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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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211
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_67, © Springer International Publishing Switzerland 2015
A 25-year-old woman presented with dyspnea on exertion
(functional class I). Physical examination showed a continu-
ous murmur at the left second intercostal space.
Electrocardiography was normal.
Patent Ductus Arteriosus
by Transthoracic
and Transesophageal
Echocardiography
Case 67
a
c
b
Fig. 67.1 The parasternal short-axis view depicts a turbulent systolic
( arrow ) ( a ) and diastolic ( arrow ) fl ow ( b ) in the pulmonary artery, in
favor of a patent ductus arteriosus (PDA). The continuous Doppler
study shows that the peak systolic and diastolic gradients are 105 and
51 mmHg, respectively ( c ). PA pulmonary artery
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_67 ) contains supplementary
material, which is available to authorized users.
212
Fig. 67.3 Transesophageal echocardiography (0°), about 25 cm from the
dental arcade, illustrates the turbulent fl ow across the descending aorta
toward the pulmonary artery ( arrow ). PA pulmonary artery, AO aorta
Fig. 67.2 The suprasternal long-axis view reveals a turbulent fl ow
( arrow ) from the descending aorta toward the pulmonary artery via the
PDA. DAO descending aorta, PA pulmonary artery
Comment
The patient was referred for the device closure of the PDA.
Case 67 Patent Ductus Arteriosus by Transthoracic and Transesophageal Echocardiography
213
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_68, © Springer International Publishing Switzerland 2015
A 28-year-old woman presented with a history of palpitation
and frequent episodes of pneumonia. Physical examination
revealed a continuous murmur (grade II/VI) in the second
and third left intercostal spaces with accentuation of the
systolic part in late systole. The patient’s blood pressure was
about 135/60 mmHg, and she had no cyanosis or clubbing.
Echocardiography demonstrated mild left ventricular dilation and normal systolic function as well as normal right ventricular size and systolic function.
Patent Ductus Arteriosus
and Pulmonary Insufficiency
Case 68
a
b
Fig. 68.1 The parasternal short-axis view shows a turbulent fl ow from
the descending aorta to the main pulmonary artery bifurcation, in favor
of a patent ductus arteriosus (PDA) fl ow ( arrow ) by the color Doppler
fl ow study ( a ). There are continuous systolic and diastolic fl ows with
accentuation in late systole by the continuous wave Doppler study ( b ).
AOV aortic valve, DAO descending aorta, RPA right pulmonary artery
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_68 ) contains supplementary
material, which is available to authorized users.
214
Fig. 68.2 The straight arrow points to the PDA, and the curved arrow
points to the pulmonary insuffi ciency fl ow in short-axis view. AOV
aortic valve, PA pulmonary artery
a
b
Fig. 68.3 The short-axis view demonstrates the pulmonic and aortic sides of the PDA and its course ( a ). The schematic illustration depicts these
points ( b ). DAO descending aorta, LA left atrium, RA right atrium, RV right ventricle, PDA patent ductus arteriosus, PA pulmonary artery
Case 68 Patent Ductus Arteriosus and Pulmonary Insuffi ciency
215
a
b
Fig. 68.4 Upper transesophageal echocardiography (TEE) (0°) reveals a turbulent fl ow ( arrow ) ( a ) from the descending aorta toward the bifurcation site
of the pulmonary artery through the PDA. DAO descending aorta, PA pulmonary artery. This is the schematic illustrations of the PDA in this view ( b )
a
b
Fig. 68.5 The PDA fl ow ( arrow ) and its length is visualized on TEE (84°) ( a ). This is a schematic depiction of the PDA in this view ( b ). DAO
descending aorta, PA pulmonary artery
Case 68 Patent Ductus Arteriosus and Pulmonary Insuffi ciency
216
Diagnosis
The patient was diagnosed with a PDA.
Comment
The patient was referred for PDA device closure.
Fig. 68.6 TEE demonstrates the continuous fl ow of the PDA
Case 68 Patent Ductus Arteriosus and Pulmonary Insuffi ciency
217
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_69, © Springer International Publishing Switzerland 2015
A middle-aged woman with a history of palpitation and a
continuous murmur (grade II/VI) in the second intercostal
space was referred to our echocardiography laboratory for
further evaluation. Echocardiography revealed a mild left
ventricular dilation with a normal systolic function.
Patent Ductus Arteriosus
by Transthoracic Echocardiography
Case 69
Fig. 69.1 The suprasternal long-axis view illustrates a tunnel ( arrow )
between the pulmonary artery and the descending aorta, in favor of a
patent ductus arteriosus (PDA). DAO descending aorta, PA pulmonary
artery
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_69 ) contains supplementary
material, which is available to authorized users.
218
Diagnosis
The patient was diagnosed with a PDA.
Comment
The patient was referred for PDA device closure.
Fig. 69.2 The suprasternal
long-axis view shows the PDA
tunnel and fl ow simultaneously
by two-dimensional
echocardiography ( left ) and the
color Doppler fl ow study ( right ).
DAO descending aorta,
PA pulmonary artery
Case 69 Patent Ductus Arteriosus by Transthoracic Echocardiography
219
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_70, © Springer International Publishing Switzerland 2015
A 35-year-old woman was referred to our echocardiography
laboratory for the evaluation of cardiac disease. She had
dyspnea on exertion (functional class II).
Patent Ductus Arteriosus
with Eisenmenger’s Syndrome
Case 70
Fig. 70.1 Right ventricular dilation is evident in this parasternal
long- axis view. LA left atrium, LV left ventricle, RV right ventricle,
AO aortic valve
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_70 ) contains supplementary
material, which is available to authorized users.
220
a
c
b
Fig. 70.2 The parasternal short-axis view illustrates moderate pulmo-
nary insuffi ciency ( arrow ) ( a ). The mean pulmonary arterial pressure is
about 87 mmHg ( b ). The main pulmonary artery is dilated and is about
26 mm in diameter ( c ). Ductus arteriosus is visisble in continuity with
pulmonary artery ( arrowhead ) ( a , c ), AO aorta, PA pulmonary artery
Fig. 70.3 The interventricular septum is fl at in systole ( arrow ) in the
parasternal short-axis view, which is in favor of pulmonary arterial
hypertension. RV right ventricle, LV left ventricle
Fig. 70.4 Moderate right ventricular dilation is also evident in the
apical four-chamber view. LA left atrium, LV left ventricle, RA right
atrium, RV right ventricle
Case 70 Patent Ductus Arteriosus with Eisenmenger’s Syndrome
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