Editorials
Acquired Cardiovascular Disease (ACD)
Correction
Congenital Heart Disease (CHD)
General Thoracic Surgery (GTS)
Cardiopulmonary Support (CPS)
Cardiothoracic Transplantation (TX)
Evolving Technology (ET)
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Brief Communications: Technical
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Editorials

1047 Relations between cardiothoracic surgeons and industry

Michael J. Mack, MD, and Robert M. Sade, MD, for the American Association for Thoracic Surgery Ethics Committee and The Society of Thoracic Surgeons Standards and Ethics Committee, Dallas and Houston, Tex, Charleston, SC, Boston, Mass, Durham, Winston-Salem, and Biltmore Forest, NC, Toronto, Ontario, Canada, St Louis, Mo, Philadelphia, Pa, Rochester, Minn, Aurora, Colo, Seattle, Wash, Ann Arbor, Mich, and Cleveland, Ohio

1050 Treatment selection for coronary artery disease: The collision of a belief system with evidence

Peter K. Smith, MD, Durham, NC

1054 Factors affecting interest in cardiothoracic surgery: Survey of North American general surgery residents

Ara A. Vaporciyan, MD, Carolyn E. Reed, MD, Clese Erikson, MPAff, Michael J. Dill, MPP, Andrea J. Carpenter, MD, Kristine J. Guleserian, MD, and Walter Merrill, MD, Houston, San Antonio, and Dallas, Tex, Charleston, SC, Washington, DC, and Cincinnati, Ohio

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Acquired Cardiovascular Disease (ACD)

1063 Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging study

Michael Flynn, MB, FRCSI (C/Th), Ronan Curtin, MD, Edward R. Nowicki, MD, MS, Jeevanantham Rajeswaran, MSc, Scott D. Flamm, MD, Eugene H. Blackstone, MD, and Tomislav Mihaljevic, MD, Cleveland, Ohio

Cardiac magnetic resonance imaging in severe functional ischemic mitral regurgitation (MR) revealed that extensive posterior papillary muscle scarring correlated with decreased segmental wall motion and MR early after coronary revascularization and annuloplasty. Routinely assessing scar burden may identify patients for whom annuloplasty alone is insufficient to eliminate MR.

1071 Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse

Rakesh M. Suri, MD, DPhil, Hartzell V. Schaff, MD, Joseph A. Dearani, MD, Thoralf M. Sundt, MD, Richard C. Daly, MD, Charles J. Mullany, MB, MS, Maurice Enriquez-Sarano, MD, and Thomas A. Orszulak, MD, Rochester, Minn

Evaluation of patients undergoing MV repair or replacement between 1980 and 2000 revealed independent predictors of higher follow-up EF, including valve repair, freedom from preoperative myocardial infarction, operation in the 1990s, greater preoperative EF, and smaller LV dimensions. Early mitral repair increases likelihood of EF normalization.

1077 Mitral leaflet anatomy revisited

Jason L. Quill, BS, Alexander J. Hill, PhD, Timothy G. Laske, PhD, Ottavio Alfieri, MD, and Paul A. Iaizzo, PhD, Minneapolis, Minn, and Milan, Italy

The human mitral valve is a complex, dynamic, and variable structure. Perfusion-fixed hearts were studied; commissure and cleft locations were charted using Carpentier's description. We suggest a simple, complementary nomenclature to address variation in mitral valve anatomy by describing clefts as “standard” or “deviant” and locating regions in which they occur.

1082 Re-creation of a sinuslike graft expansion in Bentall procedure reduces stress at the coronary button anastomoses: A finite element study

Luca Weltert, MD, Ruggero De Paulis, MD, Raffaele Scaffa, MD, Daniele Maselli, MD, Alessandro Bellisario, MD, and Stefano D'Alessandro, MD, Rome, Italy

Coronary button Bentall procedure might cause undue tension on coronary ostia anastomoses. By using finite elements study, we demonstrate that a graft with a sinus portion can effectively reduce this tension. A standard straight graft might not be the most appropriate choice for patients having root replacement.

