Baylor University Medical Center Proceedings April 2017 - 233

in the right bundle branch, the part of the atrioventricular
conduction system with the longest refractory period. The
distal part of the right bundle branch was depolarized late,
probably by transseptal conduction, and thus was refractory
when the next impulse arrived. Even longer runs of aberrant
ventricular conduction due to persistent functional refractoriness of the right bundle branch have been misdiagnosed as
ventricular tachycardia, an error recognized by Ashman and
his colleagues (1).
An hour after she arrived in the emergency department, the
patient spontaneously reverted to sinus rhythm. With her lying
on her left side, a soft opening snap and a low-pitched diastolic
murmur of mitral stenosis were heard, as well as a soft murmur
of mitral regurgitation. On chest radiograph, the pulmonary
arteries and the left atrial appendage were large and produced
a straight left heart border.
A transthoracic echo-Doppler study demonstrated a dilated
left atrium with an anteroposterior diameter of 5.6 cm (reference,

April 2017

1.9-4.0). The other chamber sizes were normal. The thicknesses
of the ventricular septum and left ventricular posterior wall
(1.2 cm) were just above the upper limit of normal. The mitral valvular leaflets were thick, calcified, and noncompliant.
The peak diastolic pressure gradient across the mitral valve was
20 mm Hg with a mean gradient of 9 mm Hg. The mitral
valvular orifice area was 0.8 cm2 both by measurement of the
two-dimensional image and by the pressure halftime. Left and
right ventricular systolic function were normal. Mild mitral
and tricuspid regurgitation were noted, and pulmonary arterial
systolic pressure was 60 mm Hg (reference, 15-30). Cardiac
catheterization confirmed the echocardiographic findings,
and coronary arteriography was normal. Mitral valve replacement with a 33 mm St. Jude mechanical prosthesis and the
postoperative course were uneventful.
1.

Gouaux JL, Ashman R. Auricular fibrillation with aberration simulating
ventricular paroxysmal tachycardia. Am Heart J 1947;34(3):366-373.

Atrial fibrillation 50 years after acute rheumatic fever as the first manifestation of rheumatic mitral stenosis

