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Heterotopic heart transplantation is an alternative option in end-stage heart disease. We present a patient with a heterotopic allograft that maintained hemodynamics at the period of a malignant ventricular dysrhythmia and supports the notion that these otherwise lethal dysrhythmias of the native heart may not carry the same risk of sudden heart death in patients with heterotopic heart transplantation.

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Acute dissections mandate surgery after the patient has been stabilized medically. Hypertension appears to be a prerequisite in the pathogenesis of aortic dissection, and control of ventricular contraction velocity may be prophylactic.

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Papillary fibroelastomas are rare, benign tumors of the heart that often are incidental findings at autopsy or cardiac surgery, or during echocardiography. These tumors are predisposed to valvular involvement, and all such lesions detected by echocardiography have occurred in the left side of the heart, except for 3 on the tricuspid valve. Left-sided lesions have been associated with embolic phenomena; however, embolization of right-sided lesions has never been documented. We report a tricuspid valve fibroelastoma detected by 2-dimensional and transesophageal echocardiography, and confirmed by surgical excision and biopsy. To our knowledge, this is the 1st reported case of pulmonary embolization of papillary fibroelastoma arising from the tricuspid valve.

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Transseptal catheterization has been routinely done at this institution for the past 19 years to evaluate the left heart. Reviewing the last 250 consecutive transseptal heart catheterizations between 1978 and 1986, the left atrium and ventricle were entered in all but six patients. One death occurred with four other major complications. There were 177 males and 73 females ranging from 18 to 84 years of age. Of these 250 studies, 31 were in association with direct left ventricular apical puncture; 42 were in patients with subaortic stenosis; 101 were in aortic stenosis; 26 were in patients with combined aortic and mitral disease; and four were in patients with triple prosthetic valve replacements. No attempts were made to cross the prosthetic mitral valves. A decline in the number of transseptal studies at this institution has been noted over the past 8 years and the technique is not longer taught routinely to Fellows. The reduction is due to increased emphasis on coronary artery anatomy, fewer rheumatic and prosthetic valvular admissions, and improved reevaluation by non-invasive echocardiography and doppler studies. This has resulted in a loss in proficiency among invasive cardiologists. In conclusion, the transseptal technique is potentially hazardous, but continued usage will maintain proficiency and a low major and minor complication rate.

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The single preformed catheter has offered an alternative to the conventional approaches to study of the coronary circulation and ventriculography. It has the advantages of being introduced percutaneouly without multiple changes for routine study or for provocative drug testing such as for spasm with Ergonovine maleate or muscular bridges with nitroglycerine. It requires no arteriotomy and has been associated with a low complication rate.

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This report describes the case of a 32-year-old woman with the sudden onset of chest pain and an evolving inferior wall infarction proved by the electrocardiogram and enzyme studies. The patient underwent embolectomy 2 months later for a thromboembolus in the right main coronary artery. An autologous patch graft was used to close the arteriotomy. Four years later, the patient is asymptomatic, having no activity limitations. The patch graft to the right coronary artery is patent. This case exemplifies and reaffirms the possibility of emboli being lodged in the coronary arteries in certain types of disease. It may be necessary to operate in order to re-establish proper coronary circulation.

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A patient with perinatal cardiomyopathy was greatly benefited physiologically by 7 weeks of intra-aortic balloon pumping. This experience documented that extended pumping can be carried out with only manageable complications. Although the patient survived the hospitalization, she died shortly thereafter of intractable congestive failure. Perinatal cardiomyopathy is a potentially reversible condition. Ventricular assistance by intra-aortic balloon pumping may be sustaining during continued systemic treatment of this entity. Further evaluation for longevity of more advanced congestive heart failure from cardiomyopathies needs further clinical trial.

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Not uncommonly, atherosclerosis may be found associated with rheumatic heart disease. The combination of atherosclerosis, rheumatic heart disease and coronary fistula is an unusual combination of hemodynamic and disease states. We report a patient with advanced mitral stenosis and atherosclerosis who also had a fistula from the left coronary artery into the left atrium. Surgical approach: combined valve replacement, bypass grafting and closure of the fistula in an attempt to relieve the pathophysiologic abnormalities.

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A 105 mm camera has been used for over 24 mo in evaluation of the coronary circulation for the most part and occasionally the proximal peripheral arteries in 2,200 patients. This photofluorographic technique provides sufficient diagnostic image detail with improved operating convenience and reduced radiation exposure compared to the large film changer. 105 mm serialography is a good adjunct to cine arteriography as a complementary film recording system, and in many cases may supplement large film serialography.

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