Propafenone versus ibutilide for post operative atrial fibrillation following cardiac surgery: neither strategy improves outcomes compared to rate control alone (the PIPAF study).

Background: It is unclear whether acute conversion of atrial fibrillation (AF) with anti-arrhythmic drugs following cardiac surgery restores and/or maintains sinus rhythm or reduces hospital length of stay (LOS).

Material/methods: A randomized prospective pilot study was conducted in 2 teaching hospitals from 3/28/98 to 8/2/99 to study the effect of the early use of ibutilide or propafenone on the duration of AF, rhythm at discharge, and LOS. A total of 42 stable patients with new AF after surgery were randomized to oral propafenone (600mg, single dose; n=20), ibutilide (1 mg up to 2 doses if necessary; n=10), or rate control only (n=12).

Routine transesophageal echocardiography for cerebral ischemia. Is it really necessary?

Background: Patients presenting with stroke or transient cerebral ischemic episodes often undergo transesophageal echocardiography (TEE) as part of their initial evaluation. Previous studies have demonstrated that TEE is superior to transthoracic echocardiography for the detection of potential cardiac sources of embolism. In our institution, this scenario now represents the most frequent reason for requesting TEE.

Coronary stenting for aortocoronary dissection following balloon angioplasty.

We report a case of coronary dissection following percutaneous transluminal coronary angioplasty (PTCA) in which the dissection extended antegrade as well as retrograde into the aortic root. Emergent stenting was able to seal the dissection entry point, resulting in restoration of normal coronary flow and diminution in the degree of aortic dissection.

Pseudoaneurysm causing partial obliteration of the left atrium: case report and review.

We describe a case of left ventricular pseudoaneurysm with subepicardial dissection onto the left atrial wall, mimicking a smooth left atrial mass, causing partial obliteration of the left atrial cavity. This patient presented with a transient ischemic attack, most likely resulting from a thromboembolic episode to the brain. Emergent surgery was successfully performed and the patient is doing well at 1-year follow-up, with no signs of left atrial compression by transthoracic echocardiography.

Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: a case report and review.

We report a pseudoaneurysm of the right coronary artery bypass graft with fistulous drainage into the right atrium. This patient presented with an acute myocardial infarction in a different vascular territory. Cardiac catheterization led to the diagnosis of the pseudoaneurysm.

Is cardiac catheterization necessary in the era of echocardiography? Cost-effective approach combining echocardiography and cardiac catheterization.

Definitive evaluation of cardiovascular disease is traditionally accomplished by cardiac catheterization. Advances in transthoracic and transesophageal Doppler echocardiography provides an accurate and cost-effective approach when compared to cardiac catheterization. Recent data suggests that for most adult patients with aortic or mitral valve disease, Doppler echocardiographic data enables the clinician to make the same decision reached with catheterization data.

Intraoperative transesophageal echocardiography--an indispensable tool in valve reconstruction and congenital anomalies.

Transesophageal echocardiography (TEE) with color flow mapping has become an excellent tool for evaluating valve reconstruction and correction of congenital anomalies intraoperatively. From February 1990 to September 1990 we have utilized TEE intraoperatively in 14 consecutive patients. Their ages ranged from 25 to 77 years, with a mean age of 58.