To the Editor.
— A 68-year-old man was involved in a severe frontal impact with another skier while "wedeling" at a high rate of speed in Vail, Colo. Medical history was unremarkable, other than having developed "sushi syncope" at 63 years of age.1 While prior to the accident he had experienced no difficulty skiing expert trails at an elevation of over 3600 m (10000 ft), afterward he became dyspneic while walking at the base of the mountain.On returning to sea level, he noted continued dyspnea on exertion; examination revealed V waves in the jugulars evident at 30° and a prominent murmur of tricuspid insufficiency. Transesophageal echocardiography demonstrated a flail tricuspid leaflet, and angiography revealed wide-open tricuspid regurgitation. Fortunately, his dyspnea gradually resolved, and by 3 months after the event he had returned to playing tennis without difficulty. Serial echocardiograms reveal that his right ventricular size has remained stable,
Spitzer DE. Sushi Syncope Schusser Gets Wedeler's Valve at Vail. JAMA. 1994;271(6):428. doi:10.1001/jama.1994.03510300028024
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