1088 Short- and midterm outcomes of coronary artery bypass surgery performed by surgeons in training

Cheng-Hon Yap, MBBS, MS, Nick Andrianopoulos, MBBS, MBiostat, Diem T. Dinh, BSc, PhD, Baki Billah, BSc, MSc, MAS, PhD, Alexander Rosalion, FRACS, Julian A. Smith, FRACS, Gilbert C. Shardey, FRACS, Peter D. Skillington, FRACS, James Tatoulis, FRACS, MD, Morteza Mohajeri, FRACS, Michael Yii, FRACS, MS, and Chistopher M. Reid, PhD, Victoria, Australia

In this statewide multi-institutional study, CABG performed by trainee surgeons within a supervised program was safe with acceptable short- and midterm outcomes.

1093 Arterial revascularization in primary coronary artery bypass grafting: Direct comparison of 4 strategies—Results of the Stand-in-Y Mammary Study

Giuseppe Nasso, MD, Roberto Coppola, MD, Raffaele Bonifazi, MD, Felice Piancone, MD, Giuseppe Bozzetti, MD, and Giuseppe Speziale, MD, Bari and Rapallo, Italy

In a randomized study, the use of 2 arterial conduits rather than 1 for myocardial revascularization offered better midterm event-free survival than a single arterial graft, even though saphenous grafts are used, irrespective of which second-choice arterial conduit is used and irrespective of the patient's age.

1101 Dimensional analysis of human saphenous vein grafts: Implications for external mesh support

Paul Human, PhD, Thomas Franz, PhD, Jacques Scherman, MBChB, Lovendran Moodley, MBChB, and Peter Zilla, MD, PhD, Observatory, South Africa

To better determine the extent of constriction effected by external mesh support required for mitigation of intimal hyperplasia of saphenous vein grafts, a thorough analysis of vein dimensions was undertaken in patients undergoing coronary artery bypass grafting. Hypothetically, a relatively mild restriction was predicted to accommodate the majority of grafts.

1109 Seven-year results with the St Jude Medical Silzone mechanical prosthesis

W. R. Eric Jamieson, MD, Guy J. Fradet, MD, James G. Abel, MD, Michael T. Janusz, MD, Samuel V. Lichtenstein, MD, PhD, Joan S. MacNab, Elizabeth A. Stanford, BScN, and Florence Chan, Vancouver, Canada

This retrospective study assessed thromboembolism and paraprosthetic leak to 7 years in 253 patients who had 254 operations with placement of Silzone prostheses. Paraprosthetic leak was managed early (≤2 years) and late (>2 years) with re-replacement. Late events may be earlier paraprosthetic leak. Follow-up echocardiograms should meet standards of care, 6 to 12 months after surgery and at suspicion of dysfunction. There is no advanced continuing risk of the St Jude Medical Silzone prosthesis beyond 2 years.

1116 Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?

Suma H. Konety, MS, MD, Gary E. Rosenthal, MD, and Mary S. Vaughan-Sarrazin, PhD, San Francisco, Calif, and Iowa City, Iowa

A large retrospective study of patients undergoing coronary artery bypass grafting evaluating relative mortality and complication rates for on-pump versus off-pump coronary bypass were evaluated across hospital volume quartiles. Outcomes were significantly better for off-pump compared with on-pump CABG. Although the benefit of off-pump CABG increased as the relative use of the procedure at a hospital increased, off-pump CABG can be safely implemented across numerous hospitals.

