15939911 Visualization

CASE: A 28 Age - year Age - old Age previously History healthy History man Sex presented Clinical_event with a 6 Duration - week Duration history of palpitations Sign_symptom .
The symptoms Coreference occurred during rest Clinical_event , 2–3 times Frequency per Frequency week Frequency , lasted up Detailed_description to Detailed_description 30 Detailed_description minutes Detailed_description at Detailed_description a Detailed_description time Detailed_description and were associated with dyspnea Sign_symptom .
Except for a grade Lab_value 2/6 Lab_value holosystolic Detailed_description tricuspid Biological_structure regurgitation Sign_symptom murmur Sign_symptom (best heard at the left Biological_structure sternal Biological_structure border Biological_structure with inspiratory Detailed_description accentuation Detailed_description ), physical Diagnostic_procedure examination Diagnostic_procedure yielded unremarkable Lab_value findings.
An electrocardiogram Diagnostic_procedure ( ECG Diagnostic_procedure ) revealed normal Lab_value sinus Diagnostic_procedure rhythm Diagnostic_procedure and a Wolff Sign_symptom – Parkinson Sign_symptom – White Sign_symptom pre Sign_symptom - excitation Sign_symptom pattern Sign_symptom (Fig.1: Top), produced by a right Detailed_description - sided Detailed_description accessory Disease_disorder pathway Disease_disorder .
Transthoracic Biological_structure echocardiography Diagnostic_procedure demonstrated the presence of Ebstein's Disease_disorder anomaly Disease_disorder of the tricuspid Biological_structure valve Biological_structure , with apical Sign_symptom displacement Sign_symptom of the valve Coreference and formation of an “ atrialized Disease_disorder ” right Biological_structure ventricle Biological_structure (a functional unit between the right Biological_structure atrium Biological_structure and the inlet Biological_structure [inflow] portion of the right Biological_structure ventricle Biological_structure ) (Fig.2).
The anterior Biological_structure tricuspid Biological_structure valve Biological_structure leaflet Biological_structure was elongated Sign_symptom (Fig.2C, arrow), whereas the septal Biological_structure leaflet Biological_structure was rudimentary Sign_symptom (Fig.2C, arrowhead).
Contrast Detailed_description echocardiography Diagnostic_procedure using Detailed_description saline Detailed_description revealed a patent Disease_disorder foramen Disease_disorder ovale Disease_disorder with right Sign_symptom - to Sign_symptom - left Sign_symptom shunting Sign_symptom and bubbles Sign_symptom in the left Biological_structure atrium Biological_structure (Fig.2D).
The patient underwent an electrophysiologic Diagnostic_procedure study Diagnostic_procedure with mapping Diagnostic_procedure of the accessory Biological_structure pathway Biological_structure , followed by radiofrequency Detailed_description ablation Therapeutic_procedure (interruption of the pathway using the heat generated by electromagnetic waves at the tip of an ablation Therapeutic_procedure catheter Therapeutic_procedure ).
His post-ablation ECG Diagnostic_procedure showed a prolonged Lab_value PR Diagnostic_procedure interval Diagnostic_procedure and an odd Lab_value “second” Lab_value QRS Diagnostic_procedure complex Diagnostic_procedure in leads Detailed_description III, Detailed_description aVF Detailed_description and Detailed_description V2 Detailed_description – V4 Detailed_description (Fig.1Bottom), a consequence of abnormal Disease_disorder impulse Disease_disorder conduction Disease_disorder in the “ atrialized Disease_disorder ” right Biological_structure ventricle Biological_structure .
The patient reported no recurrence of palpitations Sign_symptom at follow Clinical_event - up Clinical_event 6 Date months Date after Date the ablation.