Texas Heart Institute Journal Volume 44: Issue 2

Nina Starr Braunwald, the first female cardiac surgeon, made headlines during a time when almost all specialty surgeons were men.

Women have typically been deterred from entering surgical specialties, in part because of their traditional dual burden of managing their households and careers. Instead, female medical students and junior doctors have tended to be more attracted to medical specialties. This was the reality during Dr. Braunwald's venture into medicine in 1949. However, she never allowed negative ideas to keep her from joining a surgical training program.

Under the mentorship of the prominent cardiac surgeons Charles Hufnagel and Andrew Morrow, Dr. Braunwald progressed in her career by conducting research that led to her development and implantation of the first prosthetic mitral valve. She was also a great teacher.

Dr. Braunwald balanced her personal and professional activities admirably, and her example still inspires female doctors to consider careers in cardiothoracic surgery. In this report, we provide details of her impact on cardiac surgery and insights into her successes.

Constrictive pericarditis is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure.

Transthoracic echocardiography, computed tomography, and cardiac magnetic resonance imaging each can reveal severe diastolic dysfunction and increased pericardial thickness. Cardiac catheterization can help to confirm a diagnosis of diastolic dysfunction secondary to pericardial constriction, and to exclude restrictive cardiomyopathy.

Early pericardiectomy with complete decortication (if technically feasible) provides good symptomatic relief and is the treatment of choice for constrictive pericarditis, before severe constriction and myocardial atrophy occur.

We describe our surgical approach to constrictive pericarditis, summarize our results in 93 patients, and provide a brief overview of the literature.

The efficacy of pulmonary vein antral isolation for patients with prolonged sinus pauses (PSP) on termination of atrial fibrillation has been reported. We studied the right atrial (RA) electrophysiologic and electroanatomic characteristics in such patients.

Forty patients underwent electroanatomic mapping of the RA: 13 had PSP (group A), 13 had no PSP (group B), and 14 had paroxysmal supraventricular tachycardia (control group C). Group A had longer P-wave durations in lead II than did groups B and C (115.5 ± 15.4 vs 99.5 ± 10.9 vs 96.5 ± 10.4 ms; P=0.001), and RA activation times (106.8 ± 13.8 vs 99 ± 8.7 vs 94.5 ± 9.1 s; P=0.02). Group A's PP intervals were longer during adenosine triphosphate testing before ablation (4.6 ± 2.3 vs 1.7 ± 0.6 vs 1.5 ± 1 s; P <0.001) and after ablation (4.7 ± 2.5 vs 2.2 ± 1.4 vs 1.6 ± 0.8 s; P <0.001), and group A had more complex electrograms (11.4% ± 5.4% vs 9.3% ± 1.6% vs 5.8% ± 1.6%; P <0.001). Compared with group C, group A had significantly longer corrected sinus node recovery times at a 400-ms pacing cycle length after ablation, larger RA volumes (100.1 ± 23.1 vs 83 ± 22.1 mL; P=0.04), and lower conduction velocities in the high posterior (0.87 ± 0.13 vs 1.02 ± 0.21 mm/ms; P=0.02) and high lateral RA (0.89 ± 0.2 vs 1.1 ± 0.35 mm/ms; P=0.04).

We found that patients with PSP upon termination of atrial fibrillation have RA electrophysiologic and electroanatomic abnormalities that warrant post-ablation monitoring.

A 78-year-old man presented with worsening dyspnea and edema. He had undergone coronary artery bypass grafting in 2001. At the current presentation, he had ischemic cardiomyopathy with a left ventricular (LV) ejection fraction of 0.20 and was taking home inotropic therapy. Two months previously, he had begun cardiac resynchronization therapy with use of an implanted biventricular pacemaker.

Physical examination revealed elevated jugular venous pressure, bibasilar crackles, and pitting edema above both knees. An electrocardiogram (ECG) was obtained (Fig. 1).

