Hypertension, diabetes, chronic obstructive pulmonary disease, New York Heart Association (NYHA) Class III-IV, use of angiotensin converting enzyme (ACE) inhibitors, chronic renal failure, and female gender were the significant preoperative risk factors for increased volume replacement during CPB. The groups were similar in body mass index, preoperative hematocrit values, total fluid balance in the intensive care unit (ICU), and total chest tube output. However, red blood cells' transfusion rate, readmission rate to the ICU and length of hospital stay were significantly higher in Group 2 patients. Multiple logistic regression revealed that age > 70 years (p < 0.001, Odds Ratio (OR): 2, 95% CI: 1.4-2.8), and total fluid balance > 500 mL at the end of the operation (p < 0.01, OR: 2.2, 95% CI: 1.5-3.2) were the predictors of increased length of stay. For transfusion of red blood cells, age > 70 years (p < 0.0001, OR: 2.3, 95% CI: 1.6-3.3), and total fluid balance > 500 mL at the end of the operation (p < 0.001, OR: 2, 95% CI: 1.3-2.9) were the only significant risk factors. This study suggests that intraoperative volume overload increases blood transfusion and length of hospital stay in patients undergoing CABG.

The expected morphology of right ventricular pacing is a left bundle branch block (LBBB) pattern. However, right bundle branch block (RBBB) can also be seen during permanent right ventricular pacing. The aim of this study was to develop an electrocardiographic algorithm to differentiate this benign condition from septal and free wall perforation with subsequent left ventricular pacing. Three hundred consecutive patients who had permanent ventricular or dual-chamber pacemaker implantation between 1999 and 2000 were screened and 25 patients (8.3%) who exhibited RBBB configuration were included in the study. Echocardiograms and chest radiographs were evaluated in order to identify the pacing lead location in this group. The authors formed a study group with their own 25 patients and 22 cases of RBBB with permanent pacemaker from previous publications (total 47 patients). Frontal axis, QRS morphology in lead V(1), and the precordial transition point, which is defined as the precordial lead where R wave amplitude is equal to S wave amplitude, were examined. Placement of precordial leads V(1) and V(2) 1 interspace lower than the standard location (Klein maneuver) eliminated the RBBB pattern in 12 patients. RBBB pattern with "true right ventricular pacing" was detected in 24 of the 25 patients, and in 11 of the 22 patients reported in the literature (total 35 patients). Right ventricular pacing was correctly identified in 34 of 35 patients with use of criteria including left superior axis deviation, RS or qR morphology in lead V(1), and precordial transition at lead V(3) with a high sensitivity and specificity. A simple surface electrocardiogram can accurately predict the lead location in patients having RBBB morphology with right ventricular pacing.

Tricuspid valve perforation with pacemaker lead is one of the extremely rare complications of transvenous pacemaker implantation. Approximately all reported cases have been diagnosed at autopsy. The authors present a case of tricuspid valve perforation caused by pacemaker lead that was diagnosed during cardiac surgery and treated successfully by removing the lead and suturing the tricuspid valve.

A 16-year-old girl with atrial arrhythmia underwent excision of thickened pericardium with localized annular calcification over the proximal right ventricle. Sinus rhythm was restored postoperatively. Constrictive pericarditis and localized cardiac compression should be considered in the differential diagnosis of arrhythmias in young patients.