Pacemaker upgrade causing new-onset heart failure in a patient with complete congenital atrioventricular block.

For infants with congenital complete atrioventricular block (CCAVB), the choice of pacing modalities is limited. Due to their size and surgical limitations, neonates typically start with an epicardial right ventricular pacing system, then upgrade to right-sided dual-chamber pacing once appropriate size is achieved. These modes are generally well tolerated.

Cardiac transplantation in Hawai'i: a summary of the first 21 years.

Between 1987 and 2008, 45 patients have undergone cardiac transplantation in Hawai'i. This article summarizes the authors' experiences with cardiac transplantation over this 21-year period. The cumulative 1-, 3- and 5-year survival rates after transplantation have been 73.

Internal mammary hypoperfusion syndrome--diagnosis and treatment.

The use of the internal mammary artery (IMA) in coronary artery bypass surgery has increased substantially over the past 20 years, being at present the conduit of choice for most patients. Complications associated with its use occur occasionally and include life-threatening postoperative ischemia or the revascularized myocardium. We reviewed the records of 1,971 consecutive patients who underwent coronary artery bypass grafting over a 5-year period.

Cardiac transplantation in Hawaii.

Clinical cardiac transplantation was successfully introduced 26 years ago, and from an initial experimental status, it has moved forward to become an accepted and well-established treatment modality for end-stage cardiac disease. The first cardiac transplant operation in Hawaii was performed in March 1987; the patient lived for 1 year. A total of 20 heart transplant operations have been performed in 19 patients at St.

Intraoperative transesophageal echocardiography.

Intraoperative echocardiography in patients undergoing cardiac surgery was first described in 1972. Interest in intraoperative echocardiography has grown in recent years due to the extensive information provided by 2-dimensional (2-D) and color-flow Doppler imaging via the transesophageal approach. The value of this technique also has been verified in large clinical studies involving patients undergoing cardiac surgery.

Prolonged extracorporeal circulation for acute myocarditis.

Total circulatory support for acute reversible myocardial failure is rarely used in clinical situations outside the postoperative period following cardiac surgery. We treated an 8-year-old girl who suffered acute viral myocarditis and sustained cardiac arrest requiring cardiopulmonary bypass for resuscitation. This was accomplished with the use of the portable cardiopulmonary support system (CPS), which consists of a centrifugal pump and a membrane oxygenator.

Successful mechanical circulatory support for noncoronary shock.

Mechanically assisted recovery from shock and long-term survival of nontransplant patients with acute noncoronary myocardial decompensation have not been previously reported. We treated nine patients (aged 8 to 53 years) who were referred with acute nonischemic cardiogenic shock (pulmonary capillary wedge greater than 20, cardiac index less than 1.5 L/min/m2, mean blood pressure less than 60 mm Hg, ejection fraction less than 0.

Nontuberculous mycobacterial infections in heart transplant recipients: a seventeen-year experience.

A retrospective review was undertaken to determine the clinical features, outcome, and impact on survival of nontuberculous mycobacterial infections in 14 (of 502) heart transplant recipients. The prevalence of these infections was significantly higher (p less than 0.05) during the precyclosporine than during the cyclosporine era.

Eight-year results of cyclosporine-treated patients with cardiac transplants.

To elucidate the long-term effects of cyclosporine, we retrospectively studied 310 consecutive patients who have undergone cardiac transplantation at our institution since December 1980 and in whom immunosuppression has been maintained with cyclosporine. The ages of recipients ranged from 1 month to 64 years and of donors from 1 month to 48 years. The actuarial survival rates for cyclosporine-treated patients were 80.

Pulmonary infiltrates after heart-lung transplantation: evaluation by serial transbronchial biopsies.

Since January 1988, prospective serial transbronchial lung biopsies have been performed as a diagnostic procedure to facilitate the care of recipients of heart-lung transplants. Eighty-five cardiac and 70 transbronchial lung biopsies have been prospectively performed in 10 patients beginning within the first week of transplantation. Forty-eight percent (34/70) of the transbronchial lung biopsies and 16.

Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis.

We studied the effects of cytomegalovirus (CMV) infection on 301 cardiac transplant recipients who were treated during the cyclosporine era of immunosuppression (1980 to the present). These patients received varying combinations of cyclosporine, azathioprine, prednisone, rabbit antithymocyte globulin, and OKT3 as their immunosuppressive therapy. Two hundred ten patients were free of CMV infection (non-CMV group).

A simple technique for aortic valve replacement using freehand allografts.

Given the recent resurgence of interest in the use of "fresh" and cryopreserved allograft valves for aortic valve replacement, the fact that many cardiac surgeons were not exposed to the operative techniques involved in freehand implantation of allograft valves during their residency training, and the paucity of teaching materials that clearly portray such techniques, details of a simplified method of subcoronary, freehand allograft valve implantation in the aortic position are described and illustrated.

Degenerative and atherosclerotic aneurysms of the thoracic aorta. Determinants of early and late surgical outcome.

To identify significant predictors of early and late mortality, multivariate discriminant analyses were applied to the clinical outcome of 175 consecutive patients with thoracic aortic aneurysms operated upon over a 20 year span. Only atherosclerotic and degenerative aneurysms were included; the patients were segregated into two groups according to location of the aneurysm. The ascending aortic aneurysm group consisted of 124 patients, 85% of whom required concomitant aortic valve replacement.