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Correction

1124 Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome

Irina V. Volguina, PhD, D. Craig Miller, MD, Scott A. LeMaire, MD, Laura C. Palmero, MPH, Xing Li Wang, MD, PhD, Heidi M. Connolly, MD, Thoralf M. Sundt, III, MD, Joseph E. Bavaria, MD, Harry C. Dietz, MD, Dianna M. Milewicz, MD, PhD, and Joseph S. Coselli, MD, on behalf of the Aortic Valve Operative Outcomes in Marfan Patients study group, Houston, Tex, Stanford, Calif, Rochester, Minn, Philadelphia, Pa, and Baltimore, Md

Analysis of 46 valve-replacing and 105 valve-sparing aortic root replacements in patients with Marfan syndrome was performed within a prospective, international registry study involving 18 institutions. There were no early deaths. Despite the added complexity of valve-sparing procedures, there were no significant differences in the incidence of 30-day adverse events or valve-related complications.

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Congenital Heart Disease (CHD)

1133 The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database

Karl F. Welke, MD, Sean M. O'Brien, PhD, Eric D. Peterson, MD, MPH, Ross M. Ungerleider, MD, MBA, Marshall L. Jacobs, MD, and Jeffery P. Jacobs, MD, Portland, Ore, Durham, NC, Cleveland, Ohio, Philadelphia, Pa, and Saint Petersburg and Tampa, Fla

We sought to determine the association between pediatric cardiac surgical volume and mortality by using the Society of Thoracic Surgeons Congenital Heart Surgery Database. There was an inverse association between pediatric cardiac surgical volume and mortality that became increasingly important as case complexity increased.

1141 Experimental off-pump transventricular pulmonary valve replacement using a self-expandable valved stent: A new approach for pulmonary incompetence after repaired tetralogy of Fallot?

François Godart, MD, PhD, Ivan Bouzguenda, MD, Francis Juthier, MD, Fabrice Wautot, MD, Alain Prat, MD, Christian Rey, MD, Delphine Corseaux, PhD, Alexandre Ung, Brigitte Jude, MD, PhD, and André Vincentelli, MD, PhD, Lille cedex, France

Off-pump transventricular pulmonary valve replacement was achieved in 15 lambs using self-expandable valved stent combined with pulmonary artery banding. Doppler echocardiographic follow-up showed good results up to 4 months, and this approach could be effective for pulmonary insufficiency after repair to tetralogy of Fallot with transannular patch.

1146 Right ventricular hypertrophy with early dysfunction: A proteomics study in a neonatal model

Amir M. Sheikh, MBBS, FRCS(C-Th), Cindy Barrett, MD, Nestor Villamizar, MD, Oscar Alzate, PhD, Anne Marie Valente, MD, J Rene' Herlong, MD, Damian Craig, MS, Andrew Lodge, MD, Jeffrey Lawson, MD, PhD, Carmelo Milano, MD, and James Jaggers, MD, Durham and Charlotte, NC

The molecular mechanisms underlying change of RV hypertrophy from adaptive to maladaptive remain elusive. We developed a neonatal piglet model of RV hypertrophy. MRI in vivo demonstrated onset of early dysfunction. Using a proteomic approach, we demonstrated the RV myocardial protein changes at this crucial time point.

1154 Myocardial membrane injury in pediatric cardiac surgery: An animal model

Jonathan R. Egan, MBBS, FRACP, FJFICM, Tanya L. Butler, PhD, Andrew D. Cole, BAppSc, Smartin Abraham, MCh, John S. Murala, MCh, David Baines, MBBS, FANCZA, Neil Street, MBBS, FANCZA, Lance Thompson, MBChB, FCA, Oliver Biecker, BSc, John Dittmer, CCP, Sandra Cooper, PhD, Carol G. Au, BSc, Kathryn N. North, MD, and David S. Winlaw, MD, FRACS, Sydney, Australia

The role of myocardial membrane proteins after pediatric cardiac surgery was studied. This demonstrated that dystrophin was unaffected. Dysferlin expression was reduced and aquaporin expression increased. Poloxamer 188 was associated with increased dystrophin and preserved dysferlin expression. It was also associated with improved oxygen delivery, reduced capillary leak, and reduced hemodilution.

