Robert Chan

Survival after myocardial revascularization for ischemic cardiomyopathy: a prospective ten-year follow-up study.

Abstract Objective The aim was to prospectively analyze all-cause mortality, predictors of survival, and late functional results after myocardial revascularization for ischemic cardiomyopathy over a 10-year follow-up. Methods We prospectively studied 57 patients with stable coronary artery disease and poor left ventricular ejection function ( Results Operative mortality was 1.7% (1/57). The mean left ventricular ejection fraction (0.30) at 15 months postoperatively did not change from before operation (0.28, P = .09). There were 8 deaths at 1 year and 42 deaths over the course of the study, producing a survival of 82.5% at 1 year, 55.7% at 5 years, and 23.9% at 10 years (95% confidence interval: 14.6%-39.1%). Symptom-free survival was 77.2% at 1 year and 20.3% at 10 years. The leading cause of death was heart failure in 29% (12/42). Multivariate analysis showed that large reversible defects on stress thallium were associated with improved left ventricular ejection fraction at 1 year ( P = .01) but only male sex was associated with improved long-term survival ( P = .036). Conclusions Myocardial revascularization for ischemic cardiomyopathy is associated with good functional relief from the symptoms of angina initially and, to a lesser extent, heart failure. Revascularization may have the advantage of preserving the remaining left ventricular function. However, the long-term mortality remains high.

Subclavian artery occlusion causing acute myocardial infarction in a patient with a left internal mammary artery graft.

Although atherosclerotic disease of the subclavian artery has previously been reported to cause coronary–subclavian steal syndrome, acute myocardial infarction because of occlusion of the subclavian artery in a graft‐dependent coronary circulation is an uncommon and previously unreported mode of clinical presentation. Increasingly, patients undergoing high‐risk cardiopulmonary procedures have comorbidities with extensive atherosclerotic disease of many vascular beds including coronary, cranial, and peripheral. Our discussion reviews the clinical presentation of such a case and highlights some of the important treatment options available when confronted with such a finding. The successful outcome achieved by percutaneous stenting of the subclavian artery and salvage of the graft may indicate that this modality is the initial treatment of choice in such cases.

Left ventricular false aneurysm complicating mitral valve repair.

Left ventricular false aneurysm is a rare complication of mitral valve replacement or myocardial infarction. A case of left ventricular false aneurysm complicating mitral valve repair is presented. The patient was clinically asymptomatic, and the diagnosis was made on postoperative transesophageal echocardiography. The patient subsequently underwent successful mitral valve replacement and false aneurysm repair.

A Review of Radiation Protection Solutions for the Staff in the Cardiac Catheterisation Laboratory.

Adverse health effects of radiation exposure to staff in cardiac catheterisation laboratories have been well documented in the literature. Examples include increased risk of cataracts as well as possible malignancies. These risks can be partly mitigated by reducing scatter radiation exposure to staff during diagnostic and interventional cardiac procedures. There are currently commercially available radiation protection tools, including radioprotective caps, gloves, eyewear, thyroid collars, aprons, mounted shields, table skirts and patient drapes to protect staff from excessive radiation exposure. Furthermore, real-time dose feedback could lead to procedural changes that reduce operator dose. The objective of this review is to examine the efficacy of these tools and provide practical recommendations to reduce occupational radiation exposure with the aim of minimising long-term adverse health outcomes.

Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography

Coronary angiogram, while a powerful diagnostic tool in coronary artery disease, is not without an associated risk from ionising radiation. There are a number of factors that influence the amount of radiation the patient receives during the procedure, some of which are under the control of the operator. One of these is an adjustment of the fluoroscopic pulse rate. This study aims to assess the feasibility of using ultra‐low pulse rate (3 pulses per second(pps)) fluoroscopy during routine diagnostic coronary angiogram procedures and the effect it has on fluoroscopy time, diagnostic clarity and radiation dose.