Randomized controlled trials did not find, aside from atrial fibrillation, the statistically significant reductions in short-term mortality and morbidity demonstrated by observational studies. These discrepancies might be due to differing patient-selection and study methodology. Future studies must focus on improving research methodology, recruiting high-risk patients, and collecting long-term data.

OBJECTIVE:To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decisionmaking process involving treatment choices for ischemic heart disease, on patient decision-making. DESIGN:Randomized, controlled trial. SETTING:The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada. PARTICIPANTS:Two hundred forty ambulatory patients with ischemic heart disease amenable to elective revascularization and ongoing medical therapy. MEASUREMENTS AND MAIN RESULTS:The primary outcome was patient satisfaction with the decision-making process. This was measured using the 12-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores. Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, ؊ 3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patientangiographer disagreement about treatment decisions. CONCLUSIONS:There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decisionmaking autonomy without apparent impact on quality of life. C ardiovascular disease remains the leading cause of mortality in adults. 1 Standard modes of therapy for ischemic heart disease include medical therapy, coronary artery bypass surgery, and angioplasty. Utilization of bypass surgery and angioplasty has increased significantly over the last decade. [2][3][4] In cases of severe coronary artery disease, such as left main disease and triple vessel disease with poor left ventricular function, there is strong evidence that coronary artery bypass surgery can result in a definite survival advantage. 5 However, with less severe disease this survival advantage is uncertain, so the optimal choice of treatment is less clear. [6][7][8][9][10][11][12] In such circumstances, the selection of treatment must be guided not only by possible survival advantages but also by the probability...

Intimal (spindle cell) sarcomas of the left atrium are extremely rare primary cardiac tumours with three cases reported (Li et al. (2013), Cho et al. (2006), and Modi et al. (2009)). We present a 69-year-old man who first came to medical attention after experiencing abdominal discomfort. He had a 30 lb weight loss apparently due to dieting. He denied any other constitutional symptoms. His symptoms persisted despite a course of antibiotics for presumed diverticulitis. Laboratory values were within normal limits, though the haemoglobin was 131 g/L (normal: 140–180). Subsequent abdominal computed tomography (CT) scan revealed an abdominal wall mass and intracardiac lesion; the cardiac mass was further characterized by transesophageal echo (TEE), magnetic resonance imaging (MRI), and dedicated cardiac CT. TEE revealed a mass attached to the posterolateral wall of the left atrium above the mitral annulus, and the cardiac CT and MRI confirmed the TEE findings. The patient underwent extensive surgical resection and repair of the left side of the heart. Postoperatively, he developed acute renal failure requiring dialysis and reintubation for volume overload. He became acutely hypotensive, developed multiorgan failure, and succumbed to his illness. Histopathologic examination of the left atrial mass showed an intimal sarcoma.

Autologous porcine heart cell transplantation improved regional perfusion and global ventricular function after a myocardial infarction.

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While device complications were comparable, patients with HVAD experienced a significantly higher incidence of stroke and GI bleeding and therefore refinement in patients' management may decrease incidence of these complications.

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