Outcomes of sympathectomy and vascular bypass for digital ischaemia in connective tissue disorders.

All patients (36 hands) with connective tissue disorders who underwent periarterial sympathectomy of the hand alone or in conjunction with vascular bypass at our institution between 1995-2013 were reviewed. The durable resolution of ulcers was significantly higher in patients treated by periarterial sympathectomy and bypass than in patients treated by periarterial sympathectomy alone. Although there were more digital amputations in patients treated by periarterial sympathectomy alone, the difference was not statistically significant. Vascular bypass in conjunction with sympathectomy may be better than sympathectomy alone in patients with digital ischaemia related to connective tissue disorders. LEVEL OF EVIDENCE: IV.

Spontaneous left anterior descending artery to right ventricular fistula.

We report a very unusual case of a spontaneously acquired left anterior descending to right ventricular fistula. We believe that this spontaneous occurrence was the result of hemodynamic changes that occurred between the first and second catheterizations.

Single left coronary artery with origin of the right coronary artery from distal circumflex.

We report two very unusual cases of agenesis of the right coronary ostium with continuation of the left circumflex artery as the right coronary artery. The recognition of the anomaly in the first case lead to a better understanding of this finding in the second case, which translated into shorter procedure time, less contrast volume, and fewer catheter manipulations.

High-grade atrioventricular block during dipyridamole stress testing.

Dipyridamole stress testing may be used in the diagnosis of coronary artery disease and risk assessment of patients who are unable to exercise. Although dipyridamole perfusion imaging has a good safety record, serious side-effects may rarely occur. We present a case in which dipyridamole induced high-grade atrioventricular (AV) block that responded promptly to intravenous aminophylline but not to atropine.

Successful treatment of myocardial sarcoidosis with steroids.

Myocardial involvement in sarcoidosis occurs in approximately twenty-seven percent of patients and may result in a grim prognosis. The diagnosis is mainly clinical and may be supplemented by echocardiography, thallium imaging, Gallium-67 scanning, and myocardial biopsy. The value of corticosteroid treatment is still not well-established and few patients have benefitted from cardiac transplantation. We present a case with suspected myocardial sarcoidosis and congestive heart failure who had dramatic response to steroid therapy on five weeks' followup.

Deep venous thrombosis and pulmonary embolism following cardiac catheterization.

We report 4 cases of deep venous thrombosis and/or pulmonary embolism after diagnostic cardiac catheterization. Two of these cases followed left heart catheterization alone.

Sarcoidosis of the heart.

Myocardial involvement in sarcoidosis occurs in about 27% of patients. Clinical manifestations include ventricular arrhythmias, conduction abnormalities, and sudden death. Diagnosis requires clinical suspicion and may be supported by electrocardiography, echocardiography, thallium imaging, gallium-67 scanning, and myocardial biopsy. Steroids seem to be beneficial in the treatment of myocardial sarcoidosis. Those who do not respond to medical treatment may benefit from cardiac transplantation.