[Primary chylopericardium: a case report].

A case of primary chylopericardium in a 54 year-old-man was reported. Despite 3 times of pericardiocentesis, the pericardial fluid accumulated rapidly. After the fenestration of pericardium, a small cannula was inserted for the thoracic ductgram which showed a clearly visible duct upward to the angulus venosus and an abnormal branch near the bifurcation of the trachea spilling some contrast material into the pericardial cavity. Ligation and division of the thoracic duct including an abnormal branch was performed from its entry to the thorax for a length of 13 cm upward. The postoperative course was uneventful and chest X-ray film taken 6 months after surgery showed no accumulation of chyle in the pericardium and pleural cavity.

[The surgical treatment of endomyocardial fibrosis of the left ventricle--the first surgical case report in Japan].

A 66-year-old man with an ECG finding of an elevation of R in leads V5-6 and a calcified space occupying lesion in the apex of the left ventricle on echocardiography admitted for the evaluation of recent onset of shortness of breath and palpitation on exertion. Cineangiography showed an obliteration and accumulation of RI activity in the apex of the left ventricle on TI-201 scintigraphy and a neoplasm of the heart was suspected. Resection of a tumor from apical incision followed by the left atrial approach necessitated the replacement of mitral valve and confirmed the diagnosis of endomyocardial fibrosis. Heart failure persisted and the expired 2 years after surgery due to the gastrointestinal infection. An experience suggested the resection of a mass from the left atrial approach is possible and recommended to prevent the occurrence and persistence of heart failure in case the diagnosis is established preoperatively.

Acute and chronic stability of atrial screw-in leads.

The purpose of this study was to evaluate the acute and chronic stability of the atrial screw-in lead. In this study, we used CPI model 4165, 4166, and 4266 porous tip screw-in leads in 32 patients (12 for AAI pacing and 20 for DDD pacing). All of these leads were fixed to the free wall of the right atrium and used as the unipolar type. Acute voltage and current thresholds, lead impedance, P-wave amplitude, and chronic threshold were measured. Early and late complications were also investigated. The average acute stimulation thresholds at 0.6 msec pulse width were 0.82 +/- 0.43 V and 1.1 +/- 0.6 mA. Mean lead impedance was 627.2 +/- 83.1 ohms, and mean P wave amplitude was 3.1 +/- 1.1 mV. After an average follow-up period of 32 months (range: 2-72 months), we found the results of the chronic threshold study to be satisfactory. The thresholds were usually below 0.1 msec pulse width with the nominally programmed pacemaker output. Only one patient required a higher output due to an increased threshold. With regard to complications, neither lead dislodgment nor cardiac perforation was observed. In conclusion, acute and chronic thresholds were satisfactory and no serious complications occurred. Therefore the atrial screw-in lead has long-term reliability and stability.