Assessing the risk of work-related international travel.

Objective: To identify factors affecting the likelihood of requiring medical services during international business trips.

Methods: Data from more than 800,000 international trips and medical assistance cases provided to 48 multinational corporations in 2009. Travel destination countries were grouped into four a priori risk-related categories.

On-site implantation of a ventricular assist device to facilitate aeromedical transport.

Background: Experiencing an acute coronary event in a remote or community hospital can be fatal, particularly if the event is complicated by cardiogenic shock. Many remote and community hospitals do not have adequate resources to support such a compromised patient. Extrapolating from the domestic hub-and-spoke model, presently used between academic tertiary care facilities and community hospitals, we outline the implementation of such an ad hoc arrangement between Panama (spoke) and South Florida (hub).

Country factors associated with the risk of hospitalization and aeromedical evacuation among expatriate workers.

Objective: To assess country factors associated with the risk of requiring aeromedical evacuation and hospitalization among expatriate workers and their dependents.

Methods: The 2009-2010 data including 5725 aeromedical evacuations and 17,828 hospitalizations, and 2009 data of hospitalizations and aeromedical evacuations among 94,651 at-risk expatriates, were analyzed to assess 2 country risk rating tools. Each tool utilized four risk categories and reflected level of development and medical capabilities.

A hybrid approach to cardiac resynchronization therapy.

Background: CRT (atrial-synchronized bi-ventricular pacing) has been shown to significantly improve the quality of life and exercise tolerance in patients with moderate-severe heart failure and an interventricular conduction delay (>120 msec) when compared to controls. Traditionally it has been performed by cardiologists in electrophysiology laboratories. In the event that the left ventricular lead cannot be positioned percutaneously the procedure is aborted and the cardiac surgeon consulted.

Sequential bypass on the beating heart can be achieved without compromising patient safety or regional myocardial blood flow.

For some cardiac surgeons, operating on the beating heart is the preferred method of coronary revascularization. In an effort to minimize manipulation of the aorta, we have used, in addition to an internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery, a sequential reversed saphenous vein graft (rSVG) to revascularize the lateral, inferior, and posterior myocardium with a single proximal aortic anastomosis. In this report, we retrospectively summarize a recent series of off-pump coronary bypass grafting (OPCABG) cases, including the evaluation of distal conduit blood flow.

Left atrial myxoma and mitral valve endocarditis--a cause and effect: a case report.

We report the case of a 55-year-old man who presented with an infected left atrial myxoma that seeded a normal native mitral valve. Despite the absence of mitral regurgitation or heart failure, prior to the patient completing a course of IV antibiotic therapy we removed the tumor, replaced the mitral valve, and added 3 coronary artery bypass grafts, following a single embolic event. Although a completed course of antibiotic therapy may have allowed preservation of the native mitral valve, we believed that the risk of recurrent embolization from either the mass or the mitral valve vegetations was greater that the long-term risks of valve replacement.

Prevention of systolic anterior motion after repair of the severely myxomatous mitral valve with an anterior leaflet valvuloplasty.

Background: Systolic anterior motion after mitral valve repair of severely myxomatous valves is due to excess tissue or anterior displacement, or both, of the leaflet coaptation point. Our series of anterior leaflet valvuloplasty, an alternative to the sliding leaflet technique to prevent systolic anterior motion, is presented.

Methods: Between January 1, 1996 and January 6, 2003, we performed elliptical excisions of the base of the anterior leaflet in 47 patients with a mean age of 66 years (range, 29 to 86).

Synergy of old and new technology results in successful revascularization of the anterior myocardium with relief of angina in the absence of suitable targets.

Background: Diffuse and distal left anterior descending (LAD) coronary disease that is refractory to conventional surgical and/or percutaneous revascularization represents a clinical and economic dilemma. Transmyocardial laser revascularization (TMLR) has improved angina without clear measurable improvement of myocardial perfusion. This study was undertaken to determine if combining a Vineberg implant with TMLR of the LAD distribution enhances myocardial perfusion and relieves symptoms.

Prevention of systolic anterior motion after mitral valve repair with an anterior leaflet valvuloplasty.

Background And Aim Of The Study: Mitral valve repair (MVR) is the preferred method of treatment of the complex floppy mitral valve. Immediate repair failure, due to systolic anterior motion (SAM), is related to excessive anterior mitral valve leaflet (AMVL) tissue and/or anterior displacement of the leaflet coaptation point by the posterior mitral valve leaflet (PMVL) with resultant left ventricular outflow tract (LVOT) obstruction. Herein are reported the authors' experience of the AMVL valvuloplasty, a simple alternative to the sliding technique, to prevent post-MVR SAM.

The use of a rigid instrument prior to stentless valve implantation facilitates correct alignment of the prosthesis and native aortic valve apparatus.

Background And Aim Of The Study: When correctly seated in the aortic position, stentless valves are associated with a relatively low transvalvular gradient. This leads to regression of left ventricular hypertrophy and long-term survival. The alleged complexity of stentless valve implantation has led to a preference for stented/mechanical prostheses.

Off-pump coronary artery bypass surgery may produce a hypercoagulable patient.

Background: The incidence of thromboembolic events following traditional open heart surgery has not been clinically significant. However, with beating heart surgery, for which cardiopulmonary bypass (CPB) is not required, the incidence of spontaneous intravascular thrombosis may be similar to that encountered after general surgeries. Compounding this risk is that many cases of off-pump coronary artery bypass (OPCAB) surgery are reserved for the elderly patient with multiple comorbidities.

Occult cardiac lymphoma presenting with cardiac tamponade.

Subxiphoid pericardiostomy is the procedure of choice for treatment of a pericardial effusion with tamponade. We report a case in which this procedure not only failed to reveal the presence of an occult malignancy, but also resulted in a recurrent symptomatic effusion.