, Ji-Eun Ban A 16-year-old patient with pectus excavatum visited our hospital because of palpitation. He underwent first Nuss operations at the age of 3. When he was 13 years old, the slow-fast type atrioventricular nodal reentrant tachycardia was documented during electrophysiology study. However, the catheter ablation was not conducted because of recurrent atrial fibrillation during procedure. At that time, second Nuss operation was performed due to progressive chest wall deformity. And then, atrioventricular nodal reentrant tachycardia was successfully treated by radiofrequency catheter ablation at the higher position than usual slow pathway zone under the modified fluoroscopic view with the cranial angle although distorted right atrial geometry and radiographic obstacle of Nuss operation bar. The concern about abnormal cardiac and electrical anatomy, and the accurate and modified procedure technique are essential in patients with pectus excavatum. (Ewha Med J 2022;45(3):e6)
Citations
, Ji-Eun Ban Cardiac rhabdomyomas are typically presented in the tuberous sclerosis. Although benign and often associated with spontaneous regression, in rare circumstances huge mass size and critical location can lead to heart failure, ventricular outflow tract obstruction and refractory tachyarrhythmias. An 1-day-old girl was diagnosed as cardiac tumor during perinatal period. At birth, transthoracic echocardiography revealed huge cardiac mass located in septal area of both ventricle measuring 34×30 mm. It protruded into the left ventricular (LV) outflow tract, potentially obstructing it. A surface ECG revealed atrial tachycardia with nonsustained ventricular tachycardia with heart rate of 217 beats per min. The tachyarrhythmias were controlled with intravenous amiodarone. Reduction of the giant cardiac mass was treated with mammalian target of rapamycin pathway inhibitor sirolimus. However, she unfortunately died at 10 days-old because of sudden cardiac arrest maybe due to LV outflow tract obstruction during therapy. Gene analysis revealed TSC2 mutation after death. (Ewha Med J 2022;45(3):e5)
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, Se Hwan Ahn, Jong Han Kim, Su Yeong Kim, Ji-Eun Ban Although Atrial flutter (AFL) in newborn infant with normal cardiac anatomy has benign clinical course, an intractable AFL is associated with an increased risk of development of heart failure and sudden death, and is still difficult to manage. It requires multiple external electrical cardioversions, and it shows a poor response to antiarrhythmic drug therapy. We report a case of a premature infant with an intractable AFL, which we successfully treated with oral flecainide and propranolol in spite of recurred AFL. A 1-month-old, 34-week gestation, premature baby presented with an irregular heart beat and irritability. An AFL with 2:1 atrioventricular conduction was documented. Because of the intractable AFL, repeated electrical cardioversion and amiodarone were continued for 14 days. However, amiodarone was discontinued in favour of flecainide and propranolol because of the recurrent AFL and newly developed transient hypothyroidism. During 1-year follow-up period, in which oral flecainide and propranolol were continued, no AFL was observed.
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