Diagnosis and successful management of septal myocardial abscess: a complication of bacterial endocarditis.

A case of acute enterococcal aortic valve endocarditis is presented in which the complication of a septal myocardial abscess was diagnosed clinically and successfully treated surgically. This represents the first instant, to our knowledge, in which the preoperative diagnosis of a myocardial abscess served as the indication for emergency cardiac surgical intervention in active endocarditis with successful outcome. The diagnostic parameters permitting clinical recognition of a myocardial abscess include the development of advancing degrees of atrioventricular and bundle branch block, and the finding of pericarditis or pericardial effusion in aortic valvular infections.

Reduction of unexpected, life-threatening events in postoperative cardiac surgical patients; the role of computerized surveillance.

With increasing use of computerized surveillance (CS) in critical care, a key question is whether it favorably influences clinical outcome. Knowing that two intensive care unit beds would soon have CS capability, we embarked on an uninterrupted prospective study in which the incidence of sudden, unexpected life-threatening events (SULTE) was compared in post-open heart surgery patients whose subsystem performances were evaluated by conventional methods (CM) as opposed to those who would be followed by CS involving automatic acquisition and generation of 30 cardio-respiratory variables. We evaluated 211 patients, 91 with CM and 120 by CS.

Left heart assist device: early clinical experiences with management of postperfusion low cardiac output.

Low cardiac output is a continuing cause of mortality after intracardiac operation in patients coming to surgery with advanced myocardial dysfunction. A simple method using a left heart assist device (LHAD) after open heart surgery to manage low cardiac output resistant to all adjuvant therapy is described. Except for the special cannulas, all equipment necessary for the LHAD is available in any unit performing open-heart surgery.

Temporary mechanical support of left ventricular failure following open heart surgery.

Patients coming to open heart surgery with advanced cardiac dysfunction may require mechanical cardiac support to avoid life-threatening low cardiac output in the postoperative period. 15 patients who could not be withdrawn from cardiopulmonary bypass because of low cardiac output were supported with a left heart bypass system (left atrium to ascending aorta). Ten were ultimately separated from the device, 6 were dismissed from the hospital and 4 remain well (the longest 2.