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Ventricular tachycardia following aortic valve replacement
  1. Noor Mohammed,
  2. Uday Dandekar,
  3. Faizel Osman
  1. Department of Cardiology and Cardiothoracic Surgery, University Hospitals of Coventry and Warwickshire NHS trust, Coventry, UK
  1. Correspondence to Dr Noor Mohammed, Department of Cardiology, University Hospitals of Coventry and Warwickshire, Coventry CV2 2DX, UK; drnoorullah{at}yahoo.co.in

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Introduction

A 23-year-old man underwent mechanical bi-leaflet implant following infective endocarditis of native trileaflet aortic valve. He developed sustained runs of ventricular tachycardia (VT) (left bundle branch block (LBBB) morphology) 5 days postoperatively with loss of cardiac output needing external electrical cardioversion. Physical examination revealed an ejection systolic murmur in the aortic area (grade 2/6) and a pan-systolic murmur (grade 4/6) along the left sternal edge with raised jugular venous pressure. Routine blood tests demonstrated leucocytosis and a raised C reactive protein, and chest radiography showed pulmonary oedema. Transoesophageal echocardiography (TOE) was performed (figure 1).

Figure 1

Preoperative transoesophageal echocardiogram image (top) and spectral continuous wave Doppler (bottom).

Question

Based on these images and the clinical data the …

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