Ventricular tachycardia with congenital ventricular diverticulum.

A 24-year-old man presented with symptomatic, recurrent, sustained ventricular tachycardia (VT). He was found to have a basal inferior left ventricular diverticulum. His sustained VT was reproduced by programmed electrical stimulation and was unresponsive to procainamide, tocainide, propafenone, and flecainide. Endocardial mapping followed by resection and cryoablative surgery was performed. The patient had only one recurrence after 18 months, with subsequent control with procainamide for over 14 months.

Transesophageal echocardiography (TEE): its diagnostic value in endocarditis.

Transthoracic two-dimensional echocardiography (TTE) has been an accepted noninvasive procedure used to diagnose infective endocarditis by demonstrating the presence of vegetations and other complications such as ring abcess, mycotic lesions or sinus of valsalva aneurysm. Moreover, complementary Doppler and Color Flow imaging are very useful in detecting early valvular regurgitation and in evaluating the severity of such regurgitant lesions. Occasionally, TTE fails to provide an adequate quality of imaging because of the patient's obesity, chest deformity or emphysema. Transesophageal echocardiography (TEE) on the other hand, a relatively new technique, allows ultrasonic imaging of the heart through the esophagus and provides a clear visualization of all cardiac structures without any interference from the lungs, chest wall or rib cage. We present a case of aortic valve endocarditis diagnosed by TEE.

Outcome following open-heart surgery in an Oriental octagenarian population in Hawaii.

Increasingly, a surgical approach is being utilized for the management of elderly patients with ischemic or valvular heart disease. In order to further understand the outcome in this population, we performed a retrospective review of octagenarians undergoing open-heart surgery over a 2-year period. Thirteen patients were identified, with a mean age of 82.6 years. All were Oriental. Most of our patients were considered high risk, 10 of them requiring emergency surgery and 6 requiring preoperative intra-aortic balloon counterpulsation (IABP). Postoperatively, 11 of the 13 patients suffered at least 1 complication. The most frequent complications were atrial arrythmias (7 patients), a low cardiac output (5 patients), the need for prolonged ventilation (3 patients) and ventricular arrythmias (3 patients). Functionally, the patients statistically improved, from a mean preoperative classification of 3.8 (New York Heart Association Classification) (NYHA) to 1.5 at the time of discharge (p less than 0.001). All patients are still alive at the time of writing (October 1989) with a mean followup of 13.3 months. Our data show that an operative approach to heart disease can be done safely in a high risk octagenarian population. In addition, we found that a statistically significant functional improvement occurred in these patients.

Surgical resection of giant metastatic leiomyosarcoma of the heart.

A 44-year-old woman underwent a hysterectomy for leiomyosarcoma in 1969. Cardiac invasion was detected in 1981 but the tumor was considered inoperable. In 1985, 16 years after hysterectomy, malignant tamponade developed as a result of a massive tumor arising from the left ventricle. Emergency decompression by median sternotomy and tube thoracostomy was followed a week later by tumor resection and simultaneous excision of a lung metastasis with the aid of cardiopulmonary bypass. The cardiac tumor weighed 719 gm. A residual pelvic tumor found on a computed tomographic scan was subsequently removed. She is alive and well 22 months after the operation. Aggressive surgical resection of cardiac and other metastases of this slowly growing tumor can be lifesaving.

Controlled clinical evaluation of a 10% strontium chloride dentifrice in treatment of dentin hypersensitivity following periodontal surgery.

Sixty adult patients were examined for dentin hypersensitivity prior to periodontal surgery. Stimuli used included mechanical, cold water and compressed air blasts. A subjective assessment of the degree of hypersensitivity for each stimulus was recorded. This presurgical examination revealed 249 hypersensitive areas among 60 subjects. Following surgery there was over a 100% increase in the pain (hypersensitivity) score. Desensitization with a 10% strontium chloride hexahydrate dentifrice was begun 1 week after surgical treatment. After 7 weeks of dentifrice use the pain score was reduced 75.5% in the test group. This was a reduction to a point below the preoperative level. The placebo group showed a reduction of 34.2% which was still above the preoperative level. These results agree with other clinical studies that have demonstrated a desensitizing effect of strontium chloride.