1163 Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg

Tara Karamlou, MD, Alessandra Bernasconi, MD, Edgar Jaeggi, MD, Fahad Alhabshan, MD, William G. Williams, MD, Glen S. Van Arsdell, MD, John G. Coles, MD, and Christopher A. Caldarone, MD, Toronto, Ontario, Canada

We describe outcomes in infants weighing 2.5 kg or less after repair of CoA and elucidate postrepair growth trajectories of the aortic arch. Catch-up growth of both the transverse arch and the isthmus occurs after CoA repair, especially in those with the smallest arch parameters, and may be increased by using extended end-to-end repair technique.

1168 The role of enucleation with or without septal myectomy for discrete subaortic stenosis

Yasutaka Hirata, MD, Jonathan M. Chen, MD, Jan M. Quaegebeur, MD, and Ralph S. Mosca, MD, New York, NY

For those patients undergoing primary operations for discrete subaortic stenosis, routine myectomy does not offer superior relief of left ventricular outflow tract obstruction. However, in those patients with associated cardiac anomalies, concomitant additional myectomy is recommended.

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General Thoracic Surgery (GTS)

1173 The analysis of a prospective surgical database improves postoperative fast-tracking algorithms after pulmonary resection

Ayesha S. Bryant, MSPH, MD, and Robert James Cerfolio, MD, FACS, FCCP, Birmingham, Ala

Although age greater than 70 years, obesity, and poor pulmonary function are predictors of poor outcomes and prolonged length of stay after pulmonary resection, pain pumps instead of epidurals for the elderly and increased respiratory and physical therapy for those with minimal pulmonary reserve reduce morbidity and length of stay.

1180 Evaluation of the new TNM staging system proposed by the International Association for the Study of Lung Cancer at a single institution

Kotaro Kameyama, MD, Mamoru Takahashi, MD, Keiji Ohata, MD, Hitoshi Igai, MD, Akihiko Yamashina, MD, Tomoaki Matsuoka, MD, Tatsuo Nakagawa, MD, and Norihito Okumura, MD, Okayama and Nara, Japan

The International Association for the Study of Lung Cancer has proposed a revision of the current staging system for lung cancer in preparation for publication of the seventh TNM Classification of Malignant Tumours. The new staging system was considered a valid classification system based on our single-institution evaluation of pathologic staging of non–small cell lung cancers.

1185 Management of pleural recurrence after curative resection of thymoma

Marco Lucchi, MD, Federico Davini, MD, Roberta Ricciardi, MD, Leonardo Duranti, MD, Laura Boldrini, MD, Gerardo Palmiero, MD, Fulvio Basolo, MD, and Alfredo Mussi, MD, Pisa and Volterra, Italy

Pleural recurrence after a successful resection of thymoma is an uncommon but unsolved problem. Reviewing our surgical experience shows that surgical resection offers a reasonable survival. However, patients with multiple metastases and those with diaphragmatic involvement have a worse prognosis. The role of adjuvant therapy is still unknown.

1190 Stability of an autologous platelet clot in the pericardial sac: An experimental and clinical study

Leonard M. Rademakers, MD, Paul F. Gründeman, MD, PhD, Robert W. Bolderman, MD, Frederik H. van der Veen, PhD, and Jos G. Maessen, MD, PhD, Maastricht and Utrecht, The Netherlands

This study investigated intrapericardial stability of four different autologous platelet clot compositions in five pigs and 10 patients. In vitro clots served as controls. APG with or without antifibrinolytic agents is unstable both in vitro and in vivo, whereas PRF remains intact in vitro and is less subject to degradation in vivo.

1195 Pediatric empyema: Outcome analysis of thoracoscopic management

Jin-Shing Chen, MD, PhD, Kai-Chieh Huang, MD, Yen-Ching Chen, ScD, Hsao-Hsun Hsu, MD, Shuenn-Wen Kuo, MD, Pei-Ming Huang, MD, Jan-Ming Lee, MD, PhD, and Yung-Chie Lee, MD, PhD, Taipei, Taiwan

The clinical presentations of pediatric empyema requiring thoracoscopy are diverse. Outcome analyses showed that necrotizing pneumonia was significantly associated with the presence of complications, and that necrotizing pneumonia, preoperative ICU admission, and preoperative chest tube drainage were independent risk factors for a longer postoperative hospital stay.

