Use of a cutting balloon and a paclitaxel-coated balloon to treat recurrent subclavian in-stent restenosis causing coronary subclavian steal syndrome.

A 56-year-old male with a past history of coronary artery bypass graft surgery underwent stent implantation for a severe proximal left subclavian artery stenosis. Recurrent in-stent restenosis (ISR) resulted in the coronary subclavian steal syndrome (CSSS), with angina due to compromised blood flow in the left internal mammary artery/radial composite bypass graft. This was treated with cutting balloon predilatation followed by paclitaxel-coated balloon (PCB) dilatation, with an excellent angiographic result.

Measurement of intraperitoneal metabolites during hypothermic cardiopulmonary bypass using microdialysis.

Objective: Splanchnic hypoxia, with resultant mucosal acidosis during cardiopulmonary bypass (CPB) has been demonstrated using tonometry. Microdialysis is a minimally-invasive method of obtaining peritoneal fluid samples. We measured the intraperitoneal metabolites during peri-operative period following hypothermic CPB and studied the safety of intraperitoneal microdialysis.

Effect of increased pump flow on hepatic blood flow and systemic inflammatory response following on-pump coronary artery bypass grafting.

Unlabelled: Reduced organ perfusion during cardiopulmonary bypass (CPB) is responsible for morbidity associated with cardiac surgery. Non-pulsatile flow and hypothermia during CPB have been shown to cause reduced perfusion. During CPB, cardiac output is directly proportional to the pump flow rate.

Use of Ivabradine in Postural Orthostatic Tachycardia Syndrome.

Postural orthostatic tachycardia syndrome (POTS) is characterized by inappropriate increase in heart rate on assuming upright position from a supine position without a necessary drop in blood pressure. Etiology of this condition is complex and multifactorial. Autonomic dysfunction,[1] hypovolemia,[2] hyper responsiveness of beta adrenergic receptors[3] with associated elevations of plasma norepinephrine levels have been implicated as underlying pathophysiologic mechanisms.

Cholangiocarcinoma presenting as hemobilia and recurrent iron-deficiency anemia: a case report.

Introduction: Iron-deficiency anemia is a relatively common presenting feature of several gastrointestinal malignancies. However, cholangiocarcinoma has rarely been reported as an underlying cause. The association of cholangiocarcinoma with the rare clinical finding of hemobilia is also highly unusual.

Propionibacterium acnes endocarditis of a prosthetic aortic valve.

In the few reported cases of Propionibacterium infective endocarditis involving prosthetic aortic valves, abscess is common and frequently requires surgery. We report a case of P. acnes infective endocarditis identified on prolonged blood cultures with aortic root abscess involving a Starr-Edwards valve.

The effect of fenoldopam and dopexamine on hepatic blood flow and hepatic function following coronary artery bypass grafting with hypothermic cardiopulmonary bypass.

Background: Hypothermic cardiopulmonary bypass is associated with low perfusion state causing a mismatch between demand and supply to various organs such as gut, kidneys and brain. The consequences are thought to be responsible for postoperative complications like systemic inflammatory response, renal failure, neurological injury, etc. Pharmacological agents like dopamine, dopexamine and dobutamine have been used in an attempt to reduce hypoperfusion and hence complications.

Unusual case of two synchronous intracavitary primary cardiac tumors.

We report a patient who had two histologic and distinct synchronous intracardiac tumors, with one located in each atrium. The second tumor was missed on intraoperative transesophageal echocardiography, but was discovered when the right atrium was opened using a bi-atrial trans-septal approach. We discuss the merits of this approach and the role of additional imaging for cardiac tumors.

Pulmonary thromboembolism with floating thrombus trapped in patent foramen ovale.

A 39-year-old man was hospitalized with symptoms of acute deep vein thrombosis, and computed tomography showed that he had pulmonary thromboembolism. Transthoracic echocardiography showed a large, right atrial thrombus and transesophageal echocardiography showed migrating thrombus trapped in a patent foramen ovale and extending all the way up to the ascending aorta. He underwent surgical embolectomy under cardiopulmonary bypass.

Wire perforation of Flex 10 microwave device during thoracoscopic atrial fibrillation ablation.

Objectives: Rapid advances in technology are increasing the repertoire of techniques available for the surgical treatment of atrial fibrillation (AF). These techniques utilize new devices which are normally safe. However, potential problems can arise with a new device as is illustrated in this report.

Microwave surgical ablation for atrial fibrillation during off-pump coronary artery surgery using total arterial-Y-grafts: an early experience.

This study demonstrates the efficacy and eligibility of concomitant epicardial microwave AF (MWAF) ablation during off-pump arterial revascularisation using the left internal mammary to radial 'Y' graft (OPCABy) in patients with permanent and paroxysmal atrial fibrillation. From June 2004 to December 2005, sixteen consecutive patients were offered MWAF ablation and OPCABy. AF was permanent in 11 cases and paroxysmal in five.

Stabilisation of coronary stents using rapid right ventricular pacing.

Aims: Excessive movement of coronary stents within the artery can make precise stent placement difficult. This study assessed the use of rapid right ventricular pacing to reduce stent motion to improve the accuracy of placement.

Methods And Results: During percutaneous coronary intervention, if excessive stent movement prevented accurate stent placement, rapid right ventricular pacing was performed to reduce stent motion within the coronary artery during both stent positioning and deployment.

An audit of the use and complications of glycoprotein IIb/IIIa inhibitors in percutaneous coronary intervention against national UK standards.

Coronary thrombosis is a pivotal event in the pathogenesis of acute coronary syndromes and ischemic complications resulting from coronary intervention. Activation of the platelet glycoprotein (GP) IIb/IIIa receptor is the final common pathway leading to platelet aggregation, coronary thrombus formation, and myocardial ischemia. Inhibitors of platelet GP IIb/IIIa are potent agents to prevent progression to myocardial infarction and death.