OBJECTIVE: Some antidepressants have been implicated as risk factors for QT prolongation, which is a predictor of sudden cardiac death. However, the QT interval is considered an imperfect biomarker for proarrhythmic risk. Therefore, we reevaluated the risk of sudden cardiac death due to antidepressants using improved methods, namely, QT dispersion (QTD), T wave peak-to-end interval (Tp-e), and Tp-e/QT ratio. METHODS: We compared the effects of antidepressants on QTc (QT/RR1/3), QTD, Tp-e, and Tp-e/QT ratio in 378 patients with mood disorder. We also compared each index between 165 healthy controls and 215 randomly selected age-matched patients. RESULTS: Age (p < 0.01), sex (p < 0.05), tricyclic antidepressant (TCA) use (p < 0.05), and clomipramine (p < 0.01) and mianserin (p < 0.05) use in particular, significantly associated with a prolonged QTc. We also found that age (p < 0.01), TCA use (p < 0.05), and clomipramine (p < 0.01) and mianserin (p < 0.05) use in particular, significantly prolonged QTD. However, there was no correlation between each variable and Tp-e or Tp-e/QT ratio. Significant differences in QTc and QTD were found between the patients and healthy controls. CONCLUSION From our results, prediction of risk of sudden cardiac death by QTD, Tp-e, or Tp-e/QT ratio was inconsistent. Increased QTD may be more suitable for predicting sudden cardiac death due to antidepressants.

A 15-year-old boy with coronary sinus type atrial septal defect (CS-ASD) was surgically treated with 3-port totally endoscopic technique. The patient was set in a left semi-lateral position. A 3 cm skin incision retracted by a small wound protector, a trocar for the endoscope, and a trocar for left-handed instruments were placed in the right antero-lateral chest. Cardio-pulmonary bypass was established via groin cannulation. After cardioplegic arrest, the CS-ASD was favorably exposed through the left atriotomy, and closed using a bovine pericardial patch. The total operation time was 112 min. The post-operative course was uneventful. Instead of the traditional median sternotomy and right atriotomy, small right thoracotomy and left atriotomy may be a promising alternative for closure of CS-ASD.

A 68-year-old man was referred to our hospital for mitral valve stenosis, tricuspid valve insufficiency and atrial fibrillation. We performed mitral valve replacement, tricuspid valve plasty, and the MAZE operation through a right small thoracotomy under endoscopic assistance. He was discharged uneventfully 7 days after the operation. However, about 2 months later, he developed pericardial effusion, right pleural effusion, and leg edema implying as having right heart failure. Although he was treated with diuretics and steroids, improvement was temporary and he was hospitalized repeatedly. Cardiac catheterization demonstrated dip and plateau pattern of the right ventricular pressure curve. We diagnosed that he has constrictive pericarditis, although the finding of the chest CT was non-specific without remarkable thickening or calcification of the pericardium. We performed pericardiectomy through median sternotomy without pump assist. Leather-like thickening of the pericardium was recognized in the right, anterior, and inferior portion. Resection of the thickened pericardium led to instantaneous improvement of right ventricular motion and drop of central venous pressure. The patient is in NYHA Class I, one year after pericardiectomy. Constrictive pericarditis could occur even after minimally invasive surgery, and that possibility should be kept in mind if intractable right heart failure persists.