1200 Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography

Kentaro Yoshimoto, MD, Hiroaki Nomori, MD, PhD, Takeshi Mori, MD, PhD, Hironori Kobayashi, MD, PhD, Yasuomi Ohba, MD, Hidekatsu Shibata, MD, Kuniyuki Tashiro, MD, Shinya Shiraishi, MD, PhD, and Toshiaki Kobayashi, MD, PhD, Kumamoto and Tokyo, Japan

The preservation of pulmonary function after segmentectomy was assessed by perfusion SPECT/CT. Segmentectomy could preserve more FEV₁ than virtual lobectomy. The FEV₁ of each lobe that had been subjected to segmentectomy was preserved well, except for the resection of more than three segments or left upper division segmentectomy.

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Cardiopulmonary Support (CPS)

1206 Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study

Francesco Formica, MD, Francesco Broccolo, MD, Antonello Martino, MD, Jennifer Sciucchetti, MD, Vincenzo Giordano, MD, Leonello Avalli, MD, Gianluigi Radaelli, MD, Orazio Ferro, MD, Fabrizio Corti, MD, Clementina Cocuzza, MD, PhD, and Giovanni Paolini, MD, PhD, Monza and Milan, Italy

This prospective randomized study evaluates the systemic inflammatory response and the myocardial inflammation and damage in patients with coronary disease who underwent operation with MECC or OPCABG. The MECC system can be considered similar to OPCABG in terms of systemic inflammatory response, myocardial inflammation and damage, and early outcome.

1213 Dynamic computed tomography to determine cardiac output in patients with left ventricular assist devices

Subha V. Raman, MD, MSEE, Tam Tran, BS, Orlando P. Simonetti, PhD, and Benjamin Sun, MD, Columbus, Ohio

Patients with end-stage heart disease are increasingly surviving thanks to ventricular assist devices (VADs). Long-term evaluation of these patients requires improved techniques for evaluating device function. We have developed and tested a noninvasive technique to estimate cardiac output in patients with VADs that compared favorably with invasive hemodynamic assessment.

1218 A differential release of matrix metalloproteinases 9 and 2 during coronary artery bypass grafting and off-pump coronary artery bypass surgery

Adam Sokal, PhD, Michal Zembala, MD, Anna Radomski, MD, Alfred Kocher, PhD, Jerzy Pacholewicz, PhD, Joanna Los, MD, Ewa Jedrzejczyk, MD, Marian Zembala, PhD, and Marek Radomski, PhD, Zabrze, Poland, Dublin, Ireland, and Innsbruck, Austria

The objective of this study was to measure plasma and myocardial matrix metalloproteinase (MMP) 2 and MMP-9 levels in patients undergoing off-pump coronary artery bypass (OPCAB) and coronary artery bypass grafting (CABG). CABG but not OPCAB led to a 700- to 900-fold increase of plasma MMP-9 levels. Thus we propose that release of MMP-9 might contribute to extracorporeal circulation–induced inflammatory reactions.

1225 Tracking cardiac engraftment and distribution of implanted bone marrow cells: Comparing intra-aortic, intravenous, and intramyocardial delivery

Shu-Hong Li, MD, MSc, Teresa Y. Y. Lai, MSc, Zhuo Sun, MD, Mihan Han, BSc, Eduardo Moriyama, PhD, Brian Wilson, PhD, Shafie Fazel, MD, PhD, Richard D. Weisel, MD, Terrence Yau, MD, Joseph C. Wu, MD, PhD, and Ren-Ke Li, MD, PhD, Toronto, Ontario, Canada, and Stanford, Calif

Noninvasive bioluminescence imaging tracked bone marrow stromal cells implanted by using common delivery methods in acute or chronic myocardial infarction models. Cells implanted by means of intra-aortic or intravenous injections did not home to the heart. Direct intramyocardial injection produced the best cardiac engraftment, but cell survival was limited with all 3 delivery methods. Improved cell delivery will enhance engraftment and facilitate cardiac regeneration.

