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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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376
a
c
b
Fig. 115.2 The apical fi ve-chamber view demonstrates a large mass
below the aortic valve ( arrow ). It seems that the mass is attached to the
chordae ( curved arrow ) ( a ) and produces a systolic turbulency ( arrow )
( b ) and a gradient of 87 mmHg in the left ventricular outfl ow tract ( c ).
SA single atrium, AO aorta, LV left ventricle, RV right ventricle
ab
Fig. 115.3 This mass ( arrow ) is also evident in the parasternal long-axis view below the aortic valve ( curved arrow ) ( a ). The turbulency begins
in the left ventricular outfl ow tract ( arrow ) ( b ). SA single atrium, AO aorta, LV left ventricle, RV right ventricle
115 Common Atrium, Atrioventricular Septal Defect, and Subvalvular Aortic Stenosis
377
Fig. 115.4 The apical four-chamber view shows moderately severe
mitral regurgitation ( arrow ) through the anterior left-sided atrioven-
tricular valve, suggestive of a cleft. SA single atrium, LV left ventricle,
RV right ventricle
Fig. 115.5 There is mild aortic regurgitation in the apical fi ve- chamber
view ( arrow ). LV left ventricle, AO aorta
ab
Fig. 115.6 A common atrioventricular valve ( arrow ) is seen in the apical four-chamber view in diastole ( a ) and systole ( b ). LV left ventricle,
RV right ventricle
ab
Fig. 115.7 The apical four-chamber view ( a , b ) depicts a ventricular septal defect (VSD) fl ow ( curved arrow ) and left ( arrow ) and right
( arrowhead ) atrioventricular valve regurgitation due to the cleft. LV left ventricle, RV right ventricle
115 Common Atrium, Atrioventricular Septal Defect, and Subvalvular Aortic Stenosis
378
Diagnosis
The patient was diagnosed with a common atrium, intermediate
form of an atrioventricular septal defect (one annulus and two
orifi ces), small VSD, subvalvular aortic stenosis, mild aortic
regurgitation, and signifi cant left and right atrioventricular
insuffi ciency with a cleft.
Comment
The patient was referred for catheterism and surgery.
Lesson
Subaortic stenosis may be associated with a common atrioventricular valve [ 52 ].
Fig. 115.8 The cleft of the grand leafl et ( arrow ) of the atrioventricular
valve is seen in the four-dimensional reconstruction in the parasternal
long-axis view
115 Common Atrium, Atrioventricular Septal Defect, and Subvalvular Aortic Stenosis
379
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_116, © Springer International Publishing Switzerland 2015
Total Anomalous Pulmonary
Venous Connection
Case 116
Fig. 116.1 The apical four-chamber view shows right ventricular and
right atrial dilation and a relatively small left atrium. It seems that there
is no pulmonary vein draining into the left atrium. RA right atrium, LA
left atrium, LV left ventricle, RV right ventricle
Fig. 116.2 The apical four-chamber view demonstrates a very large
atrial septal defect (ASD) ( arrow ). RA right atrium, LA left atrium, LV
left ventricle, RV right ventricle
A 4-year-old girl referred for cyanosis and dyspnea. She had
recurrent respiratory tract infection.
Electronic supplementary material The online version of this chapter
(doi:
10.1007/978-3-319-12934-1_116 ) contains supplementary mate-
rial, which is available to authorized users.
380
a
b
c
Fig. 116.3 The apical four-chamber view, with a slightly posterior
tilting of the probe, reveals an area behind the left atrium that receives
the pulmonary veins. The pulse wave Doppler fl ow study of this confl uence shows a continuous pulmonary vein fl ow, which denotes a common pulmonary vein confl uence ( b ). This is a schematic illustration of
the large ASD, the drainage of the pulmonary veins into the common
pulmonary vein confl uence, which leans behind the left atrium, and the
connection of the common pulmonary vein confl uence to the vertical
vein ( c ). RA right atrium, LA left atrium, LV left ventricle, RV right
ventricle, PV pulmonary vein, VV vertical vein, CPV common pulmo-
nary vein confl uence, ASD atrial septal defect
Case 116 Total Anomalous Pulmonary Venous Connection
381
Fig. 116.4 The suprasternal short-axis view reveals that the common
pulmonary vein confl uence drains into the vertical vein. VV vertical vein
Fig. 116.5 The vertical vein is connected to the innominate vein,
which leans horizontally as a bridge into the right superior vena cava.
