Michael H. Hall

Effects of morbid obesity and diabetes mellitus on risk of coronary artery bypass grafting

Abstract Obesity has been identified as an independent risk factor for cardiovascular disease 1–4 and the occurrence of complications of coronary artery bypass grafting (CABG). 5,6 A study was designed to determine if the risks associated with morbid obesity should alter the indications for CABG, the operative strategy or the postoperative care.

Aortic dissection: Rupture into right ventricle and right pulmonary artery

Rupture of an acute ascending aortic dissection into a surrounding cardiac chamber or pulmonary artery is an uncommon occurrence, and is often only diagnoses post mortem. Although fistulization (aortopulmonary and aorta-right atrial) after acute aortic dissection has been well documented in the literature, acute aortic dissection fistulizing into both the right ventricle and pulmonary artery has not. We report on a 75-year-old woman who presented with an acute ascending aortic dissection with both aortopulmonary and aorta-right ventricular fistulas who underwent repair and had long-term survival.

Multiple Fibroelastomas: A Case Report and Review of the Literature

Cardiac papillary fibroelastoma is a rare primary cardiac tumor that usually involves the heart valves. Multiple fibroelastomas found in a single patient is an even more rare occurrence. We describe the case of a 41-year-old woman who presented with an acute cerebrovascular accident, and was found to have 4 separate fibroelastoma tumors involving the aortic and mitral valves. The role of echocardiography in the diagnosis of this unusual tumor and its therapy is discussed.

Acute surgical pulmonary embolectomy: a 9-year retrospective analysis.

Acute pulmonary embolism is a substantial cause of morbidity and death. Although the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines recommend surgical pulmonary embolectomy in patients with acute pulmonary embolism associated with hypotension, there are few reports of 30-day mortality rates. We performed a retrospective review of acute pulmonary embolectomy procedures performed in 96 consecutive patients who had severe, globally hypokinetic right ventricular dysfunction as determined by transthoracic echocardiography. Data on patients who were treated from January 2003 through December 2011 were derived from health system databases of the New York State Cardiac Surgery Reporting System and the Society of Thoracic Surgeons. The data represent procedures performed at 3 tertiary care facilities within a large health system operating in the New York City metropolitan area. The overall 30-day mortality rate was 4.2%. Most patients (68 [73.9%]) were discharged home or to rehabilitation facilities (23 [25%]). Hemodynamically stable patients with severe, globally hypokinetic right ventricular dysfunction had a 30-day mortality rate of 1.4%, with a postoperative mean length of stay of 9.1 days. Comparable findings for hemodynamically unstable patients were 12.5% and 13.4 days, respectively. Acute pulmonary embolectomy can be a viable procedure for patients with severe, globally hypokinetic right ventricular dysfunction, with or without hemodynamic compromise; however, caution is warranted. Our outcomes might be dependent upon institutional capability, experience, surgical ability, and careful patient selection.

Isolated Intrathoracic Injury with Air Bag Use

The restrained (air bag and seatbelt) driver of a vehicle involved in a high-speed motor-vehicle accident sustained a tear of the thoracic aorta with no signs of external injury. Air bag deployment may mask significant internal injury, and a high index of suspicion is warranted in such situations.

Successful minimally invasive triple coronary bypass through bilateral parasternal incisions

A 58-year-old man with left main and right coronary artery disease requiring preoperative intraaortic balloon pumping underwent successful minimally invasive triple coronary bypass through bilateral parasternal incisions. Despite taking immunosuppressive drugs because of a previous liver transplantation, the patient had all-arterial grafts without sternotomy. He was discharged on the fourth postoperative day, returned to work in 4 weeks, and has a negative thallium stress test.

Experience with Congenital Heart Disease in Children from Developing Countries

The natural history of cyanotic congenital heart disease was described in the 1940s and 1950s from experiences in the United States and other developed nations. [1–3]. Since the advent of palliative procedures (including balloon septostomy), palliative surgery, and corrective surgery, the natural history of cyanotic congenital heart disease has been greatly altered. However, in developing countries around the world, individuals with congenital heart disease still do not receive the benefits of modern therapeutic modalities. In 1980, a program called Lifeline was instituted at North Shore University Hospital, Manhasset, New York. This program was designed to provide care for children with heart disease living in developing countries.