Atrial automatic ectopic tachycardia successfully treated with encainide in a 4-week-old infant after Senning procedure

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ly 310 ms, the flap reached the anterior wall of the ascending aorta and the murmur almost disappeared coincidentally. The flap remained in this position until the following systole (Fig. 2). Color Doppler flow imaging revealed that the aortic regurgitant jet extended along the anterior mitral leaflet only during early diastole (Fig. 3). It was also demonstrated that the intimal flap obstructed the aortic root during late diastole, resulting in interruption of regurgitation. Cardiac surgery, after 1 month, disclosed a small entry of dissection at the aortic arch. There was no entry just above the aortic valve. The ascending aorta was replaced by a graft, and. the aorttc valve was resuspended and refixed. Aortic regurgitation is one of the major complications of dissecting aneurysm of the ascending aorta.’ In our case, it was significant that the aortic regurgitant murmur disappeared abruptly at early diastole. The mechanism of interruption of aortic regurgitation was the aortic root obstruction by the intimal flap. Inasmuch as the entry located at the aortic arch and the false lumen had a blind end above the aortic valve, the blood through the entry bulged the false lumen fully from mid to late diastole in the ascending aorta, resulting in interruption of aortic regurgitation. This led to a time lag between the aortic valve closure and the upward motion of the intimal flap. Thus, regurgitant volume was minimal, and the patient’s condition seemed to remain stable until surgical repair. Sraow et al2 reported one case of intimal flap prolapse from the aortic root into the left ventricle causing aortic regurgitation with proper coaptation. To our knowledge, the present case is the first one of intimal flap reduction of aortic regurgitation. This unique pathophysiology could be demonstrated by echoDoppler examinations. Among echo-Doppler examinations, color Doppler flow imaging can demonstrate intracardiac structures and blood flows simultaneously in real-time imaging and is, therefore, of great value in diagnosis of this particular aortic regurgitation.