Louis Salciccioli

Fatal left main coronary artery embolism from aortic valve endocarditis following cardiac catheterization

Coronary artery embolization has been associated with sudden cardiac death. It is more commonly seen with aortic valve endocarditis. It manifests as acute myocardial ischemia or infarction, causing instability of the cardiac rhythm, which may be fatal. We report a patient with aortic valve endocarditis who had sudden cardiac death following coronary angiography. Autopsy revealed embolic occlusion of the left main coronary artery. Cathet. Cardiovasc. Intervent. 50:74–77, 2000.

Risk Stratification for Recurrent Tachyarrhythmias in Patients with Paroxysmal Atrial Fibrillation and Flutter: Role of Signal Averaged Electrocardiogram and Echocardiography

The value of signal‐averaged P‐wave electrocardiogram and echocardiography for predicting recurrent atrial tachyarrhythmias was prospectively investigated in 60 patients presenting with paroxysmal atrial fibrillation or flutter. All patients were followed up for 1 year after restoration of sinus rhythm. A stepwise discriminant function analysis was used to identify variables predicting recurrent atrial tachyarrhythmias. Analyzed variables included signal‐averaged P‐wave duration in 3 bipolar orthogonal leads (X,Y,Z) and their vector magnitude, as well as left and right atrial dimensions and volumes. During follow‐up, 25 patients had recurrent atrial tachyarrhythmias, while 35 did not. Using discriminant function analysis, the left atrial antero‐superior dimension was found to be the only variable predicting the recurrence of atrial tachyarrhythmias (p<0.0038) and was able to correctly classify 65% of the study patients. It was concluded that, in patients with paroxysmal atrial fibrillation or flutter, the traditionally used determination of left atrial dimension was the variable most closely associated with a high risk for recurrent tachyarrhythmias. The signal‐averaged P‐wave duration did not improve tachyarrhythmia prediction.

Composite cardiac binding in experimental heart failure

BACKGROUND Composite cardiac binding consists of wrapping the heart with a synthetic membrane and a pericardial interposition. The goal of the present study was to apply composite cardiac binding to a canine model of heart failure. METHODS Twenty dogs were randomized to 2 groups: untreated heart failure (group 1, n = 13) and heart failure pretreated by composite cardiac binding (group 2, n = 7). They received a total dose of 1 mg x kg(-1) of intracoronary doxorubicin over 4 weeks. Hemodynamic data were obtained at weeks 0, 7, and 12. All animals were followed up with weekly echocardiography for 12 weeks. RESULTS Survival in group 1 was 54% and in group 2 was 100% at week 12 (p = 0.0438). Left ventricular end-diastolic pressure increased by 153% in group 1 and by 59% in group 2 (p = 0.0395) at week 12. Ejection fraction decreased by 27% in group 1 and by 19% in group 2 (p = 0.4401) at week 12. CONCLUSIONS Composite cardiac binding significantly prolongs survival and attenuates left ventricular dilatation and the increase in left ventricular end-diastolic pressure associated to chronic heart failure. Further evaluation in established heart failure is needed. Composite cardiac binding may be used for the prevention of recurrent dilatation following reduction ventriculoplasty.

An unusual case of bilateral coronary artery fistulas--a case report.

The authors report an unusual case with bilateral coronary artery fistulas at the origin of the coronary cusps. The diagnostic technique and management are discussed.