Left circumflex coronary artery occlusion after mitral valve annuloplasty: "a stitch in time".

The left circumflex coronary artery is susceptible to injury during mitral valve surgery because of its proximity to the mitral valve annulus. We report the case of a 73-year-old woman who had undergone mitral valve repair and experienced a perioperative myocardial infarction due to occlusion of the left circumflex coronary artery. After percutaneous coronary intervention, a fistulous communication had developed between the stented portion of the left circumflex coronary artery and the left atrium, which, to our knowledge, is the first report of such a complication. The patient underwent successful mitral valve replacement. Although injuries to the left circumflex coronary artery are rare during mitral valve surgery, we believe that increasing awareness of the risk will help to prevent potentially fatal complications. We also recommend that surgeons gather as much detail as possible about the patient's anatomy before operation, use careful and meticulous surgical techniques, and use transesophageal echocardiography to look for wall-motion abnormalities before closing the incision.

No evidence of increased prevalence of premature coronary artery disease in New York City police officers as predicted by coronary artery calcium scoring.

OBJECTIVES: To investigate the prevalence of coronary artery disease (CAD) in active New York City police officers as detected by coronary artery calcium (CAC) scoring. METHODS: We assessed 2064 New York City police officers who underwent electron beam computed tomography for quantification of CAC. RESULTS: The mean age of study subjects was 42 +/- 6 years. A CAC score of 0 was present in 74% of men and 80% of women. A subset of 75 officers with known early exposure to World Trade Center dust were evaluated separately. CONCLUSION: New York City police officers do not have an increased prevalence of CAD compared with the general population as assessed with CAC scoring. At 5 years, exposure to World Trade Center dust does not appear to increase the risk of premature CAD.

Differences in diagnostic evaluation and clinical outcomes in the care of patients with chest pain based on admitting service: the benefits of a dedicated chest pain unit.

BACKGROUND: Chest pain is one of the most common complaints of patients presenting at emergency departments. However, the most appropriate diagnostic evaluation for patients with chest pain but without acute coronary syndrome remains controversial, and differs greatly among institutions and physicians. At our institution, patients with chest pain can be admitted to an internist-run hospitalist service, a private attending service, or a cardiologist-run Chest Pain Unit. The goal of the present study was to compare the management and outcomes of patients admitted with chest pain based on admitting service. METHODS: The charts of 750 patients (250 consecutive patients per service) with a discharge diagnosis of chest pain were studied retrospectively. RESULTS: Patients admitted to the Chest Pain Unit were younger and had a lower prevalence of known coronary artery disease, hypertension, or diabetes, but a similar prevalence of other risk factors compared with the other groups. Sixty percent of the patients in the Chest Pain Unit underwent stress myocardial perfusion imaging as their primary diagnostic modality (vs 22% and 12% of patients in the hospitalist and private services, respectively; P < .001). In contrast, 35% of the patients admitted to the hospitalist service underwent rest echocardiography (vs 8% and 17% of patients in the Chest Pain Unit and private services, respectively; P < .001). Finally, 47% of the patients in the private service underwent coronary angiography as their primary diagnostic modality (vs 6% and 10% of patients in the Chest Pain Unit and hospitalist services, respectively; P < .001). The length of stay was shortest for patients in the Chest Pain Unit (1.4 +/- 1.2 days vs 3.9 +/- 3.4 days and 3.5 +/- 3.6 days in the hospitalist and private services, respectively; P < .001), even when corrected for patient age and number of risk factors. Readmission within 6 months was lowest for patients in the Chest Pain Unit (4.4% vs 17.6% and 15.2% in the hospitalist and private services, respectively; P < .001). CONCLUSIONS: The results of this study demonstrate that a highly protocolized chest pain unit, using myocardial perfusion imaging as primary diagnostic modality, results in a decreased length of stay and readmission rate.

Characteristics of female patients with sexual dysfunction who also had a history of blunt perineal trauma.

Perineal trauma can occur in both genders, however, data supporting the relationship between sexual dysfunction and blunt perineal trauma in women is lacking. This study reviewed the patient characteristics of women with sexual dysfunction who also had a history of blunt perineal trauma. A neurogenic form of sexual dysfunction has been implicated, with primary complaints of orgasm disorder and abnormalities noted on genital sensory testing. Further research in this area is needed.