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Recent use of clopidogrel before off-pump coronary artery bypass grafting is associated with greater risk for bleeding with similar mortality rate.

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Endocardite em marca-passo: abordagem na extração do cabo-eletrodo em endocardite com grandes vegetações Pacemaker endocarditis: approach for lead extraction in endocarditis with large vegetations AbstractThe presence of large lead vegetations poses additional difficulties for explantation because many methods cannot be used due to the potential hazard of embolism. We report two patients with large vegetation on the ventricular lead due to endocarditis and one of them with an atrial septal defect associated. It was applied a combined technique of transvenous lead removal and sternotomy with cardiopulmonary bypass for the complete removal of pacemaker wires. This procedure resolved the pacemakers endocarditis safely and subsequently a new transvenous device was placed on the opposite site.Descriptors: Endocarditis. Endocarditis, bacterial. Pacemaker, artificial. ResumoA presença de grande crescimento vegetativo no eletrodo do marca-passo impõe dificuldades adicionais para a sua extração, pois alguns métodos não podem ser aplicados pelo risco potencial de embolismo. Reportamos dois pacientes com grande crescimento vegetativo no eletrodo ventricular, devido a endocardites, um deles com comunicação intraventricular associada. Foi aplicada uma técnica combinada de extração de eletrodo transvenosa e esternotomia com circulação extracorpórea para remoção completa dos cabos do marcapasso. Este procedimento resolveu a endocardite de marcapasso de maneira segura e, subsequentemente, foi colocado um novo dispositivo intravenoso no lado oposto. Descritores INTRODUCTIONInfections involving implantable electrophysiologic cardiac devices are increasing due to the wide use of these implants all over the world. It causes severe morbidity and mortality outcomes and requires complete device replacement [1]. Several studies of pacemaker endocarditis strongly support the complete removal of the device, and the availability of technology that allows the extraction of the device by percutaneous route has facilitated the non-operative removal [2]. Sometimes, such approach is not possible to perform. The presence of large lead vegetations or a septal atrial defect poses additional difficulties for explantation as many methods cannot be used because the potential hazard of embolism. Besides this, the procedure is not 100% effective and it could fail. In a few cases, combined techniques (transvenous lead removal and by sternotomy with cardiopulmonary bypass) are necessary [3].We described both patients with large vegetation on the ventricular lead due to endocarditis and one of them with an atrial septal defect associated. 571VACCARINO, GN ET AL -Pacemaker endocarditis: approach for lead extraction in endocarditis with large vegetations Bras Cir Cardiovasc 2009; 24(4): 570-573 Rev

Bronchogenic cysts are congenital anomalies of the respiratory tract, which can affect children or adults. In adults, these cysts may be asymptomatic or present with symptoms, most often pain or cough. Intrapericardial cysts are rare and represent 27% of bronchogenic cysts. We present the case of a symptomatic adult with an intrapericardial bronchogenic cyst, who underwent surgical resection of the cyst, which successfully relieved his symptoms.

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Use of glue should be avoided for coronary reimplantation during Bentall surgery. In cases of external ostial compression by glue reaction, stenting may be ineffective and surgical coronary revascularization may be needed.