233



Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017

No label
Baylor University Medical Center Proceedings April 2017 - No label
Baylor University Medical Center Proceedings April 2017 - Cover2
Baylor University Medical Center Proceedings April 2017 - 137
Baylor University Medical Center Proceedings April 2017 - 138
Baylor University Medical Center Proceedings April 2017 - 139
Baylor University Medical Center Proceedings April 2017 - 140
Baylor University Medical Center Proceedings April 2017 - 141
Baylor University Medical Center Proceedings April 2017 - 142
Baylor University Medical Center Proceedings April 2017 - 143
Baylor University Medical Center Proceedings April 2017 - 144
Baylor University Medical Center Proceedings April 2017 - 145
Baylor University Medical Center Proceedings April 2017 - 146
Baylor University Medical Center Proceedings April 2017 - 147
Baylor University Medical Center Proceedings April 2017 - 148
Baylor University Medical Center Proceedings April 2017 - 149
Baylor University Medical Center Proceedings April 2017 - 150
Baylor University Medical Center Proceedings April 2017 - 151
Baylor University Medical Center Proceedings April 2017 - 152
Baylor University Medical Center Proceedings April 2017 - 153
Baylor University Medical Center Proceedings April 2017 - 154
Baylor University Medical Center Proceedings April 2017 - 155
Baylor University Medical Center Proceedings April 2017 - 156
Baylor University Medical Center Proceedings April 2017 - 157
Baylor University Medical Center Proceedings April 2017 - 158
Baylor University Medical Center Proceedings April 2017 - 159
Baylor University Medical Center Proceedings April 2017 - 160
Baylor University Medical Center Proceedings April 2017 - 161
Baylor University Medical Center Proceedings April 2017 - 162
Baylor University Medical Center Proceedings April 2017 - 163
Baylor University Medical Center Proceedings April 2017 - 164
Baylor University Medical Center Proceedings April 2017 - 165
Baylor University Medical Center Proceedings April 2017 - 166
Baylor University Medical Center Proceedings April 2017 - 167
Baylor University Medical Center Proceedings April 2017 - 168
Baylor University Medical Center Proceedings April 2017 - 169
Baylor University Medical Center Proceedings April 2017 - 170
Baylor University Medical Center Proceedings April 2017 - 171
Baylor University Medical Center Proceedings April 2017 - 172
Baylor University Medical Center Proceedings April 2017 - 173
Baylor University Medical Center Proceedings April 2017 - 174
Baylor University Medical Center Proceedings April 2017 - 175
Baylor University Medical Center Proceedings April 2017 - 176
Baylor University Medical Center Proceedings April 2017 - 177
Baylor University Medical Center Proceedings April 2017 - 178
Baylor University Medical Center Proceedings April 2017 - 179
Baylor University Medical Center Proceedings April 2017 - 180
Baylor University Medical Center Proceedings April 2017 - 181
Baylor University Medical Center Proceedings April 2017 - 182
Baylor University Medical Center Proceedings April 2017 - 183
Baylor University Medical Center Proceedings April 2017 - 184
Baylor University Medical Center Proceedings April 2017 - 185
Baylor University Medical Center Proceedings April 2017 - 186
Baylor University Medical Center Proceedings April 2017 - 187
Baylor University Medical Center Proceedings April 2017 - 188
Baylor University Medical Center Proceedings April 2017 - 189
Baylor University Medical Center Proceedings April 2017 - 190
Baylor University Medical Center Proceedings April 2017 - 191
Baylor University Medical Center Proceedings April 2017 - 192
Baylor University Medical Center Proceedings April 2017 - 193
Baylor University Medical Center Proceedings April 2017 - 194
Baylor University Medical Center Proceedings April 2017 - 195
Baylor University Medical Center Proceedings April 2017 - 196
Baylor University Medical Center Proceedings April 2017 - 197
Baylor University Medical Center Proceedings April 2017 - 198
Baylor University Medical Center Proceedings April 2017 - 199
Baylor University Medical Center Proceedings April 2017 - 200
Baylor University Medical Center Proceedings April 2017 - 201
Baylor University Medical Center Proceedings April 2017 - 202
Baylor University Medical Center Proceedings April 2017 - 203
Baylor University Medical Center Proceedings April 2017 - 204
Baylor University Medical Center Proceedings April 2017 - 205
Baylor University Medical Center Proceedings April 2017 - 206
Baylor University Medical Center Proceedings April 2017 - 207
Baylor University Medical Center Proceedings April 2017 - 208
Baylor University Medical Center Proceedings April 2017 - 209
Baylor University Medical Center Proceedings April 2017 - 210
Baylor University Medical Center Proceedings April 2017 - 211
Baylor University Medical Center Proceedings April 2017 - 212
Baylor University Medical Center Proceedings April 2017 - 213
Baylor University Medical Center Proceedings April 2017 - 214
Baylor University Medical Center Proceedings April 2017 - 215
Baylor University Medical Center Proceedings April 2017 - 216
Baylor University Medical Center Proceedings April 2017 - 217
Baylor University Medical Center Proceedings April 2017 - 218
Baylor University Medical Center Proceedings April 2017 - 219
Baylor University Medical Center Proceedings April 2017 - 220
Baylor University Medical Center Proceedings April 2017 - 221
Baylor University Medical Center Proceedings April 2017 - 222
Baylor University Medical Center Proceedings April 2017 - 223
Baylor University Medical Center Proceedings April 2017 - 224
Baylor University Medical Center Proceedings April 2017 - 225
Baylor University Medical Center Proceedings April 2017 - 226
Baylor University Medical Center Proceedings April 2017 - 227
Baylor University Medical Center Proceedings April 2017 - 228
Baylor University Medical Center Proceedings April 2017 - 229
Baylor University Medical Center Proceedings April 2017 - 230
Baylor University Medical Center Proceedings April 2017 - 231
Baylor University Medical Center Proceedings April 2017 - 232
Baylor University Medical Center Proceedings April 2017 - 233
Baylor University Medical Center Proceedings April 2017 - 234
Baylor University Medical Center Proceedings April 2017 - 235
Baylor University Medical Center Proceedings April 2017 - 236
Baylor University Medical Center Proceedings April 2017 - 237
Baylor University Medical Center Proceedings April 2017 - 238
Baylor University Medical Center Proceedings April 2017 - 239
Baylor University Medical Center Proceedings April 2017 - 240
Baylor University Medical Center Proceedings April 2017 - 241
Baylor University Medical Center Proceedings April 2017 - 242
Baylor University Medical Center Proceedings April 2017 - 243
Baylor University Medical Center Proceedings April 2017 - 244
Baylor University Medical Center Proceedings April 2017 - 245
Baylor University Medical Center Proceedings April 2017 - 246
Baylor University Medical Center Proceedings April 2017 - 247
Baylor University Medical Center Proceedings April 2017 - 248
Baylor University Medical Center Proceedings April 2017 - 249
Baylor University Medical Center Proceedings April 2017 - 250
Baylor University Medical Center Proceedings April 2017 - 251
Baylor University Medical Center Proceedings April 2017 - 252
Baylor University Medical Center Proceedings April 2017 - Cover3
Baylor University Medical Center Proceedings April 2017 - Cover4
http://www.brightcopy.net/allen/bapr/30-4
http://www.brightcopy.net/allen/bapr/30-3
http://www.brightcopy.net/allen/bapr/30-2
http://www.brightcopy.net/allen/bapr/30-1
http://www.brightcopy.net/allen/bapr/29-4
http://www.brightcopy.net/allen/bapr/29-3
http://www.brightcopy.net/allen/bapr/29-2
http://www.brightcopy.net/allen/bapr/29-1
http://www.brightcopy.net/allen/bapr/28-04
https://www.nxtbook.com/allen/bapr/28-3
https://www.nxtbook.com/allen/bapr/28-2
https://www.nxtbook.com/allen/bapr/28-1
https://www.nxtbook.com/allen/bapr/27-4
https://www.nxtbook.com/allen/bapr/27-3
https://www.nxtbookmedia.com