An uncommon cause of myocardial ischemia after coronary artery bypass grafting: "the dangerous drainage".

The most common causes of myocardial ischemia and myocardial infarction early after coronary artery bypass grafting surgery are early graft occlusion/thrombosis or occlusion/ thrombosis of coronary arteries due to advanced coronary heart disease. We describe a case of postoperative myocardial ischemia due to an uncommon and quickly reversible cause: mechanical compression of a vein graft by a 19F flexible silicone mediastinal drainage tube.

Bizarre case of migration of a retained epicardial pacing wire.

A 71-year-old woman, who had undergone mitral valve replacement procedure 2 years previously, presented with aortic and mitral prosthetic valve endocarditis. Preoperative examination demonstrated a wire-like structure coursing from the aortic bulb to the right carotid artery. The wire-like structure was removed during the mitral and aortic valve reoperation, and identified as an epicardial pacing wire, which was placed during the patients' first mitral valve operation. We suspect that the contaminated pacing wire migrated via the left atrium and left ventricle into the right carotid artery causing an infective endocarditis of the prosthetic mitral valve and the native aortic valve.

Evidence of left ventricular dyssynchrony resulting from right ventricular pacing in patients with severely depressed left ventricular ejection fraction.

AIMS: Cardiac resynchronization therapy (CRT) has recently emerged as an effective treatment for patients with moderate-to-severe systolic heart failure and left bundle branch block (LBBB). Right ventricular pacing (RVP) leads to an LBBB-like pattern in the electrocardiogram. The aim of this study was to evaluate the frequency of ventricular mechanical dyssynchrony in patients induced by RVP. METHODS AND RESULTS: The study included 33 patients with a conventional single or dual chamber pacemaker, 18 with ejection fraction (EF) > 35% and 15 with EF < or = 35%. In all patients, an intrinsic rhythm without intraventricular conduction delay (QRS < or = 120 ms) was present without RVP. Two-dimensional and Doppler echocardiographic criteria for mechanical dyssynchrony [aortic pre-ejection delay (APE), interventricular mechanical delay (IVMD), delayed activation of the posterior left ventricular wall (PD), septal-to-posterior wall motion delay (SPWMD)] were evaluated in all patients with and without RVP. QRS duration showed no difference between the two EF-groups without RVP (93 +/- 10 vs. 96 +/- 9 ms), but was significantly longer in patients with low EF with RVP (152 +/- 18 vs. 181 +/- 18 ms; P < 0.001). In patients with EF > 35%, only APE was slightly prolonged by RVP (111 +/- 20 vs. 129 +/- 17 ms; P = 0.03), whereas in patients with EF < or = 35% marked pathological differences in APE (118 +/- 29 vs. 169 +/- 24 ms; P < 0.001), IVMD (22 +/- 17 vs. 58 +/- 14 ms; P < 0.001), SPWMD (103 +/- 28 vs. 125 +/- 29 ms; P = 0.004), and PD (-21 +/- 25 vs. - 39 +/- 25 ms; P = 0.005) were found. A significant correlation between QRS duration and mechanical ventricular dyssynchrony was only found for two echocardiographic parameters (IVMD, APE) with RVP. CONCLUSION: In patients with a conventional pacemaker, mechanical dyssynchrony with RVP was shown exceptionally in patients with preserved or moderately depressed systolic left ventricular (LV) function, but in nearly all patients with severely depressed systolic LV function. These patients might benefit from CRT when frequent RVP is required.