Transseptal course of anomalous left main coronary artery originating from single right coronary orifice presenting as unstable angina.

Transseptal course of coronary artery has often been described as a benign entity; however, this report and literature analysis provides growing evidence of high risk of serious cardiovascular events in this anomaly. We present a case of unstable angina in a patient with anomalous common origin of left and right coronary arteries from a single coronary ostium at the right sinus of Valsalva, with subsequent transseptal course of the left main artery, review of relevant literature, and discussion of possible management options.

Off-pump epicardial atrial fibrillation surgery utilizing a novel bipolar radiofrequency system.

Background: Over the past several years, pulmonary vein isolation for the treatment of atrial fibrillation has gained significant popularity. This study was undertaken to evaluate a novel radiofrequency (RF)-enabled clamp system designed to create transmural lesions epicardially on the beating heart using bipolar RF.

Methods: A set of differently shaped clamps modified to deliver bipolar RF energy were used to create a series of lesions in a beating heart canine model.

Does a pre-left ventricular assist device screening score predict long-term transplantation success? A 2-center analysis.

Background: A risk factor summation score was previously validated to successfully predict survival after insertion of a left ventricular assist device (LVAD). We investigated whether this scoring system also predicts clinical outcomes after eventual heart transplantation in LVAD recipients.

Methods: A retrospective review was performed on 153 consecutive patients who received an LVAD as a bridge to transplantation at 2 large-volume centers from 1996 to 2003.

Surgical ablation of atrial fibrillation: the Columbia Presbyterian experience.

Background: The Maze III procedure is an effective surgical treatment for atrial fibrillation (AF). However, it is not widely applied due to its complexity, increased operative times, and the risk of bleeding. Various energy sources have been introduced to simplify the traditional "cut and sew" approach.

Mechanisms of atrial tachyarrhythmias following surgical atrial fibrillation ablation.

Introduction: Typical and atypical atrial flutters (AFLs) and atrial tachycardias (ATs) have been reported in patients with prior surgical atrial fibrillation ablation. The underlying mechanisms for this group of atrial tachyarrhythmias have not been well characterized and the efficacy of catheter ablation in their treatment is unknown.

Methods And Results: Twenty patients (6 females) with a surface ECG diagnosis of AFL or AT following surgical atrial fibrillation ablation underwent 26 electrophysiology studies.

Adhesiolysis is facilitated by robotic technology in reoperative cardiac surgery.

Over a 2-year period, 5 patients who required reoperative chest surgery underwent robotic adhesiolysis with the da Vinci (Intuitive, Sunnyvale, CA) system. Resternotomy was performed under direct visualization for coronary revascularization (n = 2) or valve replacement (n = 1). A fourth patient required coronary revascularization after a previous axilloaxillary bypass.

Thoracoscopic epicardial pulmonary vein ablation for lone paroxysmal atrial fibrillation.

Surgical treatment of atrial fibrillation recently gained new popularity since the introduction of different energy sources for ablative therapy as an alternative to the original "cut-and-sew" techniques. However, most of the cases have been performed together with other cardiac surgical procedures and mainly through a standard median sternotomy approach. We report here the first European case of closed-chest thoracoscopic pulmonary vein isolation in a patient with lone paroxysmal atrial fibrillation.

Validation study of PulseCO system for continuous cardiac output measurement.

Ultrasonic flow probes have been used to optimize biventricular pacing immediately after cardiopulmonary bypass, improving cardiac output (CO) by 10%; however, flow probes must be removed with chest closure. The PulseCO system (LiDCO Limited, Cambridge, UK) may extend optimization into the postoperative period, but controlled validations have not been reported. Six anesthetized pigs were instrumented for right heart bypass.

Magnetic resonance imaging to detect acute cerebral events in on-pump and hybrid-pump patients.

Background: Conventional cardiopulmonary bypass results in cerebral ischemic sequelae that may be reduced with hybrid pump technologies, such as the CardioVention system (CardioVention, Santa Clara, CA, USA). CardioVention differs from conventional bypass in that it has a novel air elimination module and reduced membrane surface area and priming volume. This preliminary study tested whether this pump confers neurological safety advantages over conventional bypass.

Edge-to-edge mitral valve repair: the Columbia Presbyterian experience.

Background: The edge-to-edge mitral valve repair, first described by Alfieri in 1995 treats mitral regurgitation when standard reparative techniques are difficult, unlikely to succeed, or have failed. This study examines one institution's medium-term experience with this procedure.

Methods: This study involved patients undergoing edge-to-edge mitral valve repair at a single institution from 1997 to 2003.

Robotic techniques improve quality of life in patients undergoing atrial septal defect repair.

Background: Minimally invasive cardiac surgery has emerged as an alternative to conventional, open surgery. Although most studies of robotically assisted cardiac surgery have reported morbidity and mortality, few have addressed outcome measures, such as pain and quality of life, which was the aim of this study.

Methods: Eleven patients with atrial septal defects (ASD), and five patients with patent foramen ovale, underwent repair using the Da Vinci system (Intuitive Surgical, Mountain View, CA).

Long-term results of cardiac transplantation in patients 65 years of age and older: a comparative analysis.

Background: Advanced age is viewed by some transplant centers as a contraindication for heart transplantation secondary to concerns regarding decreased survival.

Methods: Between January 1992 and June 2002, 63 of 881 (7.2%) orthotopic heart transplants were performed in patients above 65 years.

Prolonged donor ischemic time does not adversely affect long-term survival in adult patients undergoing cardiac transplantation.

Objective: With liberalization of donor eligibility criteria, organs are being harvested from remote locations, increasing donor ischemic times. Although several studies have evaluated the effects of prolonged donor ischemic times on short-term survival and graft function, few have addressed concerns regarding long-term survival.

Methods: Over the last 11 years, 819 consecutive adults underwent cardiac transplantation at Columbia Presbyterian Medical Center.

Off-pump right atrial thrombectomy for heparin-induced thrombocytopenia with thrombosis.

This report describes a 72-year-old woman with atrial fibrillation who presented with lower extremity ischemia secondary to thromboembolism. After lower extremity thrombectomy, the patient developed heparin-induced thrombocytopenia with thrombosis (HITT). Her postoperative course was complicated by recurrent supraventricular and ventricular tachycardia, secondary to a mobile thrombus in the right atrium extending into the right ventricle.