Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

9-month-old with recurrent episodes of supraventricular tachycardia despite medical therapy

Case Hi, I’m calling about a 9-month old infant, that you follow, with supraventricular tachycardia. She presented today after the parents noted that her heart rate was elevated to our urgent care. Heart rate was steady at about 220 bpm and mom said they first noted it about 2 h ago. We were able to apply ice to the face and forehead a couple of times that…

2-month-old presenting to the ER with tachycardia, fussy, unable to eat

Case Hi, I’m calling from the Children’s Emergency Room and I have a 6-week-old female that is having tachycardia at a rate of 210 beats per minute (bpm). Baby looks OK but is breathing a little fast and appears a bit mottled. The mother reports that she has not been eating all that well over the past 48 hours and has been fussy. She’s only had…

NICU infant noted to have extrasystoles on cardiac monitor

Case You receive a call from the neonatal intensive care unit (NICU) regarding an ex-34 week premature infant. “I have this 1 week old male infant who is here for a persistent oxygen requirement and feeding issues. The baby was intubated after delivery but now has weaned to 1 liter of oxygen via nasal cannula. The baby has been on parenteral nutrition but is receiving some feeds…

Atrial Fibrillation and Thrombus in a Patient With a Fontan Circulation: Submitted by Lara Curran, MBBS, BSc, Konstantinos Dimopoulos, MD, MSc, PhD, FESC and Rafael Alonso-Gonzalez, MD, MSc, FESC

Case Synopsis A 38-year-old gentleman presented to a routine clinic appointment describing a 4-month history of daily episodes of palpitations lasting between 10 and 20 min and declining exercise tolerance. Although he was continuing to work full time as a support worker in a care home, the severity of his symptoms meant that he was struggling to complete daily activities of living without becoming limited by…

Postventricular Septal Defect Repair With Bradyarrhythmias and Sudden Death: Submitted by Berardo Sarubbi, MD, PhD

Case Synopsis A.V., a 16-year-old male, was admitted to our cardiac tertiary center because of recurrent episodes of palpitations and recent episodes of “dizziness.” At the age of 1 year, he underwent a surgical repair of a perimembranous ventricular septal defect with a Gore-Tex patch, which was complicated by transient (4 days) complete heart block. His preoperative ECG was completely normal, without conduction disturbances. Two years…

Repaired Complete Atrioventricular Septal Defect Patient With Late Bradyarrhythmia: Case Presentation by Matthias Greutmann, MD, FESC

Case Synopsis We report the case of a patient with repaired atrioventricular septal defect (AVSD) and trisomy 21. He underwent surgical repair at the age of 12 years by dual patch technique. Three years later he had a second repair operation for residual ventricular septal defect and severe regurgitation of both atrioventricular (AV) valves. At the age of 17 years he had an episode of intra-atrial…

A Crisscross Heart With Brady-Tachy Issues: Case submitted by Vivienne Ezzat, MBChB

Case Synopsis A 39-year-old man was referred to the congenital heart disease (CHD) arrhythmia service in 2015. He was known to have crisscross heart with situs solitus, atrioventricular (AV) concordance, ventriculoarterial (VA) discordance, a large unrestrictive inlet ventricular septal defect (VSD), and a dysplastic pulmonary valve with severe pulmonary valve stenosis. His only intervention was a right-sided Blalock-Taussig (BT) shunt performed when he was 4.5 months…

Transposition Patient With Mustard’s Operation and Brady-Tachy Issues: Case submitted by Vivienne Ezzat, MBChB

Case Synopsis A 30-year-old female was referred to the congenital heart disease arrhythmia service in 2016. Diagnoses were transposition of the great arteries (TGA), bilateral superior vena cavae [with a left superior vena cava (SVC) draining into the systemic venous atrium (SVA) with no bridging vein], and Crohn's disease. She underwent atrial septostomy soon after birth and again at 5 months (balloon and blade, respectively), followed…

Tetralogy of Fallot and Biventricular Heart Failure: Submitted by Adam J. Small, MD and Jeremy Moore, MD

Case Synopsis AGE: 18 years GENDER: Male PERSONAL INFORMATION: High school senior WORKING DIAGNOSIS: Repaired Tetralogy of Fallot with progressive severe biventricular dysfunction in the setting of sinus node dysfunction and refractory atrial arrhythmias. History The patient was born with tetralogy of Fallot and underwent complete repair with transannular patch and ventricular septal defect closure in infancy. By age 16 he had developed progressive right heart…

