Diaphragmatic flutter resulting in failure to wean from mechanical ventilator support after coronary artery bypass surgery.

Diaphragmatic dysfunction, most commonly elevation of the left hemidiaphragm and/or phrenic nerve paralysis, are well-known complications of coronary artery bypass grafting (CABG). Diaphragmatic flutter (DF) is an easily overlooked breathing pattern characterized by rapid (greater than 40 times/min) involuntary contractions of the diaphragm, at times superimposed on a more normal breathing pattern (dirhythmic breathing). Using respiratory inductive plethysmography, we were able to record this unusual ventilatory pattern in four patients after CABG.

Right upper lobectomy twenty years after left pneumonectomy. Preoperative evaluation and follow-up.

Quantitative perfusion lung scanning coupled with spirometry and balloon occlusion of the pulmonary artery supplying the lung to be resected have been used to predict the potential operability of patients being considered for pneumonectomy. These techniques were adapted for the lobar level prior to performing a right upper lobectomy in a 59-year-old man who had undergone a left pneumonectomy 20 years previously. This case demonstrates how physiologic reserve can be predicted in patients who require sequential pulmonary resection.

DDD pacemakers maximize hemodynamic benefits and minimize complications for most patients.

A 44-month retrospective analysis was performed on 666 pacemakers implanted at Mt. Sinai Medical Center. Mapping techniques and endocardial waveform analyses were used during lead positioning to ensure the best electrical environment.

The laser: an alternative for palliative treatment of obstructing intraluminal lesions.

Twenty nine patients with carcinoma obstructing the colon, six obstructing the gastroesophageal junction, six obstructing the tracheobronchial tree, and one patient with recurrent transitional cell cancer of the bladder invading the rectum, not amenable to surgical resection, were treated by laser photocoagulation. Forty were treated with the Nd:YAG laser and two with the CO2 laser. There were 26 men and 16 women with an average age of 73.

Pacemaker clinic evaluations: key to early identification of surgical problems.

The pacemaker center evaluation was responsible for the timely reoperation of 341 pacemaker patients over the last three years. The most common indication for reoperation was battery end-of-service (46.3%).

Technique for the surgical extraction of permanent pacing leads and electrodes.

When a pacing lead becomes infected, the most expedient and successful therapy is its removal. A new surgical extraction technique, combining the use of fluoroscopy and a limited surgical dissection of the right atrium, is presented for the removal of a lead entrapped in the heart or venous system.

Computer applications to electrophysiologic studies.

The automated studies performed at implant require little extra time and provide essential information for postoperative troubleshooting and patient management. The automated testing and analysis system is but one component in a comprehensive patient management system designed for and dedicated to pacing; the system is an integral part of a complete data management system which includes extensive follow-up and management sections.

Implant experience with unipolar polyurethane pacing leads.

A total of 905 unipolar polyurethane pacing leads have been implanted by the first author's group, between April 1978 and February 1982, with a mean implant of 1.4 years. Twelve leads were explanted and analyzed.

Papillary muscle rupture following nonpenetrating chest trauma: report of a case with hemodynamic and serial echocardiographic findings and successful surgical treatment.

The pre- and postoperative echocardiographic features of a patient with severe mitral incompetence due to rupture of a papillary muscle following nonpenetrating chest trauma are presented. The mitral valve echocardiogram showed chaotic diastolic flutter suggestive of a ruptured papillary muscle or ruptured chordae tendineae. The preoperative ultrasound recording of the left ventricle revealed left ventricular enlargement and excessive motion of the interventricular septum.

Mitral valve replacement in medically unresponsive congestive heart failure due to papillary muscle dysfunction.

Forty patients with a mean age of 65 years (range 44-76 years) were operated on; 30 of 40 patients (75%) had prior myocardial infarction. All had severe therapy-resistant congestive heart failure, 75% (30 of 40 patients) were symptomatic at rest, and 25% (10 of 40 patients) were symptomatic on minimal exertion. Cardiac index ranged from 1.

Coronary artery bypass surgery in patients seventy years of age and older.

Fifty patients 70 years of age and older underwent coronary artery bypass surgery for disabling angina pectoris or congestive heart failure or both (two quadruple, 11 triple, 25 double grafts, 12 single). Twenty additional procedures were done (11 mitral valve replacements for papillary muscle dysfunction, six ventricular aneurysmectomies, four aortic valve replacements, and one repair of ventricular septal defect). Surgical mortality rate was 8 per cent (four patients).

Noninvasive cardiac evaluation (NICE) of intracardiac shunts using inhaled radioactive carbon dioxide.

A totally new, noninvasive technique is presented for the detection and analysis of left-to-right cardiac shunts. Five millicuries of oxygen 15-labeled carbon dioxide is administered by a single-breath inhalation technique. The resultant lung washout curve accurately reflects the presence or absence of a shunt.

Long-term results of "simple" thrombectomy for thrombosed Björk-Shiley aortic valve prostheses.

During the past two years 8 patients were seen with thrombosis of their Bjork-Shiley aortic valves. Six patients were from our series, an incidence of 4% and 2 patients had their original valve implanted at another institution. All patients had substantial problems with anticoagulation therapy.