of asystole before being placed on extracorporeal membrane oxygenation (ECMO). The atrial septal defect was repaired successfully. However, despite ECMO support for two days during which pulmonary artery pressures decreased (yet remained elevated), the patient did not regain consciousness and expired. Discussion: This case underscores atrial septal rupture as a potential complication during mitral valve replacement, with repair efforts complicated
by underlying pulmonary hypertension. Conditions like pulmonary hypertension can significantly compromise the integrity of a repaired atrial septum. This suggests that for patients with pulmonary hypertension undergoing mitral valve repairs or replacements, variations in surgical technique or further optimization of cardiopulmonary function prior to surgery should be investigated to prevent the failure of atrial septum repairs and subsequent catastrophic left-to-right shunting.
DELAYS IN ACCESS TO CARE IN A CASE OF BILATERAL QUADRICEPS TENDON RUPTURE Katrina Jiang, Elena Bartolone; The University of Queensland – Ochsner Clinical School, New Orleans, LA.
Introduction: Simultaneous bilateral quadriceps tendon rupture is rare, with obesity as a known risk factor. Herein is a case of a patient who presented to our community center in the Southern region of Louisiana with a complaint of an acute loss of bilateral knee extension after a traumatic fall, later found to have rupture of bilateral quadriceps tendons. Case: A 46-year-old male truck driver, with obesity (BMI 60.0), hypertension, sleep apnea, and a history of kidney stones, presented with sudden bilateral lower extremity weakness after a fall. He landed on both knees when he lost balance while walking off a curb. He experienced no pain but described spasm-like sensations and could not walk. His workup revealed hypokalemia and hypophosphatemia, with a normal creatine phosphokinase (CPK). The patient was admitted for further evaluation. On exam, there was loss of active straight leg raising and 0/5 active knee extension bilaterally. The patient was unable to bear weight. An MRI of the bilateral
knees revealed distal tears of the bilateral quadriceps tendons that were likely complete. Bilateral surgical repair was performed by anchoring the quadriceps tendons to the superior aspects of the patellae. At his 12 week follow up, patient was weight- bearing, ambulating with a walker, and showed improved range of motion for bilateral knees. Discussion: As the clinical presentation can be misleading, promptly recognizing the clinical indicators and obtaining MRIs of the lower extremities is crucial. Existing literature suggests optimal operative repair should occur within 48-72 hours after complete rupture, making early recognition and imaging essential. In our case, repair was delayed due to equipment unavailability in a rural medical setting for a high-risk obese patient, requiring transfer to a metropolitan location. Such administrative obstacles should be mitigated with prompt diagnosis and increased awareness of barriers to care
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