Heart, lung & circulation
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Heart, lung & circulation · Feb 2012
Case ReportsInversion of the left atrial appendage: a complication of cardiac surgery.
An inverted left atrial appendage which fails to revert spontaneously is a rare complication of cardiac surgery. We present a case of an inverted left atrial appendage discovered intraoperatively on transoesophageal echocardiography. ⋯ Intraoperative transoesophageal echocardiography plus an awareness of the possibility that a newly presenting left atrial mass post-bypass might be an inverted left atrial appendage, facilitates immediate correction. So doing removes any need for further investigation or further cardiac surgery and reduces the risk of a subsequent thromboembolic event if the diagnosis is not made until later.
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Heart, lung & circulation · Jan 2012
Infective endocarditis and rheumatic heart disease in the north of Australia.
To prevent infective endocarditis (IE), Australian guidelines recommend providing prophylactic antibiotics to Indigenous patients with rheumatic heart disease (RHD) prior to procedures which may cause bacteremia. In northern Australia RHD remains prevalent. We aimed to determine whether RHD is associated with an increased risk of IE, which risk factors are associated with IE, and the incidence and aetiology of IE. ⋯ In northern Australia the principle risk factor for IE is not RHD. Whilst RHD increased the risk of IE it was not restricted to Indigenous Australians. Current Australian recommendations of providing prophylactic antibiotics to Indigenous patients with RHD prior to procedures which may cause bacteremia may need to be broadened to include non-Indigenous patients.
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Heart, lung & circulation · Dec 2011
Cardiac genetic investigation of young sudden unexplained death and resuscitated out of hospital cardiac arrest.
Nearly 30% of young sudden deaths have negative autopsies and these sudden unexplained deaths (SUDs) are presumed to be due to heritable cardiac arrhythmias attributed to cardiac ion channel disorders. Comprehensive cardiac and genetic testing of families of SUD is helpful in the detection of inherited cardiac genetic conditions. ⋯ Out of Hospital Cardiac Arrest (OHCA) victims and their families also require similar assessment, although the role of genetic testing in this group should be reserved to patients where a clinical diagnosis is established. A team approach with multidisciplinary specialised clinics and increased access to genetic analysis is very helpful in achieving these goals.
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Heart, lung & circulation · Nov 2011
Case ReportsProphylactic left thoracic sympathectomy to prevent electrical storms in CPVT patients needing ICD placement.
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induced by sympathetic stimulation in susceptible individuals is often refractory to antiarrhythmic agents. First line of treatment, beta-blockers can be ineffective in up to 50% with implantable cardioverter-defibrillator (ICD) placement for refractory cases. Paradoxically ICD can be arryhthmogenic from shock-associated sympathetic stimulation, initiating more shocks and "electrical storms". ⋯ Sympathectomy has been traditionally performed long after ICD placement, after the patient has experienced multiple shocks, thus necessitating two procedures. We report simultaneous ICD insertion and thoracoscopic sympathectomy in a 10 year-old boy with CPVT, and suggest it as a better approach than sequential procedures. To our knowledge this is first such reported case.