No abstract

A left atrial appendage aneurysm is a rare cause of atrial arrhythmia in a young adult. Resection of the aneurysm is uniformly recommended in order to prevent thromboembolism and stroke. In patients without evidence of clot within the aneurysm, operative resection via a limited thoracotomy provides a safe and effective alternative to median sternotomy with cardiopulmonary bypass.

A 14-year-old boy with hypertension, obesity, anxiety, obstructive sleep apnea, and self-reported irritable bowel syndrome presented to an outside hospital with symptoms of nausea, vomiting, diaphoresis, dizziness, and weakness. He also admitted to a long-standing history of loperamide abuse (≤40 mg nightly) to treat his gastrointestinal symptoms and reported missing his nightly dose the previous evening. On the morning of admission, he took 20 mg of loperamide to treat developing gastrointestinal symptoms; this was followed by 1 episode of emesis. His home medications included Carafate, cetirizine, fluticasone, lisinopril, and omeprazole. His family history was negative for cardiac channelopathies, cardiomyopathies, or other significant cardiovascular pathologies. Informed consent was obtained from the family of the patient.

Occult coronary artery obstruction can be a late source of morbidity and mortality following the arterial switch operation for transposition of the great arteries. We describe a case of undiagnosed left coronary ostial obstruction in a teenager which may have contributed to perioperative ventricular dysfunction and subsequent mortality following a reoperation many years after arterial switch.

No abstract