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A 41-year-old male underwent orthotopic heart transplantation complicated by intraoperative acute allograft failure. The patient required immediate placement of a pneumatic biventricular assist device which was kept for 49 days until graft recovery resulted in successful explantation of the device. The patient was discharged from hospital on postoperative day 112. Management of primary cardiac allograft failure with mechanical ventricular assistance is discussed.

We present 2 cases of delayed diagnosis of rupture of the right hemidiaphragm caused by blunt thoracic trauma, in which herniation of the liver toward the thoracic cavity had occurred. Both patients showed signs of noncardiogenic hepatic venous outflow obstruction. Venous outflow returned to normal on reintroduction of the liver into the abdominal cavity and closure of the defect in the diaphragm. The pathogenesis, diagnosis, and treatment of this problem are discussed.

We report three patients with left ventricular aneurysm who underwent coronary artery bypass grafting and resection of the ventricular aneurysm. The walls of the aneurysms were immunohistochemically investigated to study whether atrial natriuretic peptide was present or not. Immunoreactivity for atrial natriuretic peptide was observed in some of the viable cardiomyocytes within the scar tissue. Mechanisms of regulation of the expression of atrial natriuretic peptide are discussed.

The frequency and clinical significance of intracardiac thrombi after orthotopic heart transplantation are still not fully understood. The aim of this article is to present five patients with heart transplants with intracardiac thrombi and to subject the possible cause, methods of diagnosis, and treatment of this phenomenon to scrutiny. The frequency of intracardiac thrombi may well be higher than anticipated, with emboli occurring only in a small proportion of cases. Hematologic, anatomic, and hemodynamic factors seem to have a bearing on thrombogenesis. Further multicenter studies are required to gain a better understanding of this disorder.

The authors present a new simplified method for implanting temporary epicardial electrodes, which can be carried out extemporaneously during operation from a standard electrode. The modified electrode showed an improvement over the standard electrode in the myocardial thresholds with respect to milliamperage as well as voltage at both atrial and ventricular levels (p less than 0.05 for atrial and P less than 0.005 for ventricular). On the 7th day after placement the modified electrode appears to be more reliable than the standard electrode and demonstrates less degeneration of its threshold and current characteristics (P less than 0.05).