[Car driving after cardiac surgery: clinical aspects, regulations, and legal implications].

Background: Car driving is one of the most perceived problems by patients after cardiac surgery. The aim of this study was to evaluate the influence of cardiac surgery and median sternotomy on driving performance after a cardiac rehabilitation program.

Methods: Seventy-four consecutive patients, usual car drivers, admitted to our Cardiac Rehabilitation Center after cardiac surgery, were evaluated 60 days from discharge using a five-item questionnaire.

Echocardiographic estimation of pulmonary pressures.

Cardiac ultrasound plays a pivotal role in assessing pulmonary artery pressures. Estimation of right atrial pressure can be derived from the dimensions and respiratory variation of the inferior vena cava and Doppler modalities provide an accurate and comprehensive evaluation of right ventricular and pulmonary artery pressures. Peak pulmonary artery pressure can be calculated from continuous wave Doppler sampling of the tricuspid regurgitant jet, while pulsed wave Doppler sampling of the pulmonary regurgitant jet allows evaluation of mean and diastolic pulmonary artery pressures.

[Mitral valve prolapse].

Mitral valve prolapse (MVP) is still a clinical challenging problem. In this report, we review the main characteristics of this entity. Epidemiology of MVP, which relies on the diagnostic criteria adopted, and the incidence of complications, both arrhythmic and structural, are influenced by the characteristics of the population studied, which may lead to bias in data interpretation.

Bedside diagnosis and follow-up of patients with pleural effusion by a hand-carried ultrasound device early after cardiac surgery.

Objectives: The aim of this study was to assess the potential value of hand-carried ultrasound (HCU) devices in the diagnosis and follow-up of patients with pleural effusion (PE) after cardiac surgery.

Methods: Seventy consecutive patients were evaluated at bedside early after cardiac surgery, in the upright sitting position, using an HCU device on hospital admission and every 3 days until hospital discharge. The posterior chest wall was scanned along the paravertebral, scapular, and posterior axillary lines.

[Digital echocardiography laboratory].

The implementation of a digital echocardiography laboratory exists today using the DICOM (Digital Imaging Communication in Medicine) standard to acquire, store and transfer echocardiographic digital images. The components of a laboratory include: 1) digital echocardiography machines with DICOM output, 2) a switched high-speed local area network, 3) a DICOM server with abundant local storage, and 4) a software to manage image and measurement information. The aim of this article was to describe the critical components of a digital echocardiography laboratory, discuss strategies for implementation, and describe some of the pitfalls that we encountered in our own implementation of the digital third level echocardiography laboratory.

Permanent pacing lead insertion through the cephalic vein using an hydrophilic guidewire.

The cephalic vein (CV) should be preferred to the subclavian vein for the insertion of permanent pacing leads because of better results. Unfortunately, the direct lead introduction using the standard CV cutdown is often unsuccessful. This study evaluated the efficacy and safety of a steerable hydrophilic guidewire (HGW) for lead insertion through the CV.