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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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354
Diagnosis
The patient was diagnosed with the D-loop transposition of
the great arteries, VSD (inlet type), ASD (ostium secundum
type), interruption of the aortic arch before the subclavian
artery, and large PDA.
Comment
The patient was referred for cardiac catheterism.
Fig. 108.7 The apical four-chamber view shows a large atrial septal
defect (ASD) (ostium secundum type) ( arrow ). RV right ventricle,
LV left ventricle, RA right ventricle, LA left ventricle
Fig. 108.8 The apical four-chamber view illustrates a very large inlet
type ventricular septal defect (VSD) ( arrow ). RV right ventricle, LV left
ventricle, TV tricuspid valve, MV mitral valve
Fig. 108.9 The apical four-chamber view demonstrates right-sided
atrioventricular valve regurgitation with a peak gradient of about
90 mmHg
Fig. 108.10 This is a schematic illustration of the heart of this patient.
LA left atrium, LV left ventricle, RA right atrium, RV right ventricle,
AO aorta, SVC superior vena cava, PA pulmonary artery, PDA patent
ductus arteriosus
Case 108 Interrupted Aortic Arch, Transposition of Great Arteries, Atrial Septal Defect, Ventricular Septal Defect
355
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_109, © Springer International Publishing Switzerland 2015
A 46-year-old woman presented with dyspnea on exertion
(functional class III) of recent duration. She was referred to
our echocardiography laboratory for a further evaluation of
aortic insuffi ciency.
Quadricuspid Aortic Valve
and Severe Aortic Regurgitation
Case 109
ab
Fig. 109.1 Transesophageal echocardiography ( TEE ) (short-axis view) shows a quadricuspid aortic valve with coaptation failure ( curved arrow )
( a ). The origin of the left main coronary artery is evident ( arrow ) ( a ), and there is severe aortic insuffi ciency ( b ). LA left atrium, RA right atrium,
RVOT right ventricular outfl ow tract, 1 - 4 fi rst to fourth aortic leafl ets
Diagnosis
The patient was diagnosed with a quadricuspid aortic valve
and severe aortic insuffi ciency.
Comment
The patient was referred for surgery.
Although tricuspidization of the aortic valve is used and
had good short- and midterm results, the results of long-term
follow-up are unclear, and some surgeons prefer aortic valve
replacement [ 124 – 126 ].
357
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_110, © Springer International Publishing Switzerland 2015
A 47-year-old woman presented with dyspnea on exertion
(functional class III) of recent duration. Transthoracic
echocardiography showed mild left ventricular dilation and a
normal systolic function.
Quadricuspid Aortic Valve and
Severe Aortic Regurgitation
with Mild Dilation of Ascending
Aorta
Case 110
ab
Fig. 110.1 Severe aortic regurgitation ( arrow ) is evident on transthoracic echocardiography (parasternal long-axis view) ( a ) and transesophageal
echocardiography (TEE) (long-axis view) ( b ). LA left atrium, LV left ventricle, RV right ventricle, AO aorta
ab
Fig. 110.2 The aortic regurgitation vena contracta is 7 mm, and the width of the aortic regurgitation to the left ventricular outfl ow tract is
15/22 mm on TEE (long-axis view) ( a, b ). 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_110 ) contains supplementary material,
which is available to authorized users.
358
Diagnosis
The patient was diagnosed with a quadricuspid aortic valve
and severe aortic regurgitation.
Comment
The patient was referred for aortic valve replacement.
Lesson
The quadricuspid aortic valve is a rare cause of aortic regurgitation. In some cases, there is aortic root dilation, and techniques of wrapping ascending aorta or aortic root replacement
are used [ 124 , 127 ].
Fig. 110.5 TEE (0°) shows mild mitral regurgitation ( arrow ). LA left
atrium, LV left ventricle
ab
Fig. 110.3 The aortic valve is quadricuspid on TEE (short-axis view) ( a, b ) ( a , color-fl ow study and, b , two-dimensional echocardiography).
LA left atrium, AO aorta, 1–4 fi rst to fourth aortic leafl ets
Fig. 110.4 The aortic annulus, sinus of Valsalva, sinotubular junction,
and ascending aorta measure 21, 26, 26, and 36 mm, respectively.
LA left atrium, LV left ventricle, AO aorta
Case 110 Quadricuspid Aortic Valve and Severe Aortic Regurgitation with Mild Dilation of Ascending Aorta
359
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_111, © Springer International Publishing Switzerland 2015
A 33-year-old woman presented with dyspnea on exertion
(functional class II) since childhood. Physical examination
revealed a continuous murmur at the left sternal border.
