The results of this 200-patient prospective study comparing tested versus empirical ATP show high success (95% versus 90%) for VT termination, with low rates of acceleration. ATP is safe and very effective and should be programmed "on" in all patients regardless of the predischarge EP inducibility.

No abstract

From 1976 to 1984, 31 patients underwent enlargement of very small aortic roots using autologous pericardial strips the subannular part of which extended into the incised anterior mitral valve leaflet. The majority of these interventions (n = 24) were carried out before the end of 1980. Over an average follow-up period of 52.5 months, only one of the surviving patients had a complication traceable to the pericardial implantation (aneurysmatic patch dilatation), and 2 late deaths were also not directly connected with the type of surgical procedure. Objective findings for evaluating the hemodynamic status and behavior of the patch material were attained in a total of 14 patients by heart catheterization and angiography. Eleven patients were examined twice at an average of 2.5 months, and 11 at an average of 52.5 months. Eight of latter patients had undergone an early postoperative investigation. The hemodynamic results after prosthetic valve replacement and aortic annulus enlargement was satisfactory in those examined. No evidence could be found in any patient of disturbance of the mitral valve's function, paravalvular leakage at the aortic prosthesis, or obstruction of the left ventricular outflow tract caused by this operative technique. Progressive patch dilatation which had already been proved at the first examination was observed in one case. These results verify not only the efficiency of this technique for the enlargement of a small aortic root in the frame of prosthetic valve replacement, but especially the suitability of autologous pericardium as patch material for this purpose.

A 51-year-old patient presented with a history of chest pain and progressive dyspnea. CT scan demonstrated a lipomatous mass encircling the heart and compressing the left lung. After median sternotomy, an intrapericardial tumor of 3200 g with a vascular pedicle arising from the circumflex coronary artery was resected. A histologic diagnosis of a well-differentiated liposarcoma was made. The patient is alive and well 2 years postoperatively. This tumor with its unusual vascularization is the largest of the few primary cardiac liposarcomas that have been reported.

In follow-up examinations of young patients we often noticed upward displacement of the left shoulder in cases where left-sided posterolateral thoracotomy had been carried out. Finding little discussion of this side-effect in the literature, we undertook the present study. The shoulder girdle of 69 patients who had undergone surgery for coarctation of the aorta between 1964 and 1984 was carefully examined to assess displacements and dysfunctions. In addition, in 24 of the patients electrodiagnostic examination was carried out of the associated muscles and nerves which were affected by the operation. We found disturbances of the muscular apparatus of the shoulder girdle in 80% of the cases: upward displacement of the shoulder (55%), downward displacement of the shoulder (8.7%), deviation of the scapula at rest (72.5%) and maximal elevated arms (40.6%), scapula alata (56.5%), and alterations of the posterior axillary line (39.1%). When considering only the cases of distinct upward or downward displacement of the shoulder, at least 25% of the operated children were affected. Children operated early (surgery during the first year of life) had more distinct alterations (47.6%) than those with later surgery (14.6%). Electromyographic examinations indicate that mainly disorders of the peripheral nerves caused by the operation led to these alterations of the shoulder girdle musculature. Although, except for one patient, no functional disorders were found, there were several cases in which the alteration caused quite severe cosmetic problems. One should pay more attention to positioning for surgery and do careful preparation to reduce these sequelae.