Texas Heart Institute Journal Volume 49: Issue 2

Continuous ganglion block is increasingly being used to help manage ventricular tachyarrhythmias. We present the cases of 2 patients in whom we used continuous left thoracic paravertebral block to achieve sympathetic denervation and improvement in drug-refractory ventricular tachyarrhythmias. Whether as destination therapy or bridging therapy, we conclude that the block is safe, improves patients' comfort, and is superior in several ways to stellate ganglion block and other single-injection techniques.

Computed tomographic coronary artery calcium scanning enables cardiovascular risk stratification; however, exposing patients to high radiation levels is an ongoing concern. New-generation computed tomographic systems use lower radiation doses than older systems do. To quantify comparative doses of radiation exposure, we prospectively acquired images from 220 patients with use of a 64-slice GE LightSpeed VCT scanner (control group, n=110) and a 256-slice GE Revolution scanner (study group, n=110). The groups were matched for age, sex, and body mass index; statistical analysis included t tests and linear regression.

The mean dose-length product was 21% lower in the study group than in the control group (60.2 ± 27 vs 75.9 ± 22.6 mGy·cm; P <0.001) and also in each body mass index subgroup. Similarly, the mean effective radiation dose was 21% lower in the study group (0.84 ± 0.38 vs 1.06 ± 0.32 mSv) and lower in each weight subgroup. After adjustment for sex, women in the study group had a lower dose-length product (50.4 ± 23.4 vs 64.7 ± 27.6 mGy·cm) than men did and received a lower effective dose (0.7 ± 0.32 vs 0.9 ± 0.38 mSv) (P=0.009). As body mass index and waist circumference increased, so did doses for both scanners.

Our study group was exposed to radiation doses lower than the previously determined standard of 1 mSv, even after adjustment for body mass index and waist circumference. In 256-slice scanning for coronary artery calcium, radiation doses are now similar to those in lung cancer screening and mammography.

Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement full of expectations, hopes, and dreams fulfilled. Caged-ball prostheses underwent numerous modifications in design and materials to improve reliability and prevent specific mechanical and thrombogenic complications. Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses.

A 76-year-old man presented with acute-onset chest pain and dyspnea. He had a history of coronary artery disease, ischemic cardiomyopathy (left ventricular ejection fraction, 25%), recent non-ST-segment-elevation myocardial infarction (NSTEMI), and stenting of the left anterior descending coronary artery (LAD) one month before the current presentation. Soon thereafter, he underwent stenting of the left main coronary artery (LMCA), obtuse marginal branch (OMB), and left circumflex coronary artery. His chest pain subsided soon after arrival at the emergency department. His cardiac troponin I level was 22 ng/mL (normal level, <0.03 ng/mL), and his brain natriuretic peptide level was 841 pg/mL (normal

To the Editor:

Orthostatic hypotension (OH) is broadly characterized by decreases in blood pressure of at least 20/10 mmHg after a person stands up. It is associated with structural or functional autonomic dysfunction in the cardiovascular responsive systems and a consequent failure to accommodate decreased vascular resistance.¹ As many as 30% of people older than 70 years are affected; however, even more may have unrecognized OH or have nonspecific symptoms that lead to misdiagnosis.¹

As people age, progressively harmful changes in the central and peripheral blood vessels can cause conditions such as neurologic or autoimmune diseases, hypertension,

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

Marco KaldasMD,

Moneal ShahMD,

Diana PashaievaBDS,

Georgios LygourisMD, and

Anita RadhakrishnanMD

Continuous Thoracic Paravertebral Block to Treat Electrical Storm

Radiation Doses in Patients Undergoing Computed Tomographic Coronary Artery Calcium Evaluation With a 64-Slice Scanner Versus a 256-Slice Scanner

The Caged-Ball Prosthesis 60 Years Later: A Historical Review of a Cardiac Surgery Milestone

Silent Kawasaki Disease Affecting Multiple Coronary Arteries in a 39-Year-Old Egyptian Woman

Spontaneous Multivessel Coronary Spasm During Diagnostic Coronary Angiography

Bilateral Giant Familial Carotid Body Tumors With Concomitant Skull-Base Paraganglioma and Facial Nerve Palsy

Continuous Arrhythmia Monitoring in Pediatric and Adult Patients With Left Ventricular Noncompaction

Artificial Intelligence in Cardiovascular Medicine: Historical Overview, Current Status, and Future Directions

Artificial Intelligence for Education, Proctoring, and Credentialing in Cardiovascular Medicine

Artificial Intelligence and Machine Learning in Cardiac Electrophysiology

Telerobotic Endovascular Interventions and Their Potential for Cerebrovascular Treatment

Artificial Intelligence in Echocardiography

Is It ST-Segment-Elevation Myocardial Infarction?

Durability Beyond Our Wildest Dreams: The Caged-Ball Valve at 60 Years

Role of Physicians in Guiding Patients Away From Unproven Stem Cell Interventions

Understanding the Market for Unproven Stem Cell

Orthostatic Hypotension and Cardiovascular Death in Older Patients

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

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

Mother and the Bicycle

Free Internal Mammary Artery Graft Reimplantation on the Same Vessel in Repeat Coronary Revascularization

Let Me Heal: An Instant Classic