Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5761_Библиотеки_им_академика_М_И_Перельмана
.pdf
92
a b
c
Fig. 28.2 The interatrial septum (IAS) seems intact on transthoracic
echocardiography (apical four chamber) ( a ), transesophageal echocar-
diography (TEE) (0°) ( b ), and even at fi rst glance in the bicaval view of
TEE ( c ). RV right ventricle, LV left ventricle, LA left atrium, RA right
atrium, SVC superior vena cava, RPA right pulmonary artery
a b
Fig. 28.3 TEE (bicaval view), with some clockwise rotation, demon-
strates an atrial septal defect (ASD) (sinus venosus type) ( arrow ) below
the superior vena cava (SVC) ( a ). The two right upper pulmonary veins
are attached to the SVC and the right atrial junction ( a , two-dimen-
sional echocardiography), and the SVC is attached to the right atrium
and left atrium simultaneously ( b , color-fl ow study). LA left atrium, RA
right atrium, SVC superior vena cava, PV pulmonary vein, ASDSV atrial
septal defect sinus venosus type
Case 28 Sinus Venosus Atrial Septal Defect with a Partial Anomalous Pulmonary Venous Return (Two Right Pulmonary Veins)
93
c
a b
Fig. 28.4 TEE (short-axis upper esophageal view) (about 15–20 cm
from the dental arcade, in the cross-sectional view) reveals the defect of
the SVC at the left atrial connection site (sinus venosus ASD) ( arrow ).
Also, the two right pulmonary veins are attached to the SVC and the left
atrial junction in two-dimensional echocardiography ( a ) and color-fl ow
study ( b ). This is a schematic illustration of the ASD (sinus venosus
type), SVC, and right pulmonary veins in this view ( c ). LA left atrium,
RA right atrium, SVC superior vena cava, PV pulmonary vein, ASDSV
atrial septal defect sinus venosus type
Case 28 Sinus Venosus Atrial Septal Defect with a Partial Anomalous Pulmonary Venous Return (Two Right Pulmonary Veins)
94
a
c
b
Fig. 28.5 TEE (0°) at mid-esophageal level reveals the ASD (sinus venosus type) ( arrow ) in the posterior part of the interatrial septum (IAS)
without ( a ) and with color-fl ow study ( b ). This is a schematic depiction of the ASD (sinus venosus type) in this view ( c )
Diagnosis
The patient was diagnosed with an ASD (sinus venosus type)
below the SVC with an anomalous connection of the two
right pulmonary veins (upper and middle) to the junction of
the SVC and both atria.
Comment
The patient had a Qp/Qs of 3.2 and a systolic peak arterial
pressure of 43 mmHg. Surgery was recommended after cardiac catheterism and coronary angiography.
Lesson
1. When transthoracic echocardiography demonstrates signifi cant right ventricular dilation without a defect in the
IAS, a possible diagnosis is an ASD (sinus venosus type),
which might not be visualized on TTE. Accordingly, TEE
may be required for the fi nal diagnosis.
2. An ASD (sinus venosus type) is almost always accompanied by a partial anomalous pulmonary venous return,
containing the right pulmonary veins and the upper and
(if it exists) middle pulmonary veins. Sometimes, a partial anomalous pulmonary venous return includes the
lower right pulmonary vein [ 7 , 60 , 61 ].
3. Because of the association between a partial anomalous
pulmonary venous return and the ASD (sinus venosus
type), the enlargement of the right atrium and the right
ventricle is always signifi cant, even if the ASD is not very
large.
Case 28 Sinus Venosus Atrial Septal Defect with a Partial Anomalous Pulmonary Venous Return (Two Right Pulmonary Veins)
95
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_29, © Springer International Publishing Switzerland 2015
A 23-year-old man presented with recently developed dyspnea on exertion (functional class II–III). Transthoracic
echocardiography showed severe right atrial and ventricular
dilation.
Atrial Septal Defect (Sinus Venosus
Type) with a Partial Anomalous
Pulmonary Venous Return
(Two Right Pulmonary Veins)
Case 29
c
a b
d
Fig. 29.1 Transesophageal echocardiography (TEE) (bicaval view)
shows a large atrial septal defect (ASD) (sinus venosus type) ( arrow )
( a ) below the superior vena cava ( SVC ) with a left-to-right shunt ( blue )
( b ). The ASD is 29 mm in size ( c ). The two right pulmonary veins
( arrows ) join at the SVC and right atrial junction in this view ( d ). LA
left atrium, RA right atrium, SVC superior vena cava
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_29 ) contains supplementary
material, which is available to authorized users.
96
Diagnosis
The patient was diagnosed with an ASD (sinus venosus type)
below the SVC with an anomalous connection between the
two right pulmonary veins and the junction of the SVC and
both atria.
Comment
The patient was referred for surgery.
ab
Fig. 29.2 TEE (0°) shows the connection of the SVC, left atrium, and
right pulmonary veins ( arrows ) at the upper esophageal level ( a ). The
right lower pulmonary vein fl ow appears blue ( arrow ) ( b ) when moving
slightly downward toward the mid-esophageal level in this view but the
fl ow of right upper pulmonary vein ( double arrow ) is still red in this
view ( b ). LA left atrium, RA right atrium, SVC superior vena cava
Case 29 Atrial Septal Defect (Sinus Venosus Type) with a Partial Anomalous Pulmonary Venous Return (Two Right Pulmonary Veins)
97
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_30, © Springer International Publishing Switzerland 2015
A 46-year-old woman referred to our echocardiography laboratory because of recurrent pericardial effusion. She had a
holosystolic murmur at the lower left sternal border.
