Texas Heart Institute journal
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We describe an operative technique used in 30 patients from 1982 to 1995, in which sinus venosus atrial septal defect with anomalous pulmonary venous connection is repaired through longitudinal incision confined to the vena cava. A single oval patch is folded like the wings of a butterfly: the posterior wing is used to separate superior vena caval and pulmonary venous blood, and the anterior wing is used to enlarge the terminal cava. ⋯ Operative findings suggest that the sinus venosus defect is a malformation involving abnormal confluence of sinus venosus, anomalous right superior pulmonary, and right common cardinal veins. Further, the sinus venosus contributes more to the formation of the right atrium, displacing the crista terminalis downward and forward and separating the atrial component of the right atrium from the terminal cava.
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Since 1988, reparative techniques have been used at our institution to treat valvular insufficiency in selected patients with aortic valve disease. The limitations of aortic valve replacement are well recognized; it is this knowledge that has motivated us to find out whether a subgroup of patients who have aortic insufficiency might be candidates for preservation of their native aortic valves. This subgroup includes patients who have leaflet prolapse, perforation, or calcification. We describe our methods of patient evaluation and selection, as well as our surgical techniques for both bicuspid and tricuspid aortic valve repair.
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Case Reports
Transesophageal electrocardiography and adenosine in the diagnosis of wide complex tachycardia.
The diagnosis of wide complex tachycardia based on surface electrocardiography can be difficult. Misdiagnosis occurs frequently and is commonly associated with increased morbidity and mortality. We describe a case of wide QRS complex tachycardia in which transesophageal electrocardiography and intravenous adenosine were used to obtain a reliable diagnosis. These are safe and readily available tools for elucidating the mechanism of wide complex tachyarrhythmias in hemodynamically stable patients.
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Papillary fibroelastoma is a rare cardiac tumor arising most frequently from valvular endocardium. These tumors are clinically important because of their tendency to embolize. ⋯ To our knowledge, only 2 such cases have been reported in the English literature. Our case illustrates the discovery of a rare, but potentially fatal cardiac tumor, successfully removed by surgery.