Surgical management of symptomatic coronary artery fistulae in the adult.

We describe the surgical management of adult symptomatic coronary artery fistulae. The technique is a fundamental approach entailing cardiopulmonary bypass and cardiac arrest with the goal of fully identifying the epicardial course of the coronary fistulae as well as that of the intrapulmonary artery ostial shunt. The more accurate the localization of these primary components of the fistulous tract, the more precise and successful is the ligation of the aberrant coronary connections. This result subsequently enhances the successful surgical obliteration of the symptomatic left-to-right shunt inherent in these congenital coronary fistulae that may not manifest symptoms until adulthood. With conventional cardiopulmonary bypass, myocardial protection and arrest, the main pulmonary artery is opened between the pulmonary valve and its bifurcation. Additional antegrade cardioplegia is administered, and the ostial connection of the coronary fistulae can be identified in the wall of the main pulmonary artery and internally ligated. After this, the epicardial course of the coronary fistulae can be identified and doubly ligated as close as possible to the native coronary from which they originate as well as their approximate external connection to the main pulmonary artery.

Techniques and best practices for optical coherence tomography: a practical manual for interventional cardiologists.

Optical coherence tomography (OCT) is a novel intracoronary imaging modality that utilizes near-infrared light to provide information regarding lesion length and severity, vessel lumen diameter, plaque morphology, as well as the opportunity for stent procedure guidance and follow-up. While analogous to intravascular ultrasound (IVUS), the specific imaging properties, including significantly higher resolution, and technical specifications of OCT offer the ability for intracoronary diagnostic and interventional procedure guidance roles that require a thorough understanding of the technology. We provide coronary interventionalist's a user's guide to OCT, focusing on techniques and approaches to optimize imaging, with a focus on efficiency, safety and strategies for effective imaging.

Lessons Learned from STEMI Clinical Trials.

Coronary artery disease is the leading cause of the death in the United States. From 2009 to 2010, however, the rate of heart disease causing death decreased by 2.5% in part due to evolving techniques used to treat and prevent heart disease. Management of acute ST-segment elevation myocardial infarction (STEMI) has evolved accordingly and the studies investigating treatment strategies that have led to an evidence-based approach are reviewed in this article.

Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function and diastolic heart failure.

PURPOSE OF REVIEW: Heart failure with preserved ejection fraction or diastolic heart failure is an increasingly prevalent disease process today. Natriuretic peptides have been shown to provide diagnostic and prognostic utility in patients with systolic heart failure. Here we review current publications exploring the relationship between B-natriuretic peptide (BNP) and diastolic dysfunction. RECENT FINDINGS: Investigators have found significant correlations between echocardiographic parameters for diastolic dysfunction and serum BNP levels in diagnosing diastolic heart failure. This relationship is linear with respect to severity of left ventricular dysfunction. Newer echocardiographic modalities like tissue Doppler imaging provide measures of elevated left ventricular filling pressures, which are associated with higher plasma BNP levels. Admission and predischarge BNP levels in patients with decompensated diastolic heart failure have been prognostic with respect to in-hospital mortality, short-term mortality, and hospital readmission. SUMMARY: Review of current literature shows that BNP can be useful in providing diagnostic and prognostic data in patients with symptomatic and asymptomatic diastolic dysfunction. These data, combined with other values such as echocardiographic indices and cardiovascular risk factors, can augment the sensitivity and specificity of BNP.