Larger chest tubes are not necessarily better when it comes to draining the mediastinum. The actual area of ingress through the sideholes is considerably less than the surface area provided by the fluted Blake drain. We believe that this system can replace standard chest tubes.

As the number of coronary sinus (CS) lead implantations for cardiac resynchronization therapy increases so will the need for extraction of these leads. The safety of extraction of leads from the branches of the CS has not been reported. We reviewed our database of patients undergoing pacemaker lead extraction from January 2002 through February 2004 at our institution. Of 149 patients referred for lead extraction, 14 (9%) had a biventricular device. The indications for lead extraction were infection, lead malfunction, and exit block. The duration of CS lead implants ranged between 2 and 43 months (mean 17 months). All 14 CS leads were removed successfully using nonsurgical lead extraction techniques. Three leads that were in place the longest (> or =27 months) were removed via the femoral vein approach due to fibrous attachment of the CS lead body to the other pacemaker leads. The leads were structurally intact and without any significant fibrosis of their tips upon visual inspection. There were no major complications of CS laceration, hypotension, pericardial effusion, or excessive blood loss associated with any of the extraction procedures. CS leads were removed safely, successfully and with relative ease based on our experience in this small cohort of patients.

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W e present the case of a 77-year-old Cambodian woman with a 3-day history of dyspnea on exertion. Physical examination revealed a murmur of mitral regurgitation and decompensated heart failure. The ECG was remarkable for atrial fibrillation with rapid ventricular response. Transthoracic echocardiography showed severe left atrial dilation, a large (5ϫ8 cm) mobile mass attached to the anterior left atrial wall, and several small, mobile aortic masses on the noncoronary cusp of the aortic valve ( Figure 1 and online-only Data Supplement Movie I).Three-dimensional transesophageal echocardiography showed a large multilobular mass being displaced by the central jet of moderate to severe mitral regurgitation during systole and prolapse of the mass through the mitral valve during diastole (Figures 2 and 3 and online-only Data Supplement Movies II and III). The atrial mass was attached with a stalk to the anterior atrial wall and appeared lobulated and deformable, consistent with the appearance of a myxoma (online-only Data Supplement Movie IV). The aortic valve masses had multiple frondlike projections, which had an appearance like a sea anemone, with stippling at the edges that arose from the noncoronary aortic valve leaflet (online-