Macro-reentrant Single-loop Biatrial Flutter Appearing as Typical Atrial Flutter: Case Study and Review.

Biatrial flutter is a rare form of macro-reentrant atrial tachycardia that involves both the right and left atria. Single-loop biatrial flutter is typically associated with scarring of the septum from prior ablation or surgery and is generally made up of two interatrial connections-that is, the coronary sinus and Bachmann's bundle. Entrainment and high-density mapping allow for rapid diagnosis and development of a treatment strategy. Ablation planning should also take into consideration the preservation of interatrial conduction. We herein discuss a case of single-loop biatrial flutter presenting as a typical atrial flutter and review the differential diagnosis and physiology of the arrhythmia.

Early experience treating tricuspid valve endocarditis with a novel extracellular matrix cylinder reconstruction.

OBJECTIVE: The short-term outcomes were evaluated in patients treated for tricuspid valve endocarditis using a novel extracellular matrix (ECM) cylinder reconstruction technique. METHODS: Patients with clinically significant tricuspid regurgitation whose valves were not repairable by conventional techniques underwent valve replacement with a cylindrical construct sewn out of CorMatrix ECM (CorMatrix Cardiovascular, Roswell, Ga). The cylinders were sized to the native valve dimensions and attached distally to the papillary muscles using polypropylene sutures and ECM pledgets, and proximally to the annulus using a running suture. Patient data were collected retrospectively. RESULTS: From November 2011 to October 2013, 12 surgeons performed 19 tricuspid valve cylinder reconstructions in 8 men and 10 women (age range, 19-53 years). Of the 19 patients, 11 had active and 5 had treated endocarditis. One case was robotic-assisted. No deaths occurred, and no new cases of heart block developed. The papillary attachments were disrupted intraoperatively in 1 patient and after 7 days in another; both were successfully revised. A third patient experienced recurrent disruption of the implant at 13 and 22 months and ultimately received a pericardial valve. Fungal infection occurred in 1 cylinder at 6 months; a second ECM cylinder was implanted. Follow-up data were available for 13 patients at 1 to 2 months, 8 at 6 months, and 3 at 12 and 18 months. Other than patients undergoing reoperation, all showed well-functioning tricuspid valves with no to mild regurgitation. CONCLUSIONS: Cylinder reconstruction with ECM could be a suitable technique for replacing the tricuspid valve while preserving annuloventricular continuity in patients with infective endocarditis not repairable by conventional techniques.

Repair of intervalvular fibrous body rupture during aortic valve replacement.

The intervalvular fibrosa, the structure that connects the mitral and the aortic valves, can be injured during aortic valve replacement. Although this complication is rare, it may require complex and extensive repair. Herein, we describe management of a damaged aortic-mitral curtain and fibrous body during tissue aortic valve replacement in a patient with mixed connective tissue disorder. A "U" suture repair combining an external and internal reinforcement repair technique via the aorta, without explanting the prosthetic valve technique, is described. The purpose of using the "externalized" buttressed U-stitch was to obliterate any residual cavity and to assure control of hemorrhage externally. Repair of damaged fibrous body during aortic valve replacement (AVR) is challenging. We managed this difficult situation in a satisfactory surgical approach without explanting the aortic prosthesis.

The hemodynamic signs of constrictive pericarditis can be mimicked by tricuspid regurgitation.

A case with clinical and hemodynamic findings consistent with constrictive pericarditis is reported. At surgery, the pericardium was not thickened or adherent to the epicardial wall. As suggested by echocardiography, a diagnosis of severe tricuspid regurgitation was confirmed. This case illustrates that invasive hemodynamic findings consistent with a picture of pericardial constriction can be produced by processes other than constrictive pericarditis.

Nonobstructive membranes of the left atrial appendage cavity: report of three cases.

A membranous structure causing functional stenosis at the mouth of the left atrial appendage (LAA) has been reported. In this study we describe the presence of nonobstructive membranes traversing the cavity of the LAA found incidentally on transesophageal echocardiography (TEE).

Survival in Infarct Related Intramyocardial Dissection Importance of Early Echocardiography and Prompt Surgery.

Infarct related intramyocardial dissection, an unusual mechanical complication associated with recent inferior/inferoposterior myocardial infarction, is characterized by a septal defect and a dissection tract that originates on the left side of the interventricular septum, extends beyond the septum into the right ventricular free wall, and subsequently re-enters the right ventricle. The utility of echocardiography for diagnosis has been described. Despite aggressive therapy, the prognosis of intramyocardial dissection is reported to be dismal. We describe the use of prompt echocardiography in two patients, which established the diagnosis of infarct related intramyocardial dissection allowing early definitive surgery and long-term survival.