JACC. Case reports · 2026
Sustained Monomorphic Ventricular Tachycardia Decades After Ventricular Septal Defect Repair.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Kothia Darpan, Mouselli Asaad, Short Lillian, Thomson Erica, Amin Rohit R
Аннотация
BACKGROUND: Ventricular tachycardia can occur decades after ventricular septal defect repair, but surface electrocardiogram (ECG) and noninvasive imaging cannot prove patch-dependent reentry.
CASE SUMMARY: A 57-year-old man with ventricular septal defect patch repair in infancy and no adult congenital heart disease follow-up presented with chest pain, dyspnea, and near-syncope. ECG showed sustained monomorphic ventricular tachycardia at 209 beats/min. Transthoracic echocardiography showed left ventricular ejection fraction 30%, right ventricular dysfunction, moderate-to-severe tricuspid regurgitation, and possible right ventricular thrombus. Transesophageal echocardiography demonstrated fixed postoperative-appearing tissue rather than thrombus. Coronary angiography showed no obstructive disease. After cardioversion, a secondary-prevention dual-chamber implantable cardioverter-defibrillator was placed, and sotalol was initiated with renal and ECG monitoring.
DISCUSSION: The case provides a framework for suspected but unproven postoperative scar-related ventricular tachycardia by separating substrate plausibility from circuit proof.
TAKE-HOME MESSAGE: Repaired ventricular septal defect carries lifelong arrhythmic risk; patch dependency requires electroanatomic mapping, whereas prevention decisions should follow clinical risk.
CASE SUMMARY: A 57-year-old man with ventricular septal defect patch repair in infancy and no adult congenital heart disease follow-up presented with chest pain, dyspnea, and near-syncope. ECG showed sustained monomorphic ventricular tachycardia at 209 beats/min. Transthoracic echocardiography showed left ventricular ejection fraction 30%, right ventricular dysfunction, moderate-to-severe tricuspid regurgitation, and possible right ventricular thrombus. Transesophageal echocardiography demonstrated fixed postoperative-appearing tissue rather than thrombus. Coronary angiography showed no obstructive disease. After cardioversion, a secondary-prevention dual-chamber implantable cardioverter-defibrillator was placed, and sotalol was initiated with renal and ECG monitoring.
DISCUSSION: The case provides a framework for suspected but unproven postoperative scar-related ventricular tachycardia by separating substrate plausibility from circuit proof.
TAKE-HOME MESSAGE: Repaired ventricular septal defect carries lifelong arrhythmic risk; patch dependency requires electroanatomic mapping, whereas prevention decisions should follow clinical risk.