Texas Heart Institute journal
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Anomalous origin of the coronary artery from the opposite sinus of Valsalva and a course of that artery between the ascending aorta and the pulmonary artery is a rare congenital anomaly. It can cause myocardial ischemia, syncope, and sudden cardiac death in young people. Herein, we report the case of a 24-year-old man who was brought to our hospital after cardiac arrest due to ventricular fibrillation. ⋯ Postoperatively, repeat coronary angiography with provocation testing for coronary spasm revealed no myocardial ischemic change. The patient recovered uneventfully. We found that cardiac multidetector computed tomography was useful in evaluating the cause of the sudden cardiac arrest, identifying the anomalous coronary artery, and helping to guide the surgical decisions.
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We reviewed our department's experience with the perioperative features and surgical treatment of isolated right-sided infective endocarditis. From January 2000 through July 2010, 35 patients underwent surgery for isolated right-sided infective endocarditis in our department. The mean pathologic course was 3.6 months. ⋯ Of the patients who underwent tricuspid valvuloplasty, 23 had no valvular incompetence and 11 had mild or moderate regurgitation before discharge from the hospital. During follow-up, no patient needed reoperation because of reinfection, and 1 underwent reoperation for severe tricuspid regurgitation. We conclude that surgery can yield satisfactory immediate and midterm results in the treatment of isolated right-sided infective endocarditis.
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Congenital heart defects that have a component of right ventricular outflow tract obstruction, such as tetralogy of Fallot, are frequently palliated in childhood by disruption of the pulmonary valve. Although this can provide an initial improvement in quality of life, these patients are often left with severe pulmonary valve insufficiency. Over time, this insufficiency can lead to enlargement of the right ventricle and to the deterioration of right ventricular systolic and diastolic function. ⋯ In patients with preoperative ejection fractions of less than 0.50, mean ejection fractions increased by 0.10. We conclude that pulmonary valve replacement in patients with biventricular dysfunction arising from severe pulmonary insufficiency and right ventricular enlargement can improve left ventricular function. Prospective studies are needed to verify this finding.