Death in low-risk patients is not studied as frequently as it is in other cardiac patients. We, therefore, sought to determine why some low-risk patients die after cardiac surgery. All low-risk patients (EuroSCORE

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The fatigued surgeon has become an object of public concern. This concern has driven great changes in working practice, both in Europe and North America. The effects of acute sleep deprivation and the acutely fatigued state it produces have been studied to a degree. The effects of the inevitable chronic fatigue that a busy clinical practice produces have not yet been addressed. A break from clinical service might enhance performance by providing a much-needed rest. On the other hand, there is reasonable concern that a break from operating might adversely affect performance, by erosion of technical skill. To evaluate the effect of a break from clinical work, we looked at the impact of seven days or more of annual or study leave on the performance of cardiac surgeons.

output. As a result, there would be an increase in V/Q mismatch in zone I pulmonary circulation and increased dyspnea.Although there is a high incidence of patent foramen ovale in the general population (ie, autopsy studies indicate an incidence of 27%), this kind of complication after surgical intervention is occurring more frequently but is not being recognized because of a lack of awareness. 5 The patient has a history of multiple cerebral infarctions and the characteristic pattern of occurrence of dyspnea, and these suggested this syndrome. It is important to note the pattern of occurrence of dyspnea for accurate diagnosis.

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