case_images: PMC4363960_01
case_images: Ocular pulse amplitude (OPA) waveform tracings of a 49 year old test subject. (a) The upper left panel shows an incidental finding of an unusual shape consistent with an early ventricular contraction. Note that the max OPA is also significantly elevated at >9 mmHg. (b) The upper right panel shows an OPA waveform tracing of the same subject during Valsalva, demonstrating a reduction in the OPA. (c) The lower left panel shows an OPA tracing 1 month postoperatively demonstrating an occasional ectopic beat and reduced OPA amplitude in the normal range. (d) The lower right panel shows an OPA waveform tracing at 6 months postoperatively
case_images: IJO-63-59-g002.jpg
case_images: PMC4363960_01_IJO-63-59-g002.jpg
case_images: F2
case_images: It was noted that the waveform had an unusual shape consistent with an early ventricular contraction every other beat [Fig. 2a]. A digital recording of the patent's OPA during Valsalva was then performed [Fig. 2b]. The waveform revealed occasional ectopic beats at both postoperative visits; however, the frequency of these and the amount of time in bigeminy was drastically reduced [Fig. 2c and d].
case_images: (a) The upper panel shows a section of the preoperative Holter monitor showing bigeminy. (b) The lower panel is an electrocardiographic recording after replacement of the ascending aorta and aortic valve showing normal sinus rhythm
case_images: IJO-63-59-g003.jpg
case_images: PMC4363960_01_IJO-63-59-g003.jpg
case_images: F3
case_images: Holter monitor testing for 24 h revealed a baseline rhythm of normal sinus with first degree atrioventricular block and intermittent episodes of sinus tachycardia, sinus bradycardia and sinus arrhythmia, including isolated premature atrial complexes, premature ventricular complexes and ventricular bigeminy [Fig. 3a]. Postoperative electrocardiogram readings revealed a progressive decrease in the frequency of arrhythmias, with the patient predominantly in normal sinus rhythm [Fig. 3b].
case_images: (a) The left panel shows the preoperative two-dimensional (2D) echocardiography demonstrating aortic regurgitation. (b) The right panel shows the postoperative 2D echocardiography demonstrating resolution of aortic regurgitation
case_images: IJO-63-59-g004.jpg
case_images: PMC4363960_01_IJO-63-59-g004.jpg
case_images: F4
case_images: There was normal right ventricular systolic function and at least moderate aortic regurgitation [Fig. 4a]. Postoperative two-dimensional echocardiography demonstrated resolution of the aortic regurgitation [Fig. 4b].