 3.

Ventricular lead transection and atrial lead damage in a young softball player shortly after the insertion of a permanent pacemaker.

We report a case in which permanent pacemaker implantation using a conventional subclavian approach on the throwing side of an avid softball player resulted in complete transection of the ventricular lead and severe damage to the atrial lead. The site of the lead fracture suggested that both leads were crushed between the clavicle and the first rib as a result of the frequent and repetitive arm movement. This case illustrates the importance of the selection of the correct approach for permanent pacing lead insertion.