Surgical ablation of atrial fibrillation with a novel bipolar radiofrequency device.

Objective: When used for epicardial ablation, unipolar devices do not predictably yield transmural scars. Bipolar radiofrequency proved highly effective on the animal model, but clinical experience is still initial. We describe acute electrophysiologic findings and follow-up results of epicardial ablation with a novel bipolar radiofrequency device.

A giant left ventricular pseudoaneurysm as a late sequela of aortic valve endocarditis.

Left ventricular pseudoaneurysm is an uncommon complication of infective endocarditis, usually presenting within several weeks of the infective episode. We describe a 37-year-old man who presented with exertional dyspnea nearly a year after a prolonged hospitalization for lung abscess. Imaging studies showed new aortic valve regurgitation and a giant pseudoaneurysm extending inferoposteriorly from the left ventricle.

Dobutamine echocardiography in patients with aortic stenosis and left ventricular dysfunction: predicting outcome as a function of management strategy.

Study Objective: To prospectively address the question whether the assessment of valvular hemodynamics and myocardial function during low-dose dobutamine infusion can guide decision making in patients with aortic stenosis and left ventricular (LV) dysfunction.

Patients And Measurements: Twenty-four patients with aortic stenosis and LV dysfunction (mean ejection fraction, 28%; New York Heart Association class, II to IV) were studied by dobutamine echocardiography assessing mean pressure gradient, aortic valve area, and aortic valve resistance. Patients were prospectively divided into severe and nonsevere aortic stenosis groups according to the response of the valve area to the augmentation of systolic flow.

[Massive pulmonary embolism--summary of experiences with 13 patients].

Pulmonary embolism is a common event in hospitalized patients. In some cases it presents with hemodynamic collapse, indicating massive obliteration of the pulmonary vasculature and has a very grim prognosis; 2/3 of such patients die within 2 hours of onset of symptoms. We describe our experience in 13 patients with massive pulmonary embolism.

Tricuspid valve surgery: recent experience at the Chaim Sheba Medical Center.

From 1 January 1989 to 30 June 1992, 35 patients underwent cardiac surgery that included a tricuspid valve (TV) procedure. All had severe TV dysfunction documented by echocardiography, and were in NYHA functional class III-IV. The etiology of TV dysfunction was rheumatic-functional in 19 patients, rheumatic-organic in 13, and infective in 3.

From swirling to a mobile, pedunculated mass--the evolution of left ventricular thrombus despite full anticoagulation. Echocardiographic demonstration.

We describe the unusual evolution of a left ventricular thrombus following acute anterior myocardial infarction despite adequate anticoagulation. Serial echocardiographic examinations demonstrated the evolution from swirling in the left ventricle through a solid apical mass gradually dislodging into a mobile, pedunculated mass that was removed surgically to prevent embolization. This report emphasizes the need to follow echocardiographically left ventricular thrombi during treatment with anticoagulants, and to identify morphologic changes that may predict embolization.

Left ventricular thrombectomy in the early postinfarction period.

Emergency left ventricular thrombectomy was performed on four patients soon after infarction. In three patients surgery was carried out after embolisation had occurred and when a large, residual, protruding, mobile thrombus remained in the left ventricle. Surgery was performed in the fourth patient after a high risk thrombus was detected and initial attempts to lyse it had failed.

Epidural anesthesia with the Trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis: a hemodynamic study.

The hemodynamic effects of epidural anesthesia (EA) with the Trendelenburg position were studied in seven patients with severe mitral stenosis undergoing emergency cesarean section (CS) because of hemodynamic deterioration. In six patients, the CS was immediately followed by an open mitral commissurotomy under general anesthesia, whereas in one patient, the CS was performed alone. A significant reduction in heart rate (120 +/- 5 to 83 +/- 7 beats/min; P less than 0.

Continuous rt-PA infusion as a salvage strategy to maintain patency of the infarct artery; safety of high cumulative dose and subsequent emergency coronary artery angioplasty and bypass surgery.

Acute re-occlusion of an infarct artery reperfusion attained by thrombolytic therapy may be treated by emergency coronary angioplasty or bypass surgery. Repeated infusion of a thrombolytic agent is an additional treatment strategy. Three patients with reinfarctions that occurred very early after successful reperfusion were treated with continuous infusion of recombinant tissue-type plasminogen activator (rt-PA).

The perioperative fate of residual gradients after repair of discrete subaortic stenosis and time-related blood levels of catecholamines.

Unlabelled: The fate of the residual peak systolic left ventricular-aortic gradient was studied perioperatively in 14 patients with membranous discrete subaortic stenosis. In nine (group A) the initial postrepair left ventricular-aortic gradient was greater than 35 mm Hg (mean 56.8 +/- 13.

Relationship of right and left ventricular negative diastolic pressures, hypercontractility, and relief of outflow tract obstructions.

Continuous postoperative right and left ventricular diastolic pressures were measured in 12 consecutive patients undergoing pulmonic valvotomy and in 13 consecutive patients undergoing membranectomy and myectomy for discrete subaortic stenosis. All 25 patients had positive preoperative diastolic ventricular pressures. Negative ventricular diastolic pressure was detected immediately postoperatively in all 25.

Pericardial patch enlargement of Blalock-Hanlon atrial septectomy.

A modified Blalock-Hanlon operation is described, in which both the right and left atriotomies were bridged by a generous pericardial patch. This patch significantly enlarged the interatrial communication and markedly increased arterial blood saturation.

Negative right ventricular diastolic pressure after operation for pulmonary valve stenosis: the phenomenon and its relation to volume load and conal contraction.

The phenomenon of negative right ventricular diastolic pressure immediately after operation for relief of isolated pulmonary valve stenosis was investigated in 11 patients. Pressures in the right ventricle and pulmonary artery were measured with a catheter tip micromanometer. One patient had a negative right ventricular diastolic pressure before operation.

Staged surgical treatment of early bacterial endocarditis after surgical repair of tetralogy of Fallot and discrete subaortic stenosis: report of a case.

An unconventional method of managing infection of the interventricular Teflon patch in a patient with tetralogy of Fallot is reported. The patch was initially replaced by a new patch. After reinfection, however, removal of the patch and pulmonary banding eradicated the infection, and at a later stage the defect was re-repaired successfully.

The effect of low-dose intravenous nitroglycerin on pulmonary hypertension immediately after replacement of a stenotic mitral valve.

The postoperative effect of infusion of nitroglycerin on pulmonary vasomotor dynamics was studied in 28 patients undergoing valve replacement for mitral valve stenosis. A 30% reduction in mean pulmonary arterial pressure (38.74 +/- 8.

Severe pulmonary nocardiosis in a kidney allograft recipient with a low immunological response.

A patient with severe pulmonary nocardiosis occurring in the early posttransplant period is presented. Three outstanding features characterized this case: 1) the failure to diagnose this rare opportunitistic pathogen by conventional detection methods necessitated open lung biopsy; 2) the initiation of trimethoprim-sulphamethoxazole therapy resulted in a dramatic clinical response; and 3) an allograft recipient with a low immunological response contracted nocardiosis. His immune status became apparent following pretransplant donor-specific blood transfusion tests, unresponsiveness to third-party transfusion and graft tolerance permitting the permanent withdrawal of azathioprine without graft function impairment.