Rupture of the Sinus of Valsalva:
The Right Coronary Cusp
to the Right Ventricle
Case 111
ab
c
Fig. 111.1 The parasternal long-axis view demonstrates the rupture of the right coronary cusp toward the right ventricle in two-dimensional
echocardiography ( arrow ) ( a ). This is the color-fl ow study in diastole and systole ( arrows ) ( b , c ). LA left atrium, LV left ventricle, RA right atrium,
RV right ventricle, AO aorta
Electronic supplementary material The online version of this chapter
(doi:
10.1007/978-3-319-12934-1_111 ) contains supplementary material,
which is available to authorized users.
360
Fig. 111.2 The parasternal long-axis view shows the systolodiastolic
fl ow with continuous fl ow Doppler from the right sinus of Valsalva
toward the right ventricle
ab
Fig. 111.3 The parasternal short-axis view demonstrates the ruptured right coronary cusp ( a ) as well as systolic ( a ) and diastolic ( b ) fl ows from
the right coronary cusp toward the right ventricular outfl ow tract ( arrows ). LA left atrium, AO aorta, RVOT right ventricular outfl ow tract
Case 111 Rupture of the Sinus of Valsalva: The Right Coronary Cusp to the Right Ventricle
361
Diagnosis
The patient was diagnosed with the rupture of the right coronary cusp of the sinus of Valsalva to the right ventricle.
Comment
The patient was referred for surgery.
Lesson
The rupture of the sinus of Valsalva usually occurs in the
third or fourth decade of life. The aneurysm of the sinus of
Valsalva is congenital and due to a defect in the aortic media;
it progresses continuously and usually produces no symptoms until the rupture occurs. It involves the right coronary
cusp in more cases and ruptures into the right ventricle.
In 5–15 % of the cases, it involves the noncoronary cusp and
ruptures into the right atrium [ 2 , 128 , 129 ].
Fig. 111.5 TEE (short-axis view) shows the rupture site as a circle
(arrow). LA left atrium, RA right atrium, AO aorta, RVOT right ventricu-
lar outfl ow tract
a
cd
b
Fig. 111.4 Transesophageal echocardiography (TEE) (long-axis view) shows the rupture site ( arrow ) ( a ) and the systolic ( b ) and diastolic
( c ) fl ows ( arrows ) using the color-fl ow study and the continuous wave Doppler study ( d ). There is a diastolic accentuation of the fl ow. LA left
atrium, LV left ventricle, RV right ventricle, AO aorta
Case 111 Rupture of the Sinus of Valsalva: The Right Coronary Cusp to the Right Ventricle
363
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_112, © Springer International Publishing Switzerland 2015
A 33-year-old male athlete presented with palpitation and
dyspnea of recent duration (within the previous 3 months).
Electrocardiography was normal. Physical examination revealed
a faint continuous murmur at the lower sternal border.
Rupture of the Sinus of Valsalva:
Noncoronary Cusp to the Right
Atrium
Case 112
Fig. 112.1 There is a diastolic fl ow across the aortic valve, suggestive
of aortic regurgitation ( arrow ). 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_112 ) contains supplementary
material, which is available to authorized users.
364
a
b
c
Fig. 112.2 Moderate tricuspid regurgitation is seen in the right ven-
tricular infl ow view ( arrow ). The vena contracta of the tricuspid regur-
gitation is about 6 mm ( a ). The tricuspid annulus is dilated (41 mm) in
this view ( b ). The tricuspid regurgitation gradient is about 50 mmHg
( c ). RA right atrium, RV right ventricle
a
b
Fig. 112.3 The parasternal short-axis view depicts a continuous fl ow from the aorta toward the right atrium in diastole ( arrow ) ( a ) and systole
( arrows ) ( b ). LA left atrium, RA right atrium, RVOT right ventricular outfl ow tract, AO aorta
Case 112 Rupture of the Sinus of Valsalva: Noncoronary Cusp to the Right Atrium
365
Fig. 112.4 The modifi ed apical four-chamber view shows the direc-
tion of the jet toward the right atrium clearly ( arrow ). LA left atrium, RA
right atrium, RV right ventricle, AO aorta
a
b
c
Fig. 112.5 The turbulent fl ow is also evident in the apical four-chamber view between the left ventricle and the right atrium ( arrow ) ( a, b ). This
fl ow is continuous via the continuous wave Doppler study ( c ). LA left atrium, LV left ventricle, RA right atrium, RV right ventricle
Case 112 Rupture of the Sinus of Valsalva: Noncoronary Cusp to the Right Atrium
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