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Daniel E. Spitzer, MD
Suffern, NY

JAMA. 1994;271(6):428.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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, . . . [Full Text PDF of this Article]

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