A case of ventricular tachycardia refractory to medical treatment related to a cystic mass in left ventricle--a case report.

This is a case report of a twenty-two-year-old woman who had attacks of ventricular tachycardia that could be prevented by the use of various antiarrhythmic drugs for three months. Electrophysiologic study showed that the mechanism of the tachycardia was "reentry." In cardiac catheterization a non-contractile mass having calcification was seen on the apical portion of the left ventricle. Angiographically, the mass resembled a diverticulum. Recurrence of attacks was terminated by resection of this mass, which had a cystic appearance.

Treatment of cardiac tamponade due to isolated chylopericardium following open heart surgery.

Cardiac tamponade due to chylous fluid following open heart surgery in a 41-year-old man, is presented. To our knowledge, this is the fourth reported case in the English literature. Treatment included aspiration of the chylous fluid through a subxiphoid incision and creation of a fistula between the pericardium and peritoneum to prevent the loss of chylous fluid.

The anatomic evolution of coronary artery disease demonstrated by coronary arteriography in 256 nonoperated patients.

Coronary arteriography was performed twice in 256 nonoperated patients, including 92 surgical candidates who were recatheterized because of the long wait for surgery. Criteria to define progression and regression were established in advance. Analysis of separate segments, reflecting separate lesions, revealed that progression percentages increased proportionally with the degree of initial narrowing and the interval between catherizations, ranging from 1.2% to more than 20%. The highest progression percentages were shown by the proximal right coronary artery, the left anterior descending artery distal to the first septal and first diagonal branches, and the obtuse marginal branch of the circumflex artery. In 56.3% of the patients, progression was found in at least one segment, ranging from 40% in patients who were recatheterized within 1 year to 92% in patients who were recatheterized after 5 years or longer (p less than 0.025). In 12 patients (4.7%), regression had occurred; in two cases obstructions had reverted to less than 50% narrowing. Regression was associated with progression in other branches in three cases. Indications for recatheterization did not correlate significantly with progression, but a higher progression percentage was found in patients who had sustained a myocardial infarction during follow-up than in those who had not (p less than 0.05). Comparison of potential surgical procedures based on the first and second angiogram revealed that at the second catheterization more distal anastomoses were required to achieve complete revascularization in 29.3% of the patients and that left ventricular contractions had deteriorated markedly in 15.6%. These fractions correlated with the duration of the interval between catheterizations.