Traumatic injuries to the tricuspid valve may present years after blunt trauma and may require repair or replacement of the valve. 1 We present images of an avulsed tricuspid valve 3 years following a motor vehicle accident (MVA).A 52-year-old male with a remote history of a myocardial infarction and multivessel coronary stenting presented with right heart failure. Three years prior to admission, he underwent a splenectomy following a MVA. A transthoracic echocardiogram now revealed moderate to severe aortic regurgitation and severe tricuspid regurgitation with an end-diastolic annular dimension of 4.8 cm and a right ventricular systolic pressure of 65 mmHg (Figure 1). An unidentified structure was noted to be "floating" in the right atrium. At the time of surgery, cardiopulmonary bypass (CPB) was established with ascending aortic and bicaval cannulation. Following cardioplegic arrest with cold crystalloid St Thomas solution, a right atriotomy revealed complete avulsion of the anterior-posterior tricuspid valve leaflets from the annulus (Figure 2). The valve was repaired by reattaching the leaflets to the annulus with a running 5-0 prolene suture and performing a modified DeVega reductive annuloplasty with a running 2-0 polyfilament suture (Figure 3). A transverse aortotomy revealed an enlarged annulus with malcoaptation of the aortic valve leaflets, not thought to be related to the previous MVA. The aortic valve was replaced with a #23 St. Jude mechanical prosthesis (Abbott Inc., Abbott Park, IL). The patient was weaned off CPB following 93 min and a crossclamp time of 80 min. He had an uneventful postop course and is asymptomatic 1 year following FIGURE 1 Preoperative transesophageal 3-D echocardiography. Arrow points massive structure floating into the right atrium RA, right atrium; RV, right ventricle FIGURE 2 Gross view of the tricuspid valve before surgery J Card Surg. 2018;33:787-788. wileyonlinelibrary.com/journal/jocs
Giant or Himalayan P waves are tall and peaked, the most prominent in lead II, and generally indicate enlargement of the right atrium. It has been rarely seen in clinical practice. The mechanism of Himalayan P wave formation is most likely related with prolonged conduction of electrical impulses through the enlarged right atrium. We describe the case of a patient with Himalayan P wave admitted for cardiac surgery.
Introduction. Hypertrophic cardiomyopathy is a disorder of the myocardium characterized by asymmetric or symmetric left ventricular hypertrophy. It is often an inherited disorder with an autosomal dominant pattern. The aim of this study was to evaluate the electrocardiographic characteristics of patients with hypertrophic cardiomyopathy, as well as to assess the accuracy of current electrocardiographic criteria for left ventricular hypertrophy used as indicators of hypertrophic cardiomyopathy. Material and Methods. This retrospective study was conducted using hospital medical records of 42 patients with the diagnosis of hypertrophic cardiomyopathy. Detailed electrocardiography analysis, apart from all the usual parameters, included the calculation of indices used to diagnose left ventricular hypertrophy including Sokolow augmented vector left, Cornell voltage, Cornell product, and Sokolow-Lyon index. Results. Sinus rhythm was present in 95.2% of patients, while atrial fibrillation was found in 4.8%. The majority of patients presented with left axis deviation. A slight positive correlation was found between the Sokolow augmented vector left index and posterolateral wall thickness (r = 0.475; p < 0.05), and also between the Cornell voltage index and posterolateral wall thickness (r = 0.368; p < 0.05). A borderline positive correlation was found between the Cornell product index and posterolateral wall thickness (r = 0.290; p = 0.063). Interventricular septum thickness showed no significant correlation with any of the electrocardiographic indices of left ventricular hypertrophy. Conclusion. In patients with hypertrophic cardiomyopathy, the Sokolow augmented vector left and Cornell voltage indices were the best indicators of posterolateral wall hypertrophy, whereas none of the examined indices correlated well with the interventricular septum thickness.
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