Texas Heart Institute journal
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The aim of this retrospective study was to determine the prevalence and predictors of electrical storm in 227 patients who had received implantable cardioverter-defibrillators (ICDs) and had been monitored for 31.7 +/- 15.6 months. Of these, 174 (77%) were men. The mean age was 55.8 +/- 15.5 years (range, 20-85 yr), and the mean left ventricular ejection fraction (LVEF) was 0.30 +/- 0.14. ⋯ Clinical variables with the most significant association with electrical storm were low LVEF (P = 0.04; hazard ratio of 0.261, and 95% confidence interval of 0.08-0.86) and higher use of class IA antiarrhythmic drugs (P = 0.018, hazard ratio of 3.84, and 95% confidence interval of 1.47-10.05). Amiodarone treatment and use of beta-blockers were not significant predictors when subjected to multivariate analysis. We conclude that electrical storm is most likely to occur in patients with lower LVEF and that the use of Class IA antiarrhythmic drugs is a risk factor.
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Acquired left ventricular-to-right atrial communication is encountered periodically. This condition is chiefly attributable to surgical mishaps, trauma, endocarditis, or endomyocardial biopsy. In a few instances, a Gerbode-like defect develops after the repair of an atrioventricular septal defect. ⋯ After surgical correction of the shunt and the associated mitral incompetence, the patient experienced a good outcome. Echocardiographic and intraoperative findings are presented, along with a plausible explanation for the mechanism and presentation of the condition in our patient. To our knowledge, this is only the 2nd report of an acquired shunt between the left atrium and the right ventricle, and the 1st such case to be accompanied by severe mitral valve incompetence.
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We describe the initial--and successful--use of the TandemHeart System's catheters to provide extracorporeal membrane oxygenation (ECMO), in 2 patients. In 1 patient, who was experiencing severe primary respiratory failure, the catheters provided a standard venovenous ECMO circuit. In the other patient, who had severe, acute pulmonary hypertension and right-heart failure, the catheters enabled a novel right atrial-to-left atrial circuit for ECMO. We discuss the potential of the TandemHeart System's catheters to provide novel and possibly superior vascular routes for the delivery of ECMO in different types of cardiopulmonary failure.
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Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, and their prevention is paramount. Herein, we review our experience with routine prophylactic use of the pedicled ipsilateral latissimus dorsi muscle flap. From January 2004 through February 2006, 10 surgically high-risk patients underwent intrathoracic transposition of this muscle flap for reinforcement of bronchial-stump closure or obliteration of empyema cavities. ⋯ Two patients retained peri-flap air that required no surgical intervention. We conclude that the use of transposed pedicled latissimus dorsi muscle flap effectively and reliably prevents clinically overt bronchopleural fistula and recurrent empyema. We advocate its routine use in first-time and selected reoperative thoracotomies in patients who are undergoing high-risk lung resection or reparative procedures.
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The incidence of arrhythmias after acute myocardial infarction of the inferior wall varies with the affected segment and increases when there is right ventricular involvement. This paper provides a clear review of the blood supply to the conduction system and gives an anatomic explanation of that supply. We dissected 20 human hearts after anterograde and retrograde injection of latex. ⋯ The incidence of arrhythmias after acute myocardial infarction of the inferior wall is greater when the occlusion of the coronary trunk is at or near the origin. This is due to the existence of the right superior descending artery, which is given off by the right coronary trunk less than 1 cm from the origin. The arrhythmias caused by the occlusion of the circumflex artery are due to the existence of Kugel's artery, which displays a peculiar anastomotic pattern.