Incessant ventricular tachycardia complicating acute myocardial infarction: treatment by map-guided infarctectomy.

A 58-year-old man developed incessant ventricular tachycardia on the fourth and fifth days following acute anterior myocardial infarction. The tachycardia was resistant to antiarrhythmic drugs, cardioversion and pacing. Preoperative and intraoperative mapping suggested a subendocardial origin, and successful infarctectomy was performed on the fifth day of the infarction.

Extended aortic bypass.

At the University of Alberta Hospital, six patients recently underwent placement of Dacron bypass grafts from the ascending aorta to the infrarenal abdominal aorta or femoral arteries for a variety of vascular problems. The operations were performed in patients with (1) multiple aortic coarctations, (2) congenital aortic arch interruption and congenital mitral stenosis, (3) recoarctation of the thoracic aorta after previous coaractation repair (two patients), (4) aortoiliac occlusive disease in a patient with multiple previous abdominal operations including an abdominal-perineal resection and left lower quadrant colostomy, and (5) idiopathic retroperitoneal fibrosis and multiple previous operations on the abdominal aorta. Surgical access was through midline sternotomy and laparotomy incisions, and groin incisions were used as required. Careful attention was paid to placing as much graft as possible in an extraperitoneal position. All patients survived the operation and had essentially uneventful postoperative courses with good results. This technique has previously been described. However, attention is drawn to it once again as an excellent means of bypassing the thoracic and abdominal aorta in selected patients with complex vascular problems.

Surgical treatment of Ebstein's anomaly.

Neither the role of surgery in Ebstein's anaomaly nor the surgical procedure of choice for its correction are clearly defined. Whether or not the artrialized right ventricle, which plays a major role in the functional abnormalities, should be obliterated in all cases remains unresolved. Of the 26 patients with Ebstein's anomaly seen at the University Hospital between 1953 and 1975, four were treated surgically at this center. All had closure of the atrial septal defect, reconstruction of a tricuspid annulus in the normal position, and insertion of a tricuspid prosthesis and an epicardial ventricular pacemaker. The two patients who also had the atrialized chamber obliterated improved dramatically. Thus, obliteration of the atrialized right ventricle appears to be associated with a better operative result.

False left ventricular aneurysm as a complication of open heart surgery.

A false aneurysm developed at the site of left ventricular venting in an 8-year-old boy who had undergone aortic valve commissurotomy under cardiopulmonary bypass. The diagnosis was made by clinical examination and chest radiography and confirmed by left ventricular cineangiography. The aneurysm was successfully resected.

An unusual case of recurrent left atrial myxoma.

In a patient who had a calcified left atrial myxoma resected, recurrence developed 31 months later. Although complete radical resection of the recurrent tumour presented a special problem, the patient survived the second operation. The tumour recurred again and the patient had two episodes of cerebral embolism 1 1/2 and 2 years later, respectively, and died 3 1/2 years after the second operation. The erythrocyte sedimentation rate correlated with the size of the tumor, and the recurrent tumour seemed to grow more rapidly than the primary tumour. Experience with this case and a review of the nine reported cases of recurrent left atrial myxoma suggest that a radical approach is necessary at the primary operation.