VV vertical vein, INV innominate vein
a
b
Fig. 116.6 The innominate vein is connected to the superior vena cava ( a ), and the superior vena cava drains into the right atrium ( b ). VV vertical
vein, INV innominate vein, SVC superior vena cava, RA right atrium
Fig. 116.7 This schematic illustration depicts a supracardiac total
anomalous pulmonary venous connection. 1 Common pulmonary
venous confl uence, 2 vertical vein, and 3 innominate vein. The arrows
show the drainage of the pulmonary vein into the common pulmonary
vein. The common pulmonary vein reaches the vertical vein, and the
latter is connected to the innominate vein, which leans horizontally as a
bridge into the right superior vena cava. RA right atrium, LV left ven-
tricle, RV right ventricle, AO aorta, PA pulmonary artery, SVC superior
vena cava
Case 116 Total Anomalous Pulmonary Venous Connection
382
Diagnosis
The patient was diagnosed with a total anomalous pulmonary
venous connection (type A) and an ASD (ostium secundum
type).
Comment
The surgeon forged a connection between the confl uence and
the left atrium and closed the ASD.
Lesson
Type A of a total anomalous pulmonary venous connection,
in which all the pulmonary veins drain into a vertical vein and
then into the innominate vein, is more common [ 71 , 137 ].
a
b
Fig. 116.8 The modifi ed apical four-chamber view shows moderate tricuspid regurgitation ( a ) with a tricuspid regurgitation gradient of about
76 mmHg ( b ). RV right ventricle, RA right atrium
Fig. 116.9 The estimated mean pulmonary arterial pressure is approx-
imately 45 mmHg. PI pulmonary insuffi ciency
Case 116 Total Anomalous Pulmonary Venous Connection
383
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_117, © Springer International Publishing Switzerland 2015
A 4-year-old boy with dyspnea on exertion and severe
cyanosis with clubbing was referred to our echocardiography
laboratory.
Truncus Arteriosus
Case 117
a
c
b
Fig. 117.1 The modifi ed parasternal long-axis view (two dimensional) ( a ), color-fl ow Doppler study ( b ), and schematic illustration ( c ) demon-
strate a tubular lumen, which resembles a side branch and originates from the ascending aorta. The arrow points to this abnormal branch. LA left
atrium, LV left ventricle, AO aorta, RV right ventricle, LPA left pulmonary artery
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_117 ) contains supplemen-
tary material, which is available to authorized users.
384
Diagnosis
The patient was diagnosed with the truncus arteriosus
(type 1), a quadricuspid aortic valve, and a large VSD.
Comment
The patient was referred for catheterism and precise evaluation of pulmonary arterial pressure.
Lesson
There are four types of the truncus arteriosus. In type 1, the
main pulmonary artery originates from the truncus arteriosus. In type 2, the pulmonary branches originate from the
truncus directly and in close proximity of one another. In
type 3, the pulmonary branches are distant from one
another. And fi nally type 4 is now considered as a doubleoutlet right ventricle and the atresia of the pulmonary valve
[ 138 ]. The truncus arteriosus is accompanied by a quadricuspid aortic valve in 22 % of the cases. For surgery, an
aortic homograft or a Dacron conduit with a porcine valve
is used. The risk of pulmonary vascular disease is high
without surgery.
Fig. 117.5 This is a schematic illustration of the patient’s heart with
the truncus arteriosus, demonstrating the origination of the pulmonary
artery from the ascending aorta, a VSD, and a quadricuspid aortic valve.
RV right ventricle, RA right atrium, LA left atrium, LV left ventricle,
SVC superior vena cava
Fig. 117.2 The short-axis view reveals a large ventricular septal defect
(VSD) ( arrow ). RV right atrium, LV left ventricle
Fig. 117.3 The short-axis view shows a quadricuspid aortic valve and the
absence of the pulmonary artery trunk. 1–4 fi rst to fourth aortic leafl ets
Fig. 117.4 The short-axis view reveals that the two pulmonary artery
branches ( orange arrows ) originate from the aorta; this denotes the
truncus arteriosus. AO aorta
Case 117 Truncus Arteriosus
385
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_118, © Springer International Publishing Switzerland 2015
A 42-year-old man was admitted to our center for pulmonary
valve replacement. A known case of pulmonary stenosis, the
patient had undergone pulmonary valvuloplasty 6 years
previously. He had easy fatigability and edema of recent
duration.
Severe Pulmonary Insufficiency
Post Percutaneous Pulmonary
Valvuloplasty
Case 118
a
b
Fig. 118.1 Moderate right ventricular dilation is evident in the parasternal long-axis ( a ) and short-axis ( b ) views. LA left atrium, LV left ventricle,
RV right ventricle, AO aorta
Electronic supplementary material The online version of this chapter
(doi:
10.1007/978-3-319-12934-1_118 ) contains supplementary material,
which is available to authorized users.
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