Giant cardiac fibroma.

A 29-year-old woman who presented with persistent ventricular premature beat during her delivery was referred to us. Her cardiac echocardiography showed a giant tumor located in the posterior wall of the left ventricle. She had no symptoms of heart failure. Partial resection of the mass was safely conducted using cardiopulmonary bypass. The histopathologic finding was fibroma. She has been doing well 6 years after operation. Periodic echocardiography has showed no growth in this tumor.

Impact of diabetic retinopathy on cardiac outcome after coronary artery bypass graft surgery: prospective observational study.

BACKGROUND: Diabetic retinopathy is a manifestation of more severe diabetes. We sought to assess the impact of diabetic retinopathy on cardiac outcome of coronary artery bypass graft surgery (CABG). METHODS: We prospectively assessed the status of the retina of 74 consecutive diabetics who were referred for first-time CABG, and compared cardiac outcome of CABG in diabetics with retinopathy with that in those without retinopathy. Cardiac events included recurrent angina or congestive heart failure that needed admission to hospital, myocardial infarction, repeat revascularization, and cardiac death. RESULTS: Twenty-six diabetics had retinopathy and 48 diabetics did not have retinopathy. Diabetics with retinopathy were likely to have higher hemoglobin A1c level (p = 0.048), and receive insulin treatment (p = 0.0065). In the 12 months of follow-up, 13 cardiac events occurred in diabetics with retinopathy and 7 in those without retinopathy (p = 0.0021). Among diabetics with retinopathy, heart failure or death due to heart failure accounted for 54% (7 of 13) of these cardiac events. Kaplan-Meier analysis showed significant difference in cardiac event-free survival between the two groups (p < 0.001). After adjustment for differences in patients' characteristics, diabetic retinopathy remained a predictor of cardiac event (adjusted relative risk = 4.2, 95% confidence interval, 1.5% to 11.9%; p = 0.0067). CONCLUSIONS: After CABG, diabetics with retinopathy have a substantially increased risk of cardiac events, especially of congestive heart failure.

Usefulness of unipolar epicardial ventricular electrogram for triggering of intraaortic balloon counterpulsation during off-pump coronary artery bypass surgery in patients with hemodynamic instability complicating acute coronary syndromes.

During off-pump coronary artery bypass graft (CABG) surgery for patients requiring preoperative intraaortic balloon counterpulsation (IABP) support, errors in timing of IABP during mobilization of the heart can induce unstable hemodynamic conditions. We applied a simple technique for triggering IABP accurately during off-pump CABG: one end of an epicardial pacemaker wire is placed on the surface of the left ventricle, and the other end is linked to one of the precordial V leads. This technique provided an exact detection of R-wave potentials in any position of the heart during the off-pump CABG procedure. Ten patients with hemodynamic instability complicating acute coronary syndromes underwent off-pump CABG with this technique, including grafting to the circumflex system, safely and successfully.

A simple method of triggering balloon counterpulsation accurately during off-pump coronary artery bypass surgery.

With increasing experience, off-pump coronary artery bypass grafting for high-risk patients can be performed safely. However, in patients who need intraaortic balloon counterpulsation support, mistriggering of intraaortic balloon counterpulsation during mobilization of the heart can induce unstable hemodynamic conditions. My colleagues and I have developed a simple method of detecting the trigger signal accurately: an epicardial pacemaker wire is placed close to the apex of the left ventricle, and 1 precordial V lead is disconnected and then linked to the epicardial pacemaker wire. This method provides an excellent detection of R-wave potentials in any position of the heart throughout an entire off-pump coronary artery bypass grafting procedure.

Internal mammary revascularization in patients with variant angina and normal coronary arteries.

Patients with variant angina refractory to medical therapy pose a difficult management problem. In patients with discrete obstructive lesions, coronary revascularization may be helpful. However, it has been widely accepted that coronary revascularization is contraindicated in patients with isolated coronary spasm without evidence of obstructive disease. Here we describe the two patients with life-threatening, medically intractable Prinzmetal's angina and angiographically normal coronary arteries, both of whom underwent coronary-artery-bypass surgery with the internal-mammary-artery (IMA) graft. These operations resulted in rapid, complete remission of coronary spastic attacks in both patients. Postoperative angiography reveals how the IMA graft works during spastic attacks.

[A technique for off-pump ablation of atrial fibrillation on beating heart using the epicardial radiofrequency approach].

Recently ablation surgery for atrial fibrillation, so-called maze procedure, has become popular. However, this procedure usually needs cardiopulmonary bypass. Here we describe 3 patients for whom the simple, new procedure in which epicardial radiofrequency ablation is sucessfully done without cardiopulmonary bypass prior to concomitant cardiac operation. Our modified maze procedure consists of isolation of pulmonary veins using the FLEX 7 radiofrequency ablation device (COBRA). Following the surgery, all patients quickly attained regular sinus rhythm. We believe our procedure would be especially useful for patients for whom concomitant cardiac procedure can be done on beating heart.