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Cardiothoracic Transplantation (TX)

1234 Matching donor to recipient in lung transplantation: How much does size matter?

David P. Mason, MD, Lillian H. Batizy, MS, Jeffrey Wu, MD, Edward R. Nowicki, MD, MS, Sudish C. Murthy, MD, PhD, Ann M. McNeill, RN, Marie M. Budev, DO, Atul C. Mehta, MD, Gösta B. Pettersson, MD, PhD, and Eugene H. Blackstone, MD, Cleveland, Ohio

Guidelines for matching donor and recipient lung size in transplantation are sparse, and effects on outcome of size mismatch are unclear. Modest size differences have little effect on survival or lung function after transplantation, suggesting a need for broader acceptance criteria when matching organs.

1241 Enhanced fibrinolysis protects against lung ischemia–reperfusion injury

Christine L. Lau, MD, Yunge Zhao, MD, PhD, Jiyoun Kim, PhD, Irving L. Kron, MD, Ashish Sharma, MBBS, Zequan Yang, MD, PhD, Victor E. Laubach, PhD, Joel Linden, PhD, Gorav Ailawadi, MD, and David J. Pinsky, MD, Charlottesville, Va, Boston, Mass, and Ann Arbor, Mich

Acute lung injury models have linked fibrin deposition to inflammation. We hypothesized that increased fibrinolysis would reduce ischemia–reperfusion injury. Enhanced fibrinolysis in PAI-1 null mice improved physiologic parameters of lung function, decreased histologic signs of lung injury, and decreased proinflammatory mediator release in a mouse model of ischemia–reperfusion.

1249 Long-acting oral phosphodiesterase inhibition preconditions against reperfusion injury in an experimental lung transplantation model

Eric S. Weiss, MD, Hunter C. Champion, MD, PhD, Jason A. Williams, MD, William A. Baumgartner, MD, and Ashish S. Shah, MD, Baltimore, Md

Ischemia–reperfusion injury remains a devastating complication of lung transplantation. In this experiment, preconditioning by use a long-acting oral phosphodiesterase inhibitor protected against ischemia–reperfusion injury in an ex vivo lung transplant model. Phosphodiesterase enzymes appear to be critical regulators of early allograft function in lung transplantation.

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Evolving Technology (ET)

1258 Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: Preprocedural assessment with multidetector computed tomography

Vikram Kurra, MD, Paul Schoenhagen, MD, Eric E. Roselli, MD, Samir R. Kapadia, MD, E. Murat Tuzcu, MD, Roy Greenberg, MD, Mateen Akhtar, MD, Milind Y. Desai, MD, Scott D. Flamm, MD, Sandra S. Halliburton, PhD, Lars G. Svensson, MD, and Srikanth Sola, MD, Cleveland, Ohio

Percutaneous aortic valve insertion is an emerging treatment option for selected patients with severe aortic stenosis. Concomitant, significant PAD is common in the high-risk patient population currently evaluated for percutaneous aortic valve insertion. CT allows identification of patients with iliofemoral anatomy unfavorable for the transfemoral approach.

1265 Epicardial off-pump pulmonary vein isolation and vagal denervation improve long-term outcome and quality of life in patients with atrial fibrillation

Louise Bagge, MD, Per Blomström, MD, PhD, Leif Nilsson, MD, PhD, Gunnar Myrdal Einarsson, MD, PhD, Lena Jidéus, MD, PhD, and Carina Blomström-Lundqvist, MD, PhD, Uppsala, Sweden

Forty-three patients with symptomatic atrial fibrillation were referred for epicardial pulmonary vein isolation combined with ganglionated plexi radiofrequency ablation. Overall, 76% (25/33) of the patients had no documented symptomatic atrial fibrillation recurrences at 12-month follow-up. Physical capacity, symptoms, and quality of life were improved at 6- and 12-month follow-up.

