Posterior cardiac compression from a large hiatal hernia—A novel cause of ventricular tachycardia Sonali R. Gnanenthiran, MBBS, FRACP, Christopher Naoum,

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Presentation transcript:

Posterior cardiac compression from a large hiatal hernia—A novel cause of ventricular tachycardia Sonali R. Gnanenthiran, MBBS, FRACP, Christopher Naoum, MBBS, FRACP, PhD, Michael J. Kilborn, MBBS, FRACP, PhD, FHRS, John Yiannikas, MBBS, FCCF, FACC, FESC, FCSANZ, FRACP HeartRhythm Case Reports Volume 4, Issue 8, Pages 362-366 (August 2018) DOI: 10.1016/j.hrcr.2018.05.003 Copyright © 2018 Terms and Conditions

Figure 1 Electrocardiogram: ventricular tachycardia. HeartRhythm Case Reports 2018 4, 362-366DOI: (10.1016/j.hrcr.2018.05.003) Copyright © 2018 Terms and Conditions

Figure 2 Transthoracic echocardiography: 4-chamber and 2-chamber views, preoperative (A, B) and postoperative (C, D). Preoperative views demonstrating left atrial compression (red arrow) and dyskinesis of the basal inferior left ventricular wall on resting echocardiography, with such changes resolving post hernia repair. HeartRhythm Case Reports 2018 4, 362-366DOI: (10.1016/j.hrcr.2018.05.003) Copyright © 2018 Terms and Conditions

Figure 3 Proposed mechanism of ventricular tachycardia (VT) secondary to posterior cardiac compression from a large hiatal hernia (long axis view). A: The mitral annulus is a saddle-shaped continuous fibrous ring that is adjacent to the aortomitral continuity (AMC). B: Direct posterior cardiac compression from the hiatal hernia (black arrows) may have resulted in indirect distortion of the anterior mitral annular annulus and/or the basal left septum (blue arrows), aggravating the propensity to VT. HeartRhythm Case Reports 2018 4, 362-366DOI: (10.1016/j.hrcr.2018.05.003) Copyright © 2018 Terms and Conditions

Supplemental Figure 1 ECG pre hiatal hernia repair. HeartRhythm Case Reports 2018 4, 362-366DOI: (10.1016/j.hrcr.2018.05.003) Copyright © 2018 Terms and Conditions

Supplemental Figure 2 ECG post hiatal hernia repair. HeartRhythm Case Reports 2018 4, 362-366DOI: (10.1016/j.hrcr.2018.05.003) Copyright © 2018 Terms and Conditions