Del Nido cardioplegia in coronary surgery: a propensity-matched analysis.

Objectives: Del Nido cardioplegia (DNC) has been shown to be safe in adults with normal coronary arteries who are undergoing valve surgery. This study compared the effects of DNC versus traditional blood-based cardioplegia on postoperative complications in patients who underwent coronary artery bypass grafting (CABG).

Methods: A retrospective analysis was performed on 863 patients who underwent CABG with DNC (n = 420) or control cardioplegia (CC) (n = 443) between 2014 and 2017.

Severe Aortic Valve Stenosis Due to Alkaptonuric Ochronosis.

Alkaptonuric ochronosis is a rare cause of aortic valve stenosis. We report the case of a 61-year-old female patient with alkaptonuria who presented to our institute with the clinical picture of severe aortic valve stenosis, which was confirmed by transthoracic echocardiography. On aortotomy, she was noted to have an impressive black discoloration of ascending aorta and the aortic root complex involving the aortic valve leaflets.

Resection of Celiac Artery Aneurysm with Bypass Grafting to the Splenic and Common Hepatic Arteries.

Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain.

Giant Right Coronary Artery Aneurysm Associated with a Fistula Draining into the Superior Vena Cava.

Giant coronary artery aneurysm associated with a coronary-cameral fistula is an uncommon condition. Such aneurysms are usually associated with other cardiac diseases, such as coronary atherosclerosis, and therefore might augment myocardial ischemia in adults. The main indications for surgical intervention are severe coexisting coronary artery disease, evidence of embolization, and aneurysmal enlargement or rupture.

Aortic valve regurgitation that resolved after a ruptured coronary sinus aneurysm was patched.

Sinus of Valsalva aneurysms appear to be rare. They occur most frequently in the right sinus of Valsalva (52%) and the noncoronary sinus (33%). More of these aneurysms originate from the right coronary cusp than from the noncoronary cusp.

Acute promyelocytic leukemia as a cause of intracoronary drug-eluting-stent thrombosis.

Stent thrombosis is a potentially lethal complication of percutaneous coronary intervention. We describe the case of a 51-year-old man who presented with acute anterior ST-segment-elevation myocardial infarction and underwent successful percutaneous transluminal coronary angioplasty and placement of 3 drug-eluting stents in the left anterior descending coronary artery. Despite receiving dual antiplatelet therapy, the patient presented a week later with a non-ST-segment-elevation myocardial infarction and was found to have nonocclusive thrombosis of the left anterior descending coronary artery stents and his ostial left main and left circumflex coronary arteries.

Contemporary relevancy of carotid-subclavian bypass defined by an experience spanning five decades.

Background: The contemporary impact of and indications for carotid-subclavian bypass (CSB) are essential considerations in decision making for brachiocephalic reconstruction.

Methods: We analyzed operative outcomes, long-term graft patency, and the extended epidemiological impact of the primary disease process in 287 consecutive patients (mean age, 60.6 years; 43.

Reoperative myectomy via the left ventricular apex in a patient with hypertrophic obstructive cardiomyopathy.

Transaortic myectomy is the standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy that proves to be refractive to medical therapy. We encountered a case that required a modified surgical approach to relieve a left ventricular outflow tract obstruction that could not be adequately resected through the aortic annulus because of poor exposure of the ventricular septum. Persistent high gradients after the 1st operation necessitated a 2nd operation.

Left main coronary artery originating from the proper sinus but with acute angulation and an intramural course, leading to critical stenosis.

Because of the variety of their anatomy and clinical implications, coronary anomalies tend to confuse many observers. Recently, our group and other investigators have proposed that only 1 specific type of anomaly, by means of a specific mechanism, is able to cause both symptoms of myocardial ischemia and sudden death. This anomaly is known as anomalous origin of a coronary artery from the opposite sinus of Valsalva, with intramural course (ACAOS).

Papillary fibroelastoma of the aortic valve as a cause of transient ischemic attack.

Diagnostic evaluation of embolic neurologic events requires the consideration of cardiac causes. We recently encountered a case that emphasizes the importance of cardiac tumor as a source of embolic events. We present herein the case of a 42-year-old woman who suffered a transient ischemic attack caused by a papillary fibroelastoma that originated from the aortic valve.

Outcomes and risk factors in 1,609 carotid endarterectomies.