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Brief Communications: Clinical

1272 Cavernous hemangioma of the bronchial wall: A systemic–pulmonary vessel fistula

Naveen Swami, MCh, Shyam K. S. Thingnam, MCh, and Harkant Singh, MCh, Chandigarh, India

1273 Early calcification of a stentless pericardial bioprosthesis in the elderly

Maria Grazia Croccia, MD, Stefano Pratali, MD, Cristina Basso, MD, PhD, Giovanni Scioti, MD, Mila Della Barbera, BSc, PhD, Gaetano Thiene, MD, and Uberto Bortolotti, MD, Pisa and Padova, Italy

1275 Acute rupture of both papillary muscles after aortic valve replacement for infective endocarditis

Rony Atoui, MD, MSc, Tarek Hijal, MD, Richard Fraser, MD, and Dominique Shum-Tim, MD, MSc, Montreal, Quebec, Canada

1277 Spontaneous regression of a mediastinal thymoma

Tsai-Wang Huang, MD, Yung-Lung Cheng, PhD, Jen-Chih Chen, MD, Wen-Chiuan Tsai, MD, Hung Chang, PhD, and Shih-Chun Lee, MD, Taipei, Taiwan

1278 Acute myocardial infarction and limb ischemia as manifestation of nonbacterial thrombotic endocarditis

Naoko Nagano, MD, Jean-François Morin, MD, FRCS, Dominique Joyal, MD, and Lawrence Rudski, MD, Montreal, Quebec, Canada

1280 Multiple papillary fibroelastoma with quadricuspid aortic valve

Reiji Hattori, MD, PhD, Chihiro Oishi, MD, Junji Iwasaka, MD, PhD, Toshiji Iwasaka, MD, PhD, Takayuki Okada, MD, Hiroyuki Johno, MD, Chiharu Enoki, MD, Tomohiko Sumida, MD, Yoshihisa Nakao, MD, PhD, and Hiroji Imamura, MD, PhD, Hirakata, Osaka, Japan

1282 Pulmonary venous obstruction in a patient with Marfan syndrome: Rare presentation of an expanding dissecting descending thoracic aortic aneurysm with annuloaortic ectasia

Yoshikatsu Saiki, MD, PhD, Shunsuke Kawamoto, MD, PhD, Junetsu Akasaka, MD, PhD, Naotaka Motoyoshi, MD, PhD, Sadahiro Sai, MD, PhD, and Koichi Tabayashi, MD, PhD, Sendai, Japan

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Brief Communications: Technical

1285 Ascending aortic pseudoaneurysm after aortic valve replacement: Watch the tip of the cardioplegia cannula!

Abbas Emaminia, MD, Ahmad Ali Amirghofran, MD, Masih Shafa, MD, Alireza Moaref, MD, and Ramin Javan, MD, Shiraz, Iran, and Charlottesville, Va

1286 Dual left ventricular restorations in a patient with cardiac sarcoidosis

Takeshi Shimamoto, MD, Takeshi Nishina, MD, PhD, Akira Marui, MD, PhD, and Masashi Komeda, MD, PhD, Kyoto, Toyohashi, and Yamato, Japan

1288 Potential role of the Impella Recover left ventricular assist device in the management of postinfarct ventricular septal defect

Francesco Patanè, MD, Paolo Centofanti, MD, Edoardo Zingarelli, MD, Fabrizio Sansone, MD, and Michele La Torre, MD, Turin, Italy

1290 Aortic dissection type A after supra-aortic debranching and implantation of an endovascular stent-graft for type B dissection: A word of caution

Payam Akhyari, MD, Hiroyuki Kamiya, MD, Tobias Heye, MD, Artur Lichtenberg, MD, and Matthias Karck, MD, Heidelberg, Germany

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