Fig. 1. — Fig. 1
Citation: Texas Heart Institute Journal 44, 2; 10.14503/THIJ-17-6255

What is the cause of this ECG pattern?

A) Loss of LV lead

Paolo Aseni, Antonino M. Grande, Luciano De Carlis. 264 pages. Springer International Publishing Switzerland; 2016. Hardcover: US $129.00; eBook: $99.00; ISBN: 978-3-319-28414-9. Available from: www.springer.com/us/book/9783319284149

Field of Medicine: Transplant Surgery and Organ Procurement, but applicable to many other medical disciplines.

Format: Hardcover book.

Recommended Readership: This book will be of interest to most practitioners of medicine, but especially to those who deal with organ procurement and transplantation—such as medical students, procurement specialists, surgeons, hepatologists, nephrologists, endocrinologists, cardiologists, pulmonologists, intensivists, and emergency-room and intensive-care-unit nurses.

Purpose: To guide and to educate those involved in organ procurement

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Marco KaldasMD,

Moneal ShahMD,

Diana PashaievaBDS,

Georgios LygourisMD, and

Anita RadhakrishnanMD

In Memoriam: Grady L. Hallman, MD (1930–2017)

In Memoriam: Mark E. Josephson, MD (1943–2017)

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases

What Makes a Medical Journal Successful? Five Crucial Components

Crucial Components

Financial Security

Finding Meaning in Silence

Nina Braunwald: A Female Pioneer in Cardiac Surgery

Surgical Treatment of Constrictive Pericarditis

Prolonged Sinus Pauses upon Termination of Paroxysmal Atrial Fibrillation: Abnormal Right Atrial Electrophysiologic and Electroanatomic Findings

Is Diabetes Mellitus a Risk Factor for Poor Outcomes after Left Ventricular Assist Device Placement?

Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography

Transcatheter Aortic Valve Implantation in a Patient with Unicuspid Aortic Valve

Phasic Compression of Left Circumflex Coronary Artery during Atrial Systole

Bioprosthetic Aortic Valve Replacement in a Donor Heart before Orthotopic Heart Transplantation

A Rare Case of Vascular Ring and Coarctation of the Aorta in Association with CHARGE Syndrome

Nonidentical Continuous-Flow Devices For Biventricular Support

Autologous Pericardial Patch Repair for Papillary Fibroelastoma on an Aortic Valve Leaflet

Isolated Tricuspid Valve Libman-Sacks Endocarditis in Systemic Lupus Erythematosus with Secondary Antiphospholipid Syndrome

Repair of Intrapericardial Diaphragmatic Hernia during Aortic Surgery in a 78-Year-Old Woman

Percutaneous Closure of 2 Paravalvular Leaks and a Gerbode Defect after Mitral Valve Replacement for Infective Endocarditis

A “De-Synching” Feeling

Fenestrated Membrane of the Left Atrial Appendage Orifice

Multiorgan Procurement for Transplantation: A Guide to Surgical Technique and Management

Compartment Syndrome of the Arm from Intravenous Infiltration during Radial Artery Catheterization

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Risk Factors for Development of Stroke in Patients With Continuous-Flow Left Ventricular Assist Device Support as Destination Therapy

Midterm Outcomes of Pediatric Mitral Valvuloplasty for Moderate to Severe Mitral Valve Regurgitation and Associated Risk Factors for Postoperative Deterioration

Navigating the Complexities of Mitral Valve Clipping: Early Severe Mitral Valve Stenosis After Mitral Valve Clipping

The Department of Cardiovascular Anesthesia of The Texas Heart Institute: An Informal History

Ectopic Right Renal Artery Originating from Anomalous Common Celio-Mesenteric Trunk: Multifaceted Imaging Approach

ACAOS Is Better Revealed by Intravascular Ultrasonography than by Computed Tomographic Angiography

Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases, One in a Child

Pulmonary Artery Sling Causing Tracheal Stenosis in a Neonate

Transcatheter Aortic Valve Replacement: A Physician-Patient's Story