ABSTRACT
During insertion, a transvenous pacing lead pierced the tricuspid valve in a 66-year-old man, causing progressive tricuspid insufficiency and congestive heart failure. The defect remained undiagnosed for ten years and was then repaired. To our knowledge, this is the first case in which this problem has been successfully treated rather than being diagnosed at autopsy.
Subject(s)
Heart Injuries/etiology , Pacemaker, Artificial , Tricuspid Valve/injuries , Wounds, Penetrating/etiology , Aged , Female , Heart Failure/etiology , Heart Injuries/diagnosis , Heart Injuries/therapy , Humans , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/surgery , Wounds, Penetrating/diagnosis , Wounds, Penetrating/therapyABSTRACT
Implantation of a prosthetic heart valve is generally contra-indicated in the presence of infection. A 68-year-old man with chronic osteomyelitis underwent successful double valve replacement, combined with coronary artery bypass, after his draining osteomyelitic fistula was controlled with antibiotics. During the 39 months since surgery, he has shown no sign of paravalvular leakage or infectious complications.
Subject(s)
Coronary Artery Bypass , Heart Valve Prosthesis , Osteomyelitis/drug therapy , Aged , Anti-Bacterial Agents/therapeutic use , Aortic Valve , Chronic Disease , Femur , Fistula/drug therapy , Humans , Male , Mitral Valve , Postoperative Care/methods , Postoperative Complications/prevention & controlABSTRACT
Congenital coronary artery fistulas usually originate from the right coronary artery. Patients with such fistulas rarely reach middle age without symptoms or complications. In the cases presented here, a congenital fistula between the left anterior descending coronary artery and the pulmonary artery was discovered in a 55-year-old man and a 41-year-old man who were being evaluated for angina. The first patient also had coronary artery disease. Both fistulas were successfully treated with ligation and division.
