Texas Heart Institute journal
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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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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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We report a case of stab wound to the heart resulting in an atrial septal defect and perforation of the anterior leaflet of the mitral valve, which we repaired successfully 7 years after the injury. To our knowledge, repair of an atrial septal defect due to penetrating trauma has never before been reported. Investigation of possible valvular heart disease in a patient with a history of chest trauma should be aimed at identifying both intracardiac shunts and valvular abnormalities, so that a complete repair can be performed.
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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.