Complex Congenital Heart Disease With Brady-Tachy Syndrome and Antitachycardia Pacing

Case Synopsis This case involves a 33-year-old woman with complex congenital heart disease consisting of heterotaxy with a single systemic right ventricle, pulmonary artery atresia, and an interrupted inferior vena cava (IVC) with hemiazygous continuation to a persistent left superior vena cava (SVC) ( Fig. 12.1 ). She is status postpulmonary artery banding, creation of bilateral bidirectional cavopulmonary anastomoses (Kawashima procedure), creation of a lateral tunnel Fontan,…

Transposition With Mustard Operation Patient With Risk of Sudden Death: Case submitted by Jim T. Vehmeijer, MD, Barbara J.M. Mulder, MD, PhD, Joris R. de Groot, MD, PhD

Case Synopsis A 37-year-old man with transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary valve stenosis presented with a history of Mustard repair, surgical VSD closure, and pulmonary valvulotomy. Because of sick sinus syndrome and intermittent complete atrioventricular (AV) block he underwent permanent pacemaker implantation in 2006. Atrial and ventricular leads were routed via the systemic venous baffle to the left atrium…

Fontan Patient With Brady and Tachyarrhythmia Issues: Case Submitted by Vivienne Ezzat, MBChB

Case Synopsis A 34-year-old man was referred to the congenital heart disease arrhythmia service in 2015. Original diagnoses were tricuspid atresia and pulmonary stenosis. Previous interventions were a left modified Blalock-Taussig shunt in 1980 as an infant; atriopulmonary Fontan operation in 1983 (aged 3 years) with subsequent conversion to an intracardiac total cavopulmonary connection (TCPC) fenestrated (4 mm) lateral tunnel, resection of right atrium (RA) wall,…

Postmaze Atrial Tachycardia: Case Submitted by: Berardo Sarubbi, MD, PhD

Case Synopsis AR was the only daughter of normal parents, with no family history of cardiac abnormalities. A cardiac murmur was heard at 8 days. At 3 years, palpation confirmed a thrill, and investigations confirmed the presence of a huge ostium secundum atrial septal defect with moderate pulmonary stenosis. At the age of 10 years she underwent an uncomplicated atrial septal defect closure and pulmonary valvotomy.…

Resynchronization Therapy and Sudden Death Management in Congenitally Corrected Transposition: Submitted by Damien Cullington, MBChB (Hons), MD, MRCP, FESC

Case Details History of Presenting Medical Complaint A 38-year-old man presented to his local hospital with a 9-month history of expectorating small volumes of hemoptysis preceded by exertional dyspnoea for 4–5 months. He also gave a history of two brief episodes of dizziness but no syncope. He was referred following a recording of his 12 lead ECG which showed complete heart block (CHB) ( Fig. 8.1 ).…

Ebstein Anomaly With Atrial Tachycardia: Case submitted by James Oliver, MBChB, PhD, MRCP

Case Synopsis Diagnoses Ebstein anomaly of the tricuspid valve (TV). TV repair with right atrial (RA) cryoablation and epicardial pacemaker, February 2015. TV replacement, March 2016. Very troublesome atrial tachyarrhythmia with multiple direct current (DC) cardioversions and ablations. Type 2 diabetes. Gout. Varicose veins. Initial Assessment, 2011 The patient is a 49-year-old male seen in our center for the first time in October 2011 following referral…

Transposition With Atrial Switch and Risk of Sudden Death: Submitted by Marc G. Cribbs, MD, FACC

Case Synopsis LB is a 26-year-old male with a history of dextro-transposition of the great arteries (DTGA) and intact ventricular septum. Desaturation and restriction of atrial level flow was almost immediately apparent and balloon atrial septostomy was performed just hours after he was born. At 3 months of age, he underwent a Senning-type atrial switch operation. One month after surgery, he was admitted with an atrial…

Ebstein Anomaly After Tricuspid Valve Replacement Needing Pacemaker Implantation: Case submitted by Christopher J. McLeod, MBChB, PhD

Case Report A 61-year-old man with a history of Ebstein anomaly underwent valve repair with concomitant intraoperative ablation of an accessory pathway and right atrial maze procedure in 1997 at age 41. This was followed by tricuspid valve replacement in 2001 with a 35-mm Carpentier-Edwards bioprosthesis. Owing to recurrent symptomatic paroxysmal atrial fibrillation, he then underwent a successful pulmonary vein isolation (PVI) procedure in 2004. The…