Intraoperative assessment of mitral regurgitation: role of phenylephrine challenge.

Objectives: We defined the effects of the operative (OP) state and phenylephrine challenge on the assessment of mitral regurgitation (MR) severity.

Methods: In all, 57 patients underwent transesophageal echocardiographic assessment of MR severity pre-OP (PREOP) and intra-OP. MR severity was assessed PREOP under conscious sedation and intra-OP with general anesthesia, before and after hemodynamic manipulation with vasoactive agents, to match intra-OP and PREOP transesophageal echocardiographic mean arterial blood pressures.

Myocardial infarction in a 14-year-old girl, ten years after surgical correction of congenital coronary artery fistula.

Acute myocardial infarction developed in a 14-year-old girl, ten years after surgical repair of a coronary artery fistula. Angiography revealed fresh thrombus in the left anterior descending branch of the left coronary artery. The thrombus probably developed in the residual cul-de-sac of the occluded fistula.

Outcome of isolated coronary artery bypass surgery in octogenarians.

Background: Between 1989 and 1992 100 consecutive patients aged 80 or older underwent isolated coronary artery bypass grafting (CABG) in our institution. Eighty-six percent had angina grade III or IV symptoms.

Methods: Emergency surgery was required in 31, urgent surgery in 30, and elective surgery in 39 patients.

Pancreatitis of unusual origin.

The anatomic pattern seen in the three patients with contiguous gastric duplications associated with pancreatic ducts evidently predisposes the patient to pancreatitis. In the previous patient reported upon from this institution, the correlation of severe bleeding episodes with attacks of pancreatitis strongly supports the concept of blood blocking the pancreatic ductal system, thereby producing pancreatitis. Passage of viscous mucoid secretions from the aberrant gastric mucosa into the pancreatic ductal system also might retard the normal flow of pancreatic juice, producing elevation of the serum amylase level and pain.