Severe carotid stenosis is typically treated with carotid endarterectomy (CEA), but there is debate about the safety of this procedure in patients with occlusion of the contralateral artery, previous CEA in the same artery, and other risk factors. To evaluate the association of these factors with outcomes in standard CEA with Dacron patch angioplasty, we examined the records of 1,609 consecutive isolated CEAs performed at our institution over a 10-year period on 1,400 patients (851 men and 549 women; mean age, 69.5 yr) with symptomatic or high-grade asymptomatic carotid lesions.

The transition from open to endoscopic saphenous vein harvesting and its clinical impact: The Texas Heart Institute experience.

Open saphenous vein harvesting can be associated with wound complications, incision pain, prolonged convalescence, and poor cosmetic results. Endoscopic vein harvesting has been widely used for prevention of these problems. We compared outcomes of open and endoscopic vein harvesting for coronary artery bypass grafting at the Texas Heart Institute.

Symptomatic anomalous origination of the left coronary artery from the opposite sinus of valsalva. Clinical presentations, diagnosis, and surgical repair.

Anomalous origination of a coronary artery can have serious, even fatal, consequences. Intravascular ultrasonography has recently provided new insights into anomalous coronary artery origination from the opposite sinus of Valsalva. On the basis of these insights, we describe 3 typical forms of this anomaly with left coronary artery involvement, including clinical presentations, diagnostic methods (particularly intravascular ultrasonography), and details of surgical treatment.

Aneurysm of the sinus of valsalva.

Aneurysms of the sinus of Valsalva (ASVs) are rare. They can be congenital or acquired through infection, trauma, or degenerative diseases. They frequently co-occur with ventricular septal defects, aortic valve dysfunction, or other cardiac abnormalities.

Myocardial thievery: the coronary-subclavian steal syndrome.

Coronary-subclavian steal syndrome entails the reversal of blood flow in a previously constructed internal mammary artery coronary conduit, which produces myocardial ischemia. The most frequent cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. Although coronary-subclavian steal was initially reported to be rare, the increasing documentation of this phenomenon and its potentially catastrophic consequences in recent series suggests that the incidence of the problem has been underreported and that its clinical impact has been underestimated.

Concomitant brachiocephalic and coronary artery disease: outcome and decision analysis.

Background: In patients with coronary artery disease, concomitant brachiocephalic disease may affect outcome and influence decision making regarding operative staging, technique, and choice of conduit.

Methods: Eighty consecutive patients (mean age, 59.3 years; 60.

Brachiocephalic reconstruction II: operative and endovascular management of single-vessel disease.

Objective: Although the surgical management of brachiocephalic disease is well established, evolving endovascular techniques present new options for treatment. We explored the potential benefits and drawbacks of these interventions in terms of outcome.

Methods: From 1966 to 2004, 391 consecutive patients (43.

Brachiocephalic reconstruction I: operative and long-term results for complex disease.

Objectives: Complex brachiocephalic disease involves multiple vessels and is frequently associated with multisystem atherosclerosis. We reviewed surgical outcome and examined the impact of this problem on decision making regarding operative staging, technique, and choice of conduit.

Methods: Between 1966 and 2000, 157 consecutive patients (mean age, 54.

Congenital coronary artery-left heart fistulas: Report of three cases.

Of 59 patients who underwent operative correction of congenital coronary artery fistulas from May 1956 through May 1980 at our institution, three had fistulas that arose from the coronary artery and terminated in the left heart. The chief indication for surgical correction in such patients is the presence of symptoms or the development of complications, which include rupture, endocarditis, and congestive heart failure. The principal objective of repair is closure or obliteration of the fistulous communication and preservation of distal myocardial perfusion.

Ionescu-Shiley pericardial xenograft valve: Hemodynamic evaluation and early clinical follow-up of 326 patients.

Dissatisfaction with the hemodynamic characteristics of available porcine valves prompted a clinical trial of the Ionescu-Shiley percardial xenograft (ISPX) valve. Three hundred fifty-six ISPX valves were implanted consecutively in 326 patients. Operative mortality was 2.

Wound complications after median sternotomy: A study of 61 patients from a consecutive series of 9,279.

Among a consecutive series of 9,279 sternotomies performed during a period of 2(1/2) years, 61 (0.66%) patients developed significant wound complications. Of these, 58 (95.