Erratum: Quadricuspid pulmonic valve found on well exam.

[This corrects the article DOI: 10.1186/s40779-015-0037-2.].

Quadricuspid pulmonic valve found on well exam.

Quadricuspid pulmonic valve (QPV) is almost always a benign anomaly and is therefore usually discovered incidentally on radiographic studies or post-mortem at autopsy. Because of its rarity, the true extent of the physiology of QPV is not fully understood, and the few reported cases of it may underestimate its physiological consequences. In this case, we report on a young active-duty solider who presented for a well check-up and was discovered on imaging to have a QPV. We also review the most recent literature and provide recommendations regarding the most effective diagnostic modalities.

Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance.

OBJECTIVES: The purpose of this study was to define the incidence and characterization of cardiovascular cause of sudden death in the young. BACKGROUND: The epidemiology of sudden cardiac death (SCD) in young adults is based on small studies and uncontrolled observations. Identifying causes of sudden death in this population is important for guiding approaches to prevention. METHODS: We performed a retrospective cohort study using demographic and autopsy data from the Department of Defense Cardiovascular Death Registry over a 10-year period comprising 15.2 million person-years of active surveillance. RESULTS: We reviewed all nontraumatic sudden deaths in persons 18 years of age and over. We identified 902 subjects in whom the adjudicated cause of death was of potential cardiac etiology, with a mean age of 38 ± 11 years. The mortality rate for SCD per 100,000 person-years for the study period was 6.7 for males and 1.4 for females (p < 0.0001). Sudden death was attributed to a cardiac condition in 715 (79.3%) and was unexplained in 187 (20.7%). The incidence of sudden unexplained death (SUD) was 1.2 per 100,000 person-years for persons <35 years of age, and 2.0 per 100,000 person-years for those ≥ 35 years of age (p < 0.001). The incidence of fatal atherosclerotic coronary artery disease was 0.7 per 100,000 person-years for those <35 years of age, and 13.7 per 100,000 person-years for those ≥ 35 years of age (p < 0.001). CONCLUSIONS: Prevention of sudden death in the young adult should focus on evaluation for causes known to be associated with SUD (e.g., primary arrhythmia) among persons <35 years of age, with an emphasis on atherosclerotic coronary disease in those ≥ 35 years of age.

Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review.

Coronary artery aneurysms are uncommon, usually associated with atherosclerosis and rarely involve all 3 main coronary arteries. Sudden death from documented thrombosis within large coronary aneurysms has been rarely reported. The authors report a case of a previously healthy 36-year-old male who presented with myocardial infarction complicated by sudden cardiac death. The patient was successfully resuscitated, and coronary angiography revealed diffuse, severe aneurysmal disease without evidence of atherosclerosis. A thrombus was visualized in a large aneurysm of the proximal left anterior descending artery, and there was total occlusion of a second diagonal branch, presumably due to thrombus embolization. The patient had no history of Kawasaki disease, and evaluation revealed no inflammatory or autoimmune condition. Optimal treatment and prognosis for patients with nonatherosclerotic coronary aneurysms remains unclear. Our patient was treated medically with chronic warfarin and low-dose aspirin therapy and recovered without complication.

Importance of transesophageal echocardiography in the evaluation of Staphylococcus aureus bacteremia.

BACKGROUND AND AIM OF THE STUDY: Staphylococcus aureus is a leading cause of bacteremia and is often associated with endocarditis. The diagnosis of endocarditis may be missed when relying on clinical risk prediction, and this has led others to recommend transesophageal echocardiography (TEE) for diagnosis in most cases of S. aureus bacteremia (SAB). The study aim was to determine the likelihood of finding vegetations on TEE in patients with SAB in a suburban teaching hospital setting, and to identify risk factors predictive of vegetation on TEE. METHODS: All cases of SAB at Walter Reed Army Medical Center between January 2000 and May 2003 were evaluated. The prevalence of vegetations was determined in those cases selected for TEE. Potential risk factors for endocarditis were analyzed by review of medical records. RESULTS: A total of 176 patients had documented SAB during the time frame of the study, and 64 of these had TEE performed. Among the latter patients, 14% had a previously unidentified vegetation discovered by TEE. Patients with vegetation on TEE were as likely as those without vegetation to have nosocomial bacteremia, an alternate source of infection, and lack of valvular disease by prior surface echocardiography. Patients with a vegetation were significantly older (mean age 68.4+/-10.9 versus 54.6+/-19.6 years; p = 0.04). CONCLUSION: TEE identified a significant number of vegetations resulting from SAB. The clinical risk profile and transthoracic echocardiography did not reliably exclude vegetation. These findings support the liberal use of TEE for the diagnosis of SAB.