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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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69
ab
Fig. 22.6 The left-to-right shunt through the ASD ( blue ) is shown on TEE (0°) ( a ) and (short-axis view) ( b ) ( arrow ). LA left atrium, RA right
atrium, RV right ventricle, AO aorta
a
c
d
b
Fig. 22.5 The ASD (ostium primum type) ( arrow ) and two atrioven-
tricular (AV) valves, which are at one level, are evident on TEE (0°) in
diastole and systole ( a , b ). The AV valve has two annuluses and two
orifi ces. This defect is 19 mm in size ( c ). This is a schematic illustration
of the transitional form of the AVSD in this view in systole ( d ). LA left
atrium, LV left ventricle, RA right atrium, RV right ventricle
Case 22 Atrioventricular Septal Defect (Transitional Form)
70
Diagnosis
The patient was diagnosed with the transitional form of the
AVSD, including an ASD (ostium primum type); an inlet
VSD; the cleft of the anterior mitral leafl et (AML); and two
annuluses and two orifi ces of two separate atrioventricular
valves, which were at one level.
A Qp/Qs of 2.2. She was referred for surgery.
Lesson
1. The AML cleft is often accompanied by an AVSD in one
of its forms, i.e., complete, intermediate, transitional, and
partial, but isolated forms of anterior and posterior mitral
cleft have been reported [ 54 , 55 ].
2. The AML cleft may be better visualized in the parasternal
long-axis or short-axis view or the apical four-chamber
view.
3. Given the nature of the disease, insofar as the mitral and
tricuspid valves are at one level and there is mitral regurgitation due to the cleft, the physician must be careful not
to measure the mitral regurgitation peak gradient instead
of the tricuspid regurgitation gradient when estimating
the systolic pulmonary arterial pressure.
4. All the complete, transitional, and intermediate forms of
AVSD should be referred for surgery of closure of defects
and valve repair except in Eisenmenger’s syndrome [ 7 ].
Case 22 Atrioventricular Septal Defect (Transitional Form)
71
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_23, © Springer International Publishing Switzerland 2015
A 20-year-old woman presented with slowly progressive cyanosis, clubbing, and dyspnea on exertion (functional class II).
She was referred to our echocardiography laboratory for
echocardiography. Physical examination revealed a loud S2.
Electrocardiography showed normal sinus rhythm, northwest
axis, and tall R in the right precordial leads.
Atrioventricular Septal Defect
(Complete Form) and a Common
Atrium with Eisenmenger’s
Syndrome
Case 23
ab
Fig. 23.1 A large ventricular septal defect (VSD) ( arrows ) is clear in the parasternal long-axis ( a ) and apical four-chamber ( b ) views. LA left
atrium, LV left ventricle, RV right ventricle
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_23 ) contains supplementary
material, which is available to authorized users.
72
ab
Fig. 23.2 A bidirectional fl ow across the VSD ( arrow ) is demonstrated
in the parasternal long-axis view: blue in diastole ( a ) and red in systole
( b ), without turbulency. Severe right ventricular wall hypertrophy is
also evident in this view ( curved arrow ) ( a ). LA left atrium, LV left
ventricle, RV right ventricle
Case 23 Atrioventricular Septal Defect (Complete Form) and a Common Atrium with Eisenmenger’s Syndrome
73
a
c
b
Fig. 23.3 The common atrium and the common atrioventricular (AV)
valve ( arrow ) ( a ) are evident in the apical four-chamber view. There is
one orifi ce and one annulus for the AV valve. The VSD ( curved arrow )
is also visualized in this view ( b ) ( a , b ), in diastole and systole.
A schematic illustration of the VSD, common atrium, and common AV
valve is presented in the apical four-chamber view ( c ). LV left ventri-
cle, RV right ventricle
Case 23 Atrioventricular Septal Defect (Complete Form) and a Common Atrium with Eisenmenger’s Syndrome
74
Diagnosis
The patient was diagnosed with common atrium, complete
form of the atrioventricular septal defect (AVSD), common
AV valve with one orifi ce and one annulus, cleft of the common AV valve, and Eisenmenger’s syndrome.
Comment
The patient had a Qp/Qs of 1, systemic vascular resistance of
19, pulmonary vascular resistance of 18 units, and no change
in the pulmonary vascular resistance and mean pulmonary
arterial pressure with O2. Medical treatment was, therefore,
recommended.
Lesson
1. In the parasternal long-axis view, when the right ventricular free wall hypertrophy is visualized, there are two pos-
sible diagnoses: pulmonary stenosis and pulmonary
arterial hypertension.
2. A bidirectional fl ow across the VSD without turbulency is
in favor of the two above mentioned possible diagnoses.
3. A common atrium is an anomaly associated with a complete AV canal [ 52 ].
4. Cyanosis and clubbing are the symptoms and signs of
Eisenmenger’s syndrome.
5. In the complete AVSD, the axis of the electrocardiogram
is northwest, while in the other forms of the AVSD, there
is left axis deviation.
6. In the complete form of the AVSD, the VSD is larger than
that in the intermediate form [ 52 ].
ba
Fig. 23.4 Moderately severe common AV valve regurgitation ( arrow ) can be seen in the apical four-chamber view ( a ). There is a clear valve cleft,
22 mm in size, in the parasternal short-axis view ( b ). LV left ventricle, RV right ventricle
Case 23 Atrioventricular Septal Defect (Complete Form) and a Common Atrium with Eisenmenger’s Syndrome
75
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_24, © Springer International Publishing Switzerland 2015
A young woman with a history of easy fatigability and cyanosis with clubbing was referred to our echocardiography
laboratory for cardiac evaluation.
Common Atrium, Atrioventricular
Septal Defect, Interrupted Inferior
Vena Cava, Left Persistent Superior
Vena Cava, and Left Azygous Vein
Case 24
Fig. 24.1 The inferior vena cava ( IVC ) is interrupted, and the hepatic
veins drain directly into the right atrium in this subcostal view. HV
hepatic vein, RA right atrium
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_24 ) contains supplementary
material, which is available to authorized users.
76
a
e
d
