Prognosis of patients with frequent premature ventricular complexes and nonsustained ventricular tachycardia after coronary artery bypass graft surgery.

BACKGROUND: Previous studies in small groups of predominantly nongeriatric patients showed that complex ventricular arrhythmias occurring after coronary artery graft (CABG) surgery are of no prognostic significance. The purpose of this study was to compare the prognosis of patients with and without advanced grade ventricular arrhythmias (AGVA) after CABG in a large group of patients. [In this paper, AGVA is used as an abridged definition of frequent premature ventricular complexes (PVCs) and nonsustained ventricular tachycardia (NSVT) which represent advanced grade ventricular arrhythmias.] METHODS: Twenty-four hour ambulatory electrocardiographic (ECG) monitoring was performed 3 days after CABG in 185 consecutive patients with 185 closely matched control patients without AGVA. Of 185 patients with AGVA, 77 had frequent PVCs, 45 had NSVT, and 63 patients had both. The average age of both groups was 65 +/ 9.7 years. Patients were followed for 34 +/ 10 months, and in 30 patients ambulatory monitoring was repeated at the end of the follow-up. RESULTS: Fifteen AGVA and nine control patients died. In each group seven deaths were noncardiac. Six nonsudden and two sudden cardiac deaths (SCD) occurred in the AGVA group at 2-36 months after CABG and two nonsudden cardiac deaths in the control group at 3 and 35 months after CABG (p = 0.053). Both SCDs occurred 33 months after CABG after new events known to predispose to SCD. In 18 of 30 patients AGVA was no longer present when ambulatory ECG monitoring was repeated 36 +/ 11 months after CABG. CONCLUSION: AGVA after CABG was not a marker of an early sudden cardiac death. In 60% of patients not treated with antiarrhythmic drugs, AGVA was no longer present late after operation.

Cardiac myxoma: the Indiana Heart Institute experience.

Surgical resection of a cardiac myxoma was performed in 14 patients at the Indiana Heart Institute at St. Vincent Hospital and Health Care Center in Indianapolis from 1974 to 1989. Thirteen were located in the left atrium and one in the right atrium. The 10 women and four men ranged in ages from 28 to 75 years. Surgical complications included one perioperative death, one late death and one late recurrence requiring reoperation. Physicians must be highly suspicious to correctly diagnose this unusual but surgically correctable entity. Two-dimensional echocardiography is the diagnostic technique of choice for both early diagnosis of a cardiac myxoma and late follow-up after resection.

Cardiac rupture following acute myocardial infarction: a case with successful surgical treatment.

This report involves a patient who sustained an acute lateral wall myocardial infarction complicated by cardiogenic shock. Cardiac catheterization revealed diastolic equilibration of all intracardiac pressures. Cardiac angiography revealed only acute occlusion of a small branch of the left circumflex coronary artery with good left ventricular systolic function. Since these findings could not explain the degree of cardiogenic shock, an immediate echocardiogram revealed a moderate pericardial effusion with an echo-dense mass suggestive of subacute cardiac rupture. Emergency cardiac surgery confirmed the diagnosis and successful surgical correction resulted in survival of the patient.

Percutaneous transluminal coronary angioplasty: update 1988.

This report updates the current indications, techniques and investigational devices used in a busy interventional cardiology practice. Specific attention is devoted toward the problem areas of thrombolytic treatment of acute myocardial infarction, restenosis after angioplasty and the use of angioplasty in the treatment of multivessel coronary artery disease.

Pulmonary venous dilatation in pulmonary veno-occlusive disease.

A case of pulmonary veno-occlusive disease in an adult is presented. The diagnosis was suspected clinically and verified at cardiac catheterization. Balloon dilatation of the pulmonary veins was attempted at operation and later again in the catheterization laboratory. The result was a significant reduction in pulmonary venous to left atrial pressure gradient and angiographic evidence of increase in venous diameter. It appears that in the focal form of pulmonary venous occlusion, balloon dilatation may offer a therapeutic approach in an otherwise progressively lethal disease.