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IT IS NOT SIMPLE
A648 JACC April 1, 2014 Volume 63, Issue 12
FIT Clinical Decision Making It Is Not Simple Poster Contributions Hall C Saturday, March 29, 2014, 3:45 p.m.-4:30 p.m.
Session Title: FIT Clinical Decision Making: Congenital and Electrophysiology Abstract Category: Congenital Heart Disease Presentation Number: 1136-02 Authors: Vijaiganesh Nagarajan, Luke Kohan, Robert Battle, University of Virginia, Charlottesville, VA, USA Background: Congenital heart diseases could present at any age. Complex patients may have multiple causes for their symptoms. Case: A 60 year old female patient has been referred to Adult Congenital Clinic for evaluation of possible interstitial lung disease. She was having dyspnea for few months without any relief with antibiotics or steroids. Her past history was significant for coarctation of aorta surgical repair (end to end anastomosis) when she was 2 years old. Cardiac exam showed systolic ejection murmur at left sternal edge and BP of 150/67 mm of Hg. Decision Making: Echocardiogram showed severe aortic stenosis with valve area of 0.82 cm2 and mean gradient of 40 mm of Hg. It also showed possible repeat coarctation and mild mitral stenosis. CT angiogram of chest showed repeat aortic coarctation with luminal narrowing to 11 mm with bicuspid aortic valve. Cardiac catheterization (see image) confirmed findings with transaortic gradient of 64 mm of Hg, recoarctation with gradient of 15 mm of Hg and transmitral gradient of 14 mm of Hg showing severe mitral stenosis. Multiple left side obstructive lesions comprise incomplete form of Shone’s syndrome. Patient is scheduled for aortic valve replacement soon. Conclusion: High index of suspicion is needed to look for associated cardiac defects in congenital heart disease patients as some of these may become clinically significant later in the life. Recurrence of coarctation is possible even after end-end anastomotic surgical repair (3% of cases).
FIT Clinical Decision Making It Is Not Simple Poster Contributions Hall C Saturday, March 29, 2014, 3:45 p.m.-4:30 p.m.
Session Title: FIT Clinical Decision Making: Congenital and Electrophysiology Abstract Category: Congenital Heart Disease Presentation Number: 1136-02 Authors: Vijaiganesh Nagarajan, Luke Kohan, Robert Battle, University of Virginia, Charlottesville, VA, USA Background: Congenital heart diseases could present at any age. Complex patients may have multiple causes for their symptoms. Case: A 60 year old female patient has been referred to Adult Congenital Clinic for evaluation of possible interstitial lung disease. She was having dyspnea for few months without any relief with antibiotics or steroids. Her past history was significant for coarctation of aorta surgical repair (end to end anastomosis) when she was 2 years old. Cardiac exam showed systolic ejection murmur at left sternal edge and BP of 150/67 mm of Hg. Decision Making: Echocardiogram showed severe aortic stenosis with valve area of 0.82 cm2 and mean gradient of 40 mm of Hg. It also showed possible repeat coarctation and mild mitral stenosis. CT angiogram of chest showed repeat aortic coarctation with luminal narrowing to 11 mm with bicuspid aortic valve. Cardiac catheterization (see image) confirmed findings with transaortic gradient of 64 mm of Hg, recoarctation with gradient of 15 mm of Hg and transmitral gradient of 14 mm of Hg showing severe mitral stenosis. Multiple left side obstructive lesions comprise incomplete form of Shone’s syndrome. Patient is scheduled for aortic valve replacement soon. Conclusion: High index of suspicion is needed to look for associated cardiac defects in congenital heart disease patients as some of these may become clinically significant later in the life. Recurrence of coarctation is possible even after end-end anastomotic surgical repair (3% of cases).