Electrocardiography showed right axis deviation.
Atrial Septal Defect (Sinus Venosus
Type) with a Partial Anomalous
Pulmonary Venous Return
(Three Right Pulmonary Veins)
Case 30
Fig. 30.1 Right ventricular enlargement is shown in this parasternal
long-axis view. There is also hypertrophy of the interatrial septum
(IAS). LA left atrium, LV left ventricle, RV right ventricle, AO aorta
Fig. 30.2 Transesophageal echocardiography (TEE) (bicaval view)
shows a bilayered IAS and a patent foramen ovale (PFO) fl ow ( arrow ).
LA left atrium, RA right atrium
Fig. 30.3 The IAS seems intact at fi rst glance on TEE. LA left atrium,
RA right atrium
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_30 ) contains supplementary
material, which is available to authorized users.
98
Diagnosis
The patient was diagnosed with an ASD (sinus venosus type)
below the SVC with an anomalous connection between the
three right pulmonary veins (upper, middle, and lower) and
the junction of the SVC and both atria.
Comment
The patient was referred for angiography and cardiac catheterism and then surgery.
Lesson
1. The detection of an anomaly such as a PFO should not
stop us from searching for other coexisting anomalies.
2. The anomalous pulmonary venous return of the three
right veins sometimes occurs with an ASD (sinus venosus
type).
3. Sometimes, the visualization of an ASD (sinus venosus
type) is not easy and requires some maneuvering, for
example, by slightly pulling back the probe and rotating it
clockwise.
Fig. 30.5 This view illustrates the three right upper, middle, and lower
right pulmonary veins at the junction of the SVC and the atria. LA left
atrium, RA right atrium, SVC superior vena cava, RUPV right upper
pulmonary vein, RMPV right middle pulmonary vein, RLPV right lower
pulmonary vein
a b
Fig. 30.4 TEE (bicaval view by slightly pulling back the probe and
rotating it clockwise) reveals an atrial septal defect (ASD) (sinus venosus type), about 18 mm in size, below the superior vena cava ( SVC ) by
two-dimensional echocardiography ( a ) and a left-to-right shunt via this
defect by color-fl ow study ( b ). LA left atrium, RA right atrium, SVC
superior vena cava, RPA right pulmonary artery
Case 30 Atrial Septal Defect (Sinus Venosus Type) with a Partial Anomalous Pulmonary Venous Return
99
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_31, © Springer International Publishing Switzerland 2015
A 44-year-old man presented with dyspnea on exertion
(functional class II) of recent duration. Transthoracic
echocardiography showed moderate right atrial and
ventricular dilation.
Atrial Septal Defect
(Sinus Venosus Type)
with a Partial Anomalous
Pulmonary Venous Return
(Right Upper Pulmonary Vein)
Case 31
Fig. 31.1 Transesophageal echocardiography ( TEE ) (0°) demonstrates
a defect ( arrow ) in the posterior part of the interatrial septum (IAS). LA
left atrium, RA right atrium
ab
Fig. 31.2 TEE (bicaval view) illustrates a turbulent fl ow below the
superior vena cava ( arrow ) (SVC) and the entrance of the right upper
pulmonary vein ( curved arrow ) into the junction of the SVC and both
atria in favor of sinus venosus type atrial septal defect ( a ); more
clockwise rotation of probe demonstrates better the course of right
upper pulmonary vein ( b ). RUPV right upper pulmonary vein, SVC
superior vena cava, LA left atrium, RA right atrium
Electronic supplementary material The online version of this chapter
(doi:
10.1007/978-3-319-12934-1_31 ) contains supplementary material,
which is available to authorized users.
100
Diagnosis
The patient was diagnosed with an atrial septal defect (sinus
venosus type) below the SVC with an anomalous connection
between one of the right pulmonary veins (upper) and the
junction of the SVC and both atria.
Comment
The patient was referred for surgery.
Case 31 Atrial Septal Defect (Sinus Venosus Type) with a Partial Anomalous Pulmonary Venous Return (Right Upper Pulmonary Vein)
101
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_32, © Springer International Publishing Switzerland 2015
A 22-year-old man referred to our echocardiography
laboratory due to exertional dyspnea (functional class III)
with recent exacerbation.
Left Persistent Superior Vena
Cava with an Atrial Septal Defect
(Sinus Venosus Type)
with a Partial Anomalous
Pulmonary Venous Return
Case 32
a
b
Fig. 32.1 This parasternal long-axis view shows a dilated coronary
sinus ( arrow ) ( a ). An agitated saline injection demonstrates the appear-
ance of bubbles in the coronary sinus before the right ventricle, in favor
of a left persistent superior vena cava (SVC) ( arrow ) ( b ). LA left atrium,
AOV aortic valve, RV right ventricle
Electronic supplementary material The online version of this chapter
(doi:
10.1007/978-3-319-12934-1_32 ) contains supplementary mate-
rial, which is available to authorized users.
Fig. 32.2 The right atrium and the right ventricle are moderately
dilated in the apical four-chamber view ( a ). No atrial septal defect
(ASD) is seen in the apical four-chamber ( a ) and parasternal short-axis
( b ) views. RA right atrium, RV right ventricle, CS coronary sinus, LA
left atrium
a
b
Соседние файлы в папке Библиотека им академика М.И. Перельмана