Low-dose postoperative beta-adrenergic blockade is valuable for patients who receive these medications before off-pump coronary artery bypass grafting procedures and may be beneficial against AF in all patients.

Brucella endocarditis, although a rare complication of brucellosis, is a life threatening and often under-diagnosed complication. Despite its high mortality rate with combined medical and surgical treatment, has a low occurrence rate in cases of brucellosis. Here we describe a patient who underwent mitral valve replacement for 3 times due to underdiagnosis of Brucella endocarditis. If a valve replacement fails because of an unknown reason, the doubt of a Brucella infection should be kept in mind for accurate treatment of such patients.

Temporary wires are routinely sutured to both the atrial and ventricular epimyocardium after open heart surgery. Despite their rarity, complications related to removal of such pacemaking wires may cause life threatening situations. We describe here a patient who developed ventricular fibrillation immediately after removal of temporary epicardial pacemaking wires.

We had good success using aggressive early debridement, closure of the sternal halves with titanium plates, mobilization of muscular flaps, high-volume mediastinal irrigation, and intravenous antibiotics. This approach was a successful salvage technique for revision cases in achieving sternal stability and union when standard methods of closure failed or were unlikely to succeed.

Coronary artery aneurysms may predispose to acute thrombosis, embolisation and myocardial ischaemia or rupture with subsequent tamponade and/or sudden death. The optimal therapy for patients with coronary artery aneurysm is unknown, and controversy persists regarding the use of medical or surgical modalities. There is no doubt that surgical therapy is reserved for cases with large aneurysms or with myocardial ischaemia due to significant associated coronary artery stenoses. We discuss here the surgical management of a case with coronary artery aneurysm and concomitant coronary artery disease. Although the beating heart technique of myocardial revascularisation and repair of coronary artery aneurysm without cardiopulmonary bypass is not suitable for all patients, it should be considered for those high-risk patients who have impaired left ventricular function or who are at high risk for pulmonary or neurological complications.

Left atrial dissection is a severe but rare complication, and it is generally associated with mitral valve interventions. But other predisposing factors should be considered in pathogenesis. Here we describe a patient who developed interatrial dissection following a mass removal from right ventricle. The dissection was recognised with transesophageal echocardiography and it was spontaneously cured with conservative therapy. Transesophageal echocardiography is strongly recommended during and after operations in patients with heart valve interventions in order to recognise such rare but severe complications.

Levosimendan (LS) is a novel calcium sensitizer drug that enhances cardiac contractility without increasing myocardial oxygen consumption, and induces vasodilatation. Positive inotropic support is routinely used for weaning from cardiopulmonary bypass circulation in patients with reduced left ventricular function. This case report represents the successful usage of LS for weaning from cardiopulmonary bypass circulation after coronary artery bypass surgery. Levosimendan infusion was started at the sixth hour of cardiopulmonary bypass circulation. There was a dramatic increase in cardiac output 20 minutes after LS infusion, and weaning from cardiopulmonary bypass circulation was achieved. We suggest that LS enhances cardiac performance during and after cardiopulmonary bypass, and can be useful for patients who are unable to be weaned from cardiopulmonary bypass.

No abstract