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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5761_Библиотеки_им_академика_М_И_Перельмана
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79
c
b
a
Fig. 24.8 The short-axis view reveals a thick pulmonary valve ( a ) with
severe pulmonary insuffi ciency ( b ). The estimated mean pulmonary
arterial pressure is approximately 53 mmHg (elevated mean pulmonary
arterial pressure) ( c ). PV pulmonic valve, PA pulmonary artery, PI pul-
monary insuffi ciency
Diagnosis
The patient was diagnosed with levoisomerism, interrupted
IVC, left persistent SVC, left azygous vein, intermediate
form of the AVSD, and pulmonary arterial hypertension.
Comment
Given the patient’s pulmonary arterial hypertension, medical
treatment with sildenafi l and follow-up echocardiography
were recommended.
Lesson
An interrupted IVC is associated with levoisomerism, left
persistent SVC, and left azygous vein. An AVSD may be
associated with left or right isomerism [ 56 ].
Case 24 Common Atrium, Atrioventricular Septal Defect, Interrupted Inferior Vena Cava
81
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_25, © Springer International Publishing Switzerland 2015
A 12-year-old girl with a history of dyspnea on exertion
(functional class II–III) was referred to our echocardiography laboratory. Physical examination revealed a systolic
murmur (grade III/VI) in the pulmonic area.
Complete Atrioventricular Canal
Case 25
Fig. 25.1 The apical four-chamber view shows a ventricular septal
defect ( VSD ) (inlet type) and one atrioventricular valve ( AV ) with one
ring, which suggests a complete atrioventricular septal defect ( AVSD ).
The arrowhead points to the insertion of one of the right-sided leafl ets
to the base of the interventricular septum (straddling). LA left atrium,
LV left ventricle, RA right atrium, RV right ventricle
Fig. 25.3 The apical fi ve-chamber view demonstrates the overriding
of the aorta on both ventricles but more than 50 % on left ventricle. AOV
aortic valve, LV left ventricle, LA left atrium
Fig. 25.2 The apical four-chamber view demonstrates two atrial septal
defects ( ASDs ): a large primum type and a small secundum type. LA left
atrium, LV left ventricle, RA right atrium, RV right ventricle
82
c
a b
Fig. 25.5 The parasternal short-axis view illustrates a subpulmonic valve narrowing ( a ) and a systolic turbulency that originates from this area
( b ) with a peak gradient of about 76 mmHg across it ( c ). AOV aortic valve, PV pulmonary valve
Fig. 25.4 Moderate right and left-sided AV valve regurgitations are
shown in this apical four-chamber view ( arrows )
Case 25 Complete Atrioventricular Canal
83
Diagnosis
The patient was diagnosed with common AV valve, AVSD,
ASD (ostium secundum type), moderate left and right AV
valve regurgitation, and subvalvular pulmonary stenosis.
Comment
The patient was referred for surgery.
Lesson
The patient did not develop pulmonary arterial hypertension
due to subvalvular pulmonary stenosis.
Pulmonary stenosis is one of the anomalies associated
less frequently with the common atrioventricular valve [ 56 ].
Case 25 Complete Atrioventricular Canal
85
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_26, © Springer International Publishing Switzerland 2015
A 12-year-old girl, who had undergone surgery for an
atrioventricular septal defect (AVSD) at infancy, was referred
to our echocardiography laboratory. She had dyspnea
functional class II symptoms and was underweight. Physical
examination revealed a holosystolic murmur at the apex and
the left sternal border.
Severe Mitral Regurgitation
Due to the Anterior Mitral Leaflet
Cleft Post Surgery for an
Atrioventricular Septal Defect
Case 26
ab
Fig. 26.2 The parasternal short-axis view demonstrates the anterior mitral leafl et (AML) cleft ( arrow ) ( a ); the cleft is 9 mm in size ( b )
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_26 ) contains supplementary
material, which is available to authorized users.
Fig. 26.1 The parasternal long-axis view shows severe mitral regurgi-
tation, originating from a cleft ( arrow ). LA left atrium, LV left ventricle,
AO aorta
86
The patient was symptomatic and was diagnosed with severe
mitral regurgitation due to the AML cleft following surgery
for AVSD at infancy.
Given that the patient had severe mitral regurgitation and
was underweight, she was referred for surgery of the mitral
valve (repair or replacement) [ 57 ].
Case 26 Severe Mitral Regurgitation Due to the Anterior Mitral Leafl et Cleft Post Surgery for an Atrioventricular Septal Defect
87
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_27, © Springer International Publishing Switzerland 2015
A 27-year-old woman, who had undergone surgery for an
atrioventricular septal defect (AVSD) at childhood, presented with recent dyspnea on exertion (functional class I).
She had one child and had a holosystolic murmur at the apex.
Severe Mitral Regurgitation Post
Surgery for an Atrioventricular
Septal Defect
Case 27
Fig. 27.1 An anterior mitral leafl et (AML) cleft, 4 mm in size, is seen
in the parasternal short-axis view
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_27 ) contains supplementary
material, which is available to authorized users.
88
Fig. 27.4 The apical four-chamber view illustrates moderate tricuspid
regurgitation ( arrow ). A pacemaker wire is seen in the right atrium
( curved arrow ) and right ventricle. LA left atrium, LV left ventricle, RA
right atrium, RV right ventricle
a
c
b
Fig. 27.2 Severe mitral regurgitation ( curved arrow ) is patent in the
parasternal long-axis view ( a ) and the apical four-chamber view ( b ).
Also, there is mild mitral regurgitation, originating from the cleft
( arrow ) ( c ). LA left atrium, LV left ventricle, RA right atrium, RV right
ventricle
Fig. 27.3 A small residual ventricular septal defect (VSD) is seen in
the apical four-chamber view ( arrow ). LA left atrium, LV left ventricle,
RA right atrium, RV right ventricle
Case 27 Severe Mitral Regurgitation Post Surgery for an Atrioventricular Septal Defect
89
Diagnosis
The patient was symptomatic and was diagnosed with severe
mitral regurgitation and AML cleft post surgery for AVSD at
childhood.
Comment
The patient was referred for surgery of the mitral valve.
Lesson
Mitral regurgitation in an AVSD may persist or recur after surgery. The role of the cleft in producing mitral regurgitation is
important. Furthermore, the size of an AML cleft varies among
patients [ 58 , 59 ]. It is of notice that in cases of residual interatrial or interventricular communications, endocardial pacing
increases the risk of paradoxical emboli [ 7 ].
Case 27 Severe Mitral Regurgitation Post Surgery for an Atrioventricular Septal Defect
91
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_28, © Springer International Publishing Switzerland 2015
A 44-year-old woman presented with recent dyspnea on
exertion (functional class II). Physical examination revealed
a systolic murmur at the left sternal border and a fi xed S2
splitting.
Sinus Venosus Atrial Septal
Defect with a Partial Anomalous
Pulmonary Venous Return (Two
Right Pulmonary Veins)
Case 28
a
c
b
Fig. 28.1 Signifi cant right ventricular dilation can be seen in the parasternal long-axis ( a ) and short-axis ( b ) views and the apical four-chamber
view ( c ). The right ventricle/left ventricle is 37/36. RV right ventricle, LV left ventricle, LA left atrium, AO aorta
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_28 ) contains supplementary
material, which is available to authorized users.
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