Iatrogenic left main coronary artery dissection.

We present a case of iatrogenic left main coronary artery dissection, successfully treated by prompt bail-out stenting, and provide a brief discussion on its occurrence and treatment, as well as the immediate and long-term outcome of percutaneous coronary intervention, including our own single-centre experience, for this potentially catastrophic complication.

Aneurysms and pseudoaneurysms of coronary arteries and saphenous vein coronary artery bypass grafts: a case report and literature review.

Aneurysms or pseudoaneurysms of the native coronary arteries or bypass grafts are uncommon and represent a pathology with high morbidity and mortality. We report the diagnosis of an aneurysm of a saphenous vein coronary artery bypass graft with an atypical presentation and review incidence, modes of presentation, aetiology and proposed mechanisms of formation of this and similar entities. Complications, diagnostic clues and therapeutic options are also discussed.

Changes in intrathoracic pressures induced by positive end-expiratory pressure ventilation after cardiac surgical procedures.

The consequences of controlled ventilation with positive end-expiratory pressure (PEEP) were studied, after cardiac surgical procedures, in two groups of patients supposed to have different lung and chest wall mechanical properties. The first group included 6 patients who had undergone coronary artery graft surgical procedures (CGS). The second group included 5 patients who had undergone a mitral valve replacement (MVR). Postoperatively, static lung and chest wall compliance was measured by stepwise inflation and deflation of the thorax. Esophageal, pericardial, and pleural pressures were then measured, and cardiac output was determined while PEEP was increased from 0 to 20 cm H2O. Lung and chest wall compliance values sharply decreased in MVR patients. This accounts for the lower values for pleural and pericardial pressures in this group than in the CGS patient group, but the transmission of airway pressure was identical in the two groups when PEEP was increased. The decrease in cardiac output induced by PEEP was similar in the two groups. The results suggest that the opposing influences of lung and chest wall compliance on airway pressure transmission could at least partly explain the hemodynamic effects of PEEP in patients in whom the mechanical properties of the lung and thorax are impaired. PEEP ventilation should be used cautiously in patients suspected of having thoracic rigidity.