Frequency of severe valvular disease caused by mediastinal radiation among patients undergoing valve surgery in a community-based, regional academic medical center.

Background: Our goal was to define the prevalence of radiation-induced valvular heart (RIVD) disease among patients undergoing cardiac valve surgery in a community-based, regional academic medical center. Mediastinal radiation is a treatment modality for various hematologic and solid malignancies; however, long-term cardiac complications, including radiation-induced valvular heart disease, can occur years after the radiation treatments.

Hypothesis: Mediastinal radiation exposure is an independent risk factor for valvular heart disease often necessitating valve replacement in patients without other risk factors for valve disease.

Gastro-right ventricular fistula: a deadly complication of a gastric pull-through.

A 70-year-old patient presented with melena, dyspnea, and generalized weakness. An endoscopy revealed a deep ulcer with a pulsatile clot in the intrathoracic gastric tube that had been previously constructed for esophageal replacement. Shortly thereafter, the patient died of exsanguination secondary to a fistula between the stomach and the right ventricle.

Recovery after resuscitation from cardiac arrest in ST-elevation myocardial infarction: a computer-based medical decision-support tool.

Prediction of outcomes in ST-elevation myocardial infarction with cardiac arrest often presents difficult clinical decision making. Using the observed results from our institution's data, we introduce a customized, computer-based decision support tool to assist in evaluating and predicting outcomes in such situations. We conclude that this tool can be beneficial to clinicians in decision making or triage of this condition.

Survival and neurologic recovery in patients with ST-segment elevation myocardial infarction resuscitated from cardiac arrest.

Objectives: We examined outcomes of patients resuscitated from cardiac arrest owing to ST-segment elevation myocardial infarction (STEMI) and predictors of survival and neurologic recovery.

Background: Immediately after resuscitation from cardiac arrest owing to STEMI, many patients show signs of neurologic impairment, and benefits of percutaneous coronary intervention and subsequent prognosis are not well defined.

Methods: Between January 1, 2002, and December 31, 2006, we retrospectively identified consecutive patients resuscitated from cardiac arrest, regardless of time to return of spontaneous circulation (ROSC) and neurologic status, and reviewed the outcomes of those who had STEMI.