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
201
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_64, © Springer International Publishing Switzerland 2015
A 24-year-old man presented with dyspnea on exertion
(functional class II). Physical examination revealed a systolic ejection murmur at the left sternal border.
Electrocardiography showed right axis deviation and right
ventricular hypertrophy.
Ventricular Septal Defects
and Double-Chamber
Right Ventricle
Case 64
Fig. 64.1 The apical four-chamber view demonstrates the dilation of
the right ventricle and hypertrophy of the right ventricular free wall
( arrow ). LA left atrium, LV left ventricle, RA right atrium, RV right
ventricle
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_64 ) contains supplementary
material, which is available to authorized users.
202
a
b
c
d
Fig. 64.2 The modifi ed parasternal short-axis view depicts the severe
hypertrophy of the right ventricular outfl ow tract wall ( arrow ) and a
muscle bundle from the interventricular septum toward the right ventricular outfl ow tract ( curved arrow ) ( a ), which produces severe nar-
rowing and gradient in the right ventricular outfl ow tract. The diameter
of the lumen of the right ventricular outfl ow tract in the site of the
obstruction is approximately 6 mm ( b ). The peak gradient is 90 mmHg
( c ), and the length of this prominence is 20 mm ( d ). RVOT right ven-
tricular outfl ow tract
a
b
Fig. 64.3 The parasternal short-axis view illustrates mild valvular pulmonary stenosis ( arrow ) ( a ). The peak gradient is 20 mmHg ( b ). RA right
atrium, RV right ventricle, PA pulmonary artery, AO aorta
Case 64 Ventricular Septal Defects and Double-Chamber Right Ventricle
203
a
b
c
Fig. 64.5 The modifi ed apical four-chamber view demonstrates another apical VSD ( arrow ) by two-dimensional echocardiography ( a ) and the
color-fl ow study ( b ), which is 7 mm in size ( c ). LA left atrium, LV left ventricle, RA right atrium, RV right ventricle
a
b
Fig. 64.4 The modifi ed parasternal short-axis view shows a perimembranous ventricular septal defect (VSD) ( arrow ) ( a ). The size of this VSD
is about 17 mm ( b ). RA right atrium, RV right ventricle, AO aorta
Case 64 Ventricular Septal Defects and Double-Chamber Right Ventricle
204
Diagnosis
The patient was diagnosed with a perimembranous VSD, in
addition to a muscular VSD and a double-chamber right
ventricle.
Comment
The patient was referred for surgery after cardiac
catheterism.
Lesson
When there is a VSD and subvalvular pulmonary stenosis,
the diagnosis of additional VSDs may be diffi cult, and the
VSD fl ow is not well visualized or nonturbulent. Also, the
murmur, which is heard, is the ejection murmur of the subvalvular pulmonary stenosis, not the murmur of the VSD. It
has been suggested that the double-chamber right ventricle
may be a result of the VSD jet lesion [ 2 , 7 , 96 , 97 ].
Case 64 Ventricular Septal Defects and Double-Chamber Right Ventricle
205
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_65, © Springer International Publishing Switzerland 2015
A 56-year-old woman presented with dyspnea on exertion
(functional class III) with recent exacerbation (during the
previous 2–3 months). She was a known case of asthma of
10-year duration. Physical examination revealed a conti-
nuous murmur at the second intercostal space.
Electrocardiography was normal. She was referred to our
echocardiography laboratory for stress echocardiography to
rule out ischemia.
Patent Ductus Arteriosus Type B by
Transthoracic and Transesophageal
Echocardiography in a Middle-Aged
Woman
Case 65
a
b
Fig. 65.1 The parasternal long-axis view shows mild calcifi cation at
the base of the posterior mitral leafl et ( arrow ) ( a ). Moderate mitral
regurgitation is seen in this view by the color Doppler study ( arrow )
( b ). The left ventricle is mildly dilated. LA left atrium, LV left ventricle,
AO aorta, RV right ventricle
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_65 ) contains supplementary
material, which is available to authorized users.
206
Fig. 65.3 The continuous wave Doppler study in the parasternal short-
axis view demonstrates a peak gradient in systole and diastole of 103
and 68 mmHg, respectively
a
b
Fig. 65.2 The ductal view depicts a turbulent fl ow in the pulmonary artery in diastole ( a ) and systole ( b ) ( arrow ), in favor of a patent ductus
arteriosus (PDA). PA pulmonary artery
Case 65 Patent Ductus Arteriosus Type B by Transthoracic and Transesophageal Echocardiography in a Middle-Aged Woman
207
a
c
b
Fig. 65.4 The PDA is 12 mm in size on the pulmonic side ( a ), 10 mm in size on the aortic side ( b ), and 24 mm in length ( c ) in the parasternal
short-axis view by two-dimensional echocardiography. PA pulmonary artery, DAO descending aorta
a
a b
b
Fig. 65.5 The PDA is seen on transesophageal echocardiography (TEE) (0°), focusing on the descending aorta by color Doppler ( a ) ( arrow ) and
two-dimensional echocardiography ( arrow ) ( b ). PA pulmonary artery, DAO descending aorta
Case 65 Patent Ductus Arteriosus Type B by Transthoracic and Transesophageal Echocardiography in a Middle-Aged Woman
208
a
b
Fig. 65.6 Moderate mitral regurgitation is seen on TEE (long-axis view) ( arrow ) ( a ). There is also mild aortic regurgitation in this view ( arrow )
( b ). LA left atrium, LV left ventricle, AO aorta
Fig. 65.7 The gradient of the tricuspid regurgitation is about 40 mmHg
Diagnosis
PDA type B
Comment
The patient was referred for the percutaneous device closure
of the PDA [ 98 ].
Case 65 Patent Ductus Arteriosus Type B by Transthoracic and Transesophageal Echocardiography in a Middle-Aged Woman
209
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_66, © Springer International Publishing Switzerland 2015
A 31-year-old woman presented with dyspnea on exertion
(functional class II). Physical examination revealed a systolic murmur at the second intercostal space.
Electrocardiography was normal. Chest X-ray showed cardiomegaly and mild pulmonary congestion.
Patent Ductus Arteriosus Type B by
Transthoracic and Transesophageal
Echocardiography in a Young
Woman
Case 66
a
c
b
Fig. 66.1 The parasternal short-axis view depicts a turbulent diastolic
( arrow ) ( a ) and systolic ( arrow ) ( b ) fl ow entering at the bifurcation of
the main pulmonary artery from the descending aorta, in favor of a pat-
ent ductus arteriosus (PDA). The peak gradient is about 86 mmHg in
systole and about 42 mmHg in diastole by the continuous wave Doppler
study ( c ). PA pulmonary artery, DAO descending aorta
Electronic supplementary material The online version of this
chapter (doi: 10.1007/978-3-319-12934-1_66 ) contains supplementary
material, which is available to authorized users.
210
Diagnosis
The patient was diagnosed with a PDA type B.
Comment
The patient was referred for the device closure of the PDA.
Lesson
The sizing of the PDA is usually made at the time of device
closure in the catheterism laboratory. However, there are
some trials for the sizing of the duct by echocardiography
[ 98 ]. In our center, we found a good correlation between
transthoracic echocardiographic sizing, especially on the
aortic side, and the fi nal device size [ 98 ].
There are different anatomic types of PDAs according to
the Krichenko classifi cation:
1. Type A: pulmonic diameter is the narrowest part or cone
shape [ 98 , 99 ].
2. Type B: Aortic diameter is the narrowest part [ 98 , 99 ].
3. Type C: The pulmonic and aortic diameters are equal
(tunnel shape).
4. Type D: Multiple constrictions.
5. Type E: The duct is very long and tortuous with a distant
constriction [ 80 ].
Non-type A are technically more challenging for PDA
device closure. PDA device closure by coils has been performed for many years, and the device is chosen twice the
pulmonary end; for devices greater than 8 mm, the risk of
complications will be increased.
Since the introduction of Amplatzer device occluder
(ADO), moderate and large size PDA can be closed percutaneously. In type I ADO, the aortic end is 1–2 mm greater
than the pulmonic end, and the length is between 5 and
8 mm. The device is available from 5/4 up to 16/14 mm for
aortic and pulmonary ends. The device is chosen 2 mm
greater than the pulmonic end [ 80 ].
a
b
Fig. 66.3 The turbulent fl ow from the descending aorta toward the pulmonary artery ( arrow ) is also evident on transesophageal echocardiography
(0°) at 25 cm from the dental arcade in systole ( a ) and diastole ( b ). PA pulmonary artery, AO aorta
Fig. 66.2 The duct is about 9 mm in size on the aortic side, 10 mm in
size on the pulmonic side, and 8 mm in length by two-dimensional
echocardiography in the parasternal short-axis view. DAO descending
aorta, PA pulmonary artery
Case 66 Patent Ductus Arteriosus Type B by Transthoracic and Transesophageal Echocardiography in a Young Woman
Соседние файлы в папке Библиотека им академика М.И. Перельмана