Cor triatriatum dextrum is an extremely rare congenital heart abnormality in which the right atrium is separatedinto two chambers by a persistent fibrous membrane. A transvenous approach to place a dual-chamber pacema...Cor triatriatum dextrum is an extremely rare congenital heart abnormality in which the right atrium is separatedinto two chambers by a persistent fibrous membrane. A transvenous approach to place a dual-chamber pacemaker in such patients is technically challenging. We report the first case of a transvenous permanent pacemaker placement in a patient with cor triatriatum dextrum. An 87-year-old woman was diagnosed with paroxysmal atrial fibrillation. She was accidentally found to have cor triatriatum dextrum during the transesophageal echocardiography(TEE) prior to cardioversion. Later during her hospital stay, it was indicated to place a permanant pacemaker due to high grade atrioventricular block. After thorough reviewing TEE imagings, a transvenous catheter-based approach was decided feasible. Patient successfully received a dual chamber pacemaker through left subclavian venous approach. Furthermore in our case, using specially designed pacemaker leads and cautious intra-procedural maneuvering under fluoroscopic guidance ensured procedural success. In summary, a thorough pre-operative evaluation with transesophageal echocardiography is critical for the planning and eventual success of the transvenous placement of rightsided leads.展开更多
<strong>Background:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>Arrhythmias after acute myocardial infarctio...<strong>Background:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>Arrhythmias after acute myocardial infarction are common. Bra</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dyarrhythmias need specific insight into when and how to treat them. <b>Objective</b></span><b style="white-space:normal;"><span style="font-size:10pt;font-family:;" "="">s</span><span style="font-size:10pt;font-family:;" "="">: </span></b><span style="white-space:normal;font-size:10pt;font-family:;" "="">To delineate the incidence, course, and management of different types of</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">bradyarrhythmia</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">s</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> after acute myocardial infarction, </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">the </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">study period was five years. <b>Methods: </b>453 patients with Acute Myocardial Infarction (AMI) were admitted to intensive care in five years. ECGs were analyzed for the presence of bra</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dyarrhythmias and details of management. <b>Results: </b>65 patients with bradycardia were found. Sinus bradycardia </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">in</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> 40, sick sinus syndrome </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">in</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> 10, junctional rhy</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">thm </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">in</span><span style="white-space:normal;fo展开更多
A sinus of Valsalva aneurysm (SOVA) is abnormal dilatation of the either aortic sinuses, area of the aortic root between the aortic valve annulus and the sinotubular junction. Their clinical presentation may range fro...A sinus of Valsalva aneurysm (SOVA) is abnormal dilatation of the either aortic sinuses, area of the aortic root between the aortic valve annulus and the sinotubular junction. Their clinical presentation may range from being asymptomatic as an incidental finding on cardiac imaging to symptomatic presentations related to the compression of adjoining structures or intracardiac shunting caused by rupture of the SOVA mostly into the right side of the heart. The compression leads to findings of tricuspid valve regurgitation, right ventricular outflow tract (RVOT) obstruction and rarely complete heart block (CHB). Dissection or erosion into interventricular septum is one of the rarest complications of SOVA. The symptomatic presentation is almost always a surgical emergency. Here we present a case report of a patient with unruptured sinus of valsalva originating from right sinus dissecting into interventricular septum causing complete heart bock. In this case after surgical correction the complete heart block reverted to sinus rhythm.展开更多
The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertio...The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.展开更多
目的探讨双胎先天性完全性房室传导阻滞(CCHB)的发病机制及防治措施。方法回顾分析新乡医学院第一附属医院新生儿科收治的1例CCHB双胎早产儿的临床资料,并复习相关文献。结果1.病例回顾:37岁无症状孕妇,孕23周胎儿超声心动图提示双胎心...目的探讨双胎先天性完全性房室传导阻滞(CCHB)的发病机制及防治措施。方法回顾分析新乡医学院第一附属医院新生儿科收治的1例CCHB双胎早产儿的临床资料,并复习相关文献。结果1.病例回顾:37岁无症状孕妇,孕23周胎儿超声心动图提示双胎心率下降,房室传导阻滞,母亲完善检查诊断为"未分化结缔组织病",予人免疫球蛋白、地塞米松及羟氯喹等治疗后,孕31周胎儿超声心动图仍提示房室传导阻滞,孕32^+3周因先兆早产行剖宫产,双胎自身抗体筛查均示抗核抗体(ANA)弱阳性,Ro60及Ro52阳性,24 h Holter均提示Ⅲ度房室传导阻滞,宝一对症治疗后出院时体质量增加至2200 g,但仍为CCHB(心室率80~90次/min),宝二住院期间突然出现心率及血压下降,最终心脏骤停,抢救无效死亡。2.文献检索:中文文献2例,英文文献9例,其中9例为抗干燥综合征抗体A(SSA)/Ro和抗干燥综合征抗体B(SSB)/La相关的CCHB,2例为特发性CCHB。结论胎盘转移SSA或SSB是双胎发生CCHB的重要机制,其他因素可能也参与其发病进程。目前的治疗方法仍不尽人意,大多患儿需要起搏治疗,早期诊断和产前管理可改善患儿预后。展开更多
文摘Cor triatriatum dextrum is an extremely rare congenital heart abnormality in which the right atrium is separatedinto two chambers by a persistent fibrous membrane. A transvenous approach to place a dual-chamber pacemaker in such patients is technically challenging. We report the first case of a transvenous permanent pacemaker placement in a patient with cor triatriatum dextrum. An 87-year-old woman was diagnosed with paroxysmal atrial fibrillation. She was accidentally found to have cor triatriatum dextrum during the transesophageal echocardiography(TEE) prior to cardioversion. Later during her hospital stay, it was indicated to place a permanant pacemaker due to high grade atrioventricular block. After thorough reviewing TEE imagings, a transvenous catheter-based approach was decided feasible. Patient successfully received a dual chamber pacemaker through left subclavian venous approach. Furthermore in our case, using specially designed pacemaker leads and cautious intra-procedural maneuvering under fluoroscopic guidance ensured procedural success. In summary, a thorough pre-operative evaluation with transesophageal echocardiography is critical for the planning and eventual success of the transvenous placement of rightsided leads.
文摘<strong>Background:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>Arrhythmias after acute myocardial infarction are common. Bra</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dyarrhythmias need specific insight into when and how to treat them. <b>Objective</b></span><b style="white-space:normal;"><span style="font-size:10pt;font-family:;" "="">s</span><span style="font-size:10pt;font-family:;" "="">: </span></b><span style="white-space:normal;font-size:10pt;font-family:;" "="">To delineate the incidence, course, and management of different types of</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">bradyarrhythmia</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">s</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> after acute myocardial infarction, </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">the </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">study period was five years. <b>Methods: </b>453 patients with Acute Myocardial Infarction (AMI) were admitted to intensive care in five years. ECGs were analyzed for the presence of bra</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dyarrhythmias and details of management. <b>Results: </b>65 patients with bradycardia were found. Sinus bradycardia </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">in</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> 40, sick sinus syndrome </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">in</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> 10, junctional rhy</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">thm </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">in</span><span style="white-space:normal;fo
文摘A sinus of Valsalva aneurysm (SOVA) is abnormal dilatation of the either aortic sinuses, area of the aortic root between the aortic valve annulus and the sinotubular junction. Their clinical presentation may range from being asymptomatic as an incidental finding on cardiac imaging to symptomatic presentations related to the compression of adjoining structures or intracardiac shunting caused by rupture of the SOVA mostly into the right side of the heart. The compression leads to findings of tricuspid valve regurgitation, right ventricular outflow tract (RVOT) obstruction and rarely complete heart block (CHB). Dissection or erosion into interventricular septum is one of the rarest complications of SOVA. The symptomatic presentation is almost always a surgical emergency. Here we present a case report of a patient with unruptured sinus of valsalva originating from right sinus dissecting into interventricular septum causing complete heart bock. In this case after surgical correction the complete heart block reverted to sinus rhythm.
文摘The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.
文摘目的探讨双胎先天性完全性房室传导阻滞(CCHB)的发病机制及防治措施。方法回顾分析新乡医学院第一附属医院新生儿科收治的1例CCHB双胎早产儿的临床资料,并复习相关文献。结果1.病例回顾:37岁无症状孕妇,孕23周胎儿超声心动图提示双胎心率下降,房室传导阻滞,母亲完善检查诊断为"未分化结缔组织病",予人免疫球蛋白、地塞米松及羟氯喹等治疗后,孕31周胎儿超声心动图仍提示房室传导阻滞,孕32^+3周因先兆早产行剖宫产,双胎自身抗体筛查均示抗核抗体(ANA)弱阳性,Ro60及Ro52阳性,24 h Holter均提示Ⅲ度房室传导阻滞,宝一对症治疗后出院时体质量增加至2200 g,但仍为CCHB(心室率80~90次/min),宝二住院期间突然出现心率及血压下降,最终心脏骤停,抢救无效死亡。2.文献检索:中文文献2例,英文文献9例,其中9例为抗干燥综合征抗体A(SSA)/Ro和抗干燥综合征抗体B(SSB)/La相关的CCHB,2例为特发性CCHB。结论胎盘转移SSA或SSB是双胎发生CCHB的重要机制,其他因素可能也参与其发病进程。目前的治疗方法仍不尽人意,大多患儿需要起搏治疗,早期诊断和产前管理可改善患儿预后。
