Elevated pre-operative serum peptides for collagen I and III synthesis result in post-surgical atrial fibrillation.

Objectives: This study sought to determine if serum markers for collagen I and III synthesis, the carboxyl terminal peptide from pro-collagen I (PICP) and the amino terminal peptide from pro-collagen III (PIIINP), correlate with left atrial (LA) fibrosis and post-operative atrial fibrillation (AF).

Background: AF after cardiac surgery is associated with adverse outcomes. We recently demonstrated that LA fibrosis is associated with post-operative AF in patients with no previous history of AF.

Left versus right atrial difference in dominant frequency, K(+) channel transcripts, and fibrosis in patients developing atrial fibrillation after cardiac surgery.

Background: The development of atrial fibrillation (AF) after cardiac surgery is associated with adverse outcomes; however, the mechanism(s) that trigger and maintain AF in these patients are unknown.

Objective: The purpose of this study was to test our hypothesis that postoperative AF is maintained by high-frequency sources in the left atrium (LA) resulting from ion channel and structural features that differ from the right atrium (RA).

Methods: Forty-four patients with no previous history of AF who underwent cardiac surgery consented to LA and RA biopsies.

Novel treatment of an 11-cm saphenous vein graft aneurysm.

Saphenous vein graft pseudoaneurysms are rare and potentially fatal complications after coronary artery bypass graft surgery. Here we present an 11-cm saphenous vein graft pseudoaneurysm from a 20-year-old vein graft to the obtuse marginal artery. The pseudoaneurysm was directly located beneath the sternum and adjacent to two patent grafts.

Cerebral oxygen desaturation after cardiopulmonary bypass in a patient with raynaud's phenomenon detected by near-infrared cerebral oximetry.

Raynaud's phenomenon is characterized by episodes of arterial vasospasm precipitated by cold stress, usually affecting the digits of the hands. There is controversy about the occurrence of vasospasm in internal organ systems. In this report, we present a case of Raynaud's peripheral vasospasm accompanied by cerebral oxygen desaturation as detected by near infrared cerebral oximetry after separation from cardiopulmonary bypass.

Atrial myxomas: pathologic types, tumor location, and presenting symptoms.

Background: Atrial myxoma is the most common cardiac neoplasm. Although not widely reported, two anatomic types have been observed: solid and papillary. We examined whether differences in gross or microscopic appearance and location correlated with symptomatology, specifically congestive heart failure (CHF), neurologic symptoms, and embolic events.

Chemically modified tetracycline improves contractility in porcine coronary ischemia/reperfusion injury.

Background: Reperfusion of ischemic myocardium has been implicated in extension of infarct size and deleterious clinical outcomes. Anti-inflammatory agents reduce this reperfusion injury. Chemically modified tetracycline-3 (CMT-3) (Collagenex Pharmaceuticals, Newtown, PA, USA) lacks antimicrobial properties yet retains anti-inflammatory activity.

Enteric cyst with epicardial attachment to the left ventricle.

Enteric cysts result from an anomaly of embryonic foregut development. In adults, these are frequently asymptomatic. The following is a case of an enteric cyst identified during routine coronary artery bypass attached directly to the epicardium of the left ventricle, a finding not previously reported.

Aprotinin and hemostasis monitoring concerns during cardiac surgery.

Aprotinin (Trasylol) is a serine protease inhibitor, isolated from bovine lung that initially was marketed for the treatment of pancreatitis. In the mid 1980s, reports of its ability to decrease hemorrhaging after cardiopulmonary bypass surgery introduced the drug to the realm of cardiac surgery. Unfortunately, its introduction into this arena was followed by the publication of multiple studies and case reports that blamed aprotinin for poor outcomes in the form of early graft closure.

Use of a biventricular assist device in the treatment of acute doxorubicin-induced cardiotoxicity.

This report describes a patient treated for metastatic leiomyosarcoma, who acutely developed doxorubicin-induced cardiotoxicity, and consequently developed heart failure. Medical therapy was initiated; however, her condition deteriorated and a surgical alternative was proposed. A biventricular assist device was implanted, allowing her multisystem organ failure to improve.

Surgical management of leiomyosarcoma of the mediastinum.

Leiomyosarcoma of the mediastinum is sufficiently rare; therefore therapeutic approaches are not well defined. Current therapy primarily rests with the thoracic surgeon. We report a single case of a large leiomyosarcoma of the mediastinum invading the heart and right lung.

New approach to the surgical management of pulmonary arteriovenous malformations after cavopulmonary anastomosis.

The development of pulmonary arteriovenous malformations after cavopulmonary bypass in patients with congenital heart disease is well documented. We report successful management of pulmonary arteriovenous malformations after cavopulmonary bypass in a patient with an interrupted inferior vena cava (IVC) and multiple hepatic veins utilizing an extracardiac conduit from the hepatic veins to the hemiazygous continuation of the interrupted IVC. This technique, performed without circulatory arrest or an atriotomy, may limit morbidity associated with intracardiac procedures in patients with single ventricle morphology.