Faculty Bibliography

Penetrating aortic ulcers (PAUs) are rare exotic pathological entities, classically located in the descending thoracic aorta. Their association with syphilis has never been reported. We describe a first case of a patient with cardiovascular syphilis presenting as PAU in the ascending aorta

Bilateral electrical stimulation of the subthalamic nucleus is being used with increasing frequency as a treatment for severe Parkinson disease (PD). Implantable cardiac defibrillators improve survival in certain high-risk patients with coronary artery disease and ventricular arrhythmias. Because of concern about possible interaction between these devices, deep brain stimulation (DBS) systems are routinely disconnected before defibrillators are implanted in patients with PD and arrhythmia. The authors report on a patient with bilateral subthalamic stimulators who underwent successful placement of an implantable defibrillator. Testing of the devices over a wide range of settings revealed no interaction. The patient subsequently underwent multiple episodes of cardioversion when the ventricular lead became dislodged. There was no evidence of adverse neurological effects, and interrogation of the DBS devices after cardioversion revealed no changes in stimulus parameters. The outcome in this case indicates that DBS systems may be safely retained in selected patients who require implantable cardiac defibrillators

The bidirectional Glenn shunt has been successfully applied as an adjunct to ventricular septal defect closure and pulmonary valvulotomy to treat congenitally corrected transposition of the great arteries (ccTGA). The purpose of this study was to examine the volume and pressure unloading effects of the bidirectional Glenn shunt on the hypertrophied pulmonary ventricle in a canine model of ccTGA. Five beagles underwent survival surgery to band the pulmonary artery. Three months later, a polytetrafluoroethylene graft was anastomosed to the superior vena cava and right pulmonary artery. The graft or superior vena cava was clamped to create the normal or bidirectional Glenn circulation, and hemodynamic data were recorded. The bidirectional Glenn shunt significantly reduced right ventricular volume loading and stroke work. Dogs with normal pre-bidirectional Glenn cardiac outputs had greatly reduced right ventricular volumes and pressures with the bidirectional Glenn shunt. Dogs with pre-bidirectional Glenn right ventricular dysfunction had moderate volume but no pressure decreases with the bidirectional Glenn shunt owing to improved left ventricular output. In these dogs it is likely that the decreased level of pressure and volume unloading is because of a concomitant improvement in left ventricular output post-bidirectional Glenn shunt placement. The bidirectional Glenn shunt is effective at unloading the right ventricle in a canine model of ccTGA