Patency of vein graft anastomoses facilitated with the hexalon device.

PURPOSE: The Hexalon system (Castlewood Surgical, Inc, Dallas, TX) is a new device that facilitates a clampless, hand-sutured, vein-to-aorta anastomoses in no-touch off-pump coronary artery bypass surgery. Hexalon-facilitated anastomoses are structurally equivalent to traditional sutured anastomoses, but can be placed during off-pump coronary artery bypass surgery. It follows that these facilitated anastomoses would show similar patency rates to traditional sutured anastomoses. This is the first published data validating mid-term patency of Hexalon-facilitated anastomoses. DESCRIPTION: Evaluation of bypass grafts by cardiac computed tomography angiography is highly accurate and has increasingly been used to assess graft patency in anastomotic device feasibility trials. We studied 15 proximal Hexalon-facilitated anastomoses for patency in 10 patients at least 6 months after off-pump coronary bypass surgery using gated cardiac computed tomography angiography. EVALUATION: All 15 facilitated anastomoses were patent. All 10 CT studies were of sufficient quality for accurate interpretation. CONCLUSIONS: The Hexalon system is a new and potentially valuable tool in advancing off-pump coronary artery bypass surgery.

Causes and management of drug-induced long QT syndrome.

Long QT syndrome (LQTS) is characterized by inherited or acquired prolonged QT interval on the surface electrocardiogram. This can lead to torsade de pointes ventricular tachycardia (TdP VT) and ventricular fibrillation. In the acquired form of the disease, medications from several classes can cause TdP VT or potentiate the electrocardiographic findings. These include class IA and III antiarrhythmics, antibiotics (macrolides and quinolones), antidepressants (tricyclics and selective serotonin reuptake inhibitors), antipsychotics (haloperidol and phenothiazines), and antiemetics (ondansetron and prochlorperazine). We present four cases of drug-induced LQTS resulting in life-threatening cardiac arrhythmias. Antiarrhythmic medications were the cause in two cases, and the other two cases involved noncardiac medications. All four patients had at least one risk factor for LQTS in addition to the offending drug, including female gender, hypokalemia, hypomagnesemia, and bradycardia. In one patient, amiodarone was administered for treatment of VT, although the correct diagnosis was actually TdP VT. In patients with polymorphic VT or ventricular fibrillation without a significant history of cardiovascular disease, drug-induced LQTS should be high in the differential diagnosis. Prompt diagnosis is key, as amiodarone, while often used to suppress VT, is potentially harmful in the setting of LQTS and TdP VT.

Congenital pulmonic stenosis in a 77-year-old woman successfully treated with percutaneous balloon valvuloplasty.

Congenital pulmonic stenosis (PS) rarely presents in patients over the age of 55 years. A stable asymptomatic course into late adulthood is the usual history of mild to moderate PS. Balloon valvuloplasty has become the procedure of choice for congenital PS, especially in children and young adults. There are rare reports of its use in older adults. Significant valve calcium is believed to limit its success. We present a case of a 77-year-old woman with symptomatic congenital PS and severe valve calcium who underwent successful balloon valvuloplasty.