The present report is the first to describe a case of hemoptysis caused by an endocardial pacemaker lead. In addition, the patient presented with endocarditis and tricuspid valve stenosis. Aggressive treatment consisted of surgical extraction of two pacemaker leads and one pacemaker battery, replacement of the tricuspid valve and implantation of a DDD-R epicardial pacemaker.

This study is a prospective trial comparing the incidence of post-operative complications to fluid status in patients undergoing coronary artery bypass grafting (CABG) surgery.One hundred and nine subjects undergoing CABG surgery at the Jewish general hospital were recruited over a 5 months period in the year 2006.All of the patients underwent CABG surgery "on pump".Post operative fluid overload was measured by weight gain.Using logistic regression with complications (major vs. minor only/none) as an outcome and fluid overload as a covariate, the risk of major complications significantly increases for fluid overload ≥5 kg compared to 1 -5 kg (p < 0.001), while the risk for ≤1 kg is not significantly different from 1 -5 kg.Also, the risk of major complications significantly (p = 0.012) increases for days with fluid overload ≥5 days in comparison to ≤1 day.

OBJECTIVES:The purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery. BACKGROUND:It is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery because existing risk assessment tools are incomplete. METHODS:A multicenter prospective cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009. Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and/or valve replacement or repair. The primary predictor was slow gait speed, defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity. RESULTS:The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years; 34% were female patients. Sixty patients (46%) were classified as slow walkers before cardiac surgery. Slow walkers were more likely to be female (43% vs. 25%, p = 0.03) and diabetic (50% vs. 28%, p = 0.01). Thirty patients (23%) experienced the primary composite end point of mortality or major morbidity after cardiac surgery. Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score (odds ratio: 3.05; 95% confidence interval: 1.23 to 7.54). CONCLUSIONS:Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery.

This is a very unusual case with unexpected findings. In spite of sophisticated investigation tests such as MRI and pulmonary angiogram, it may be very difficult to identify the nature of pulmonary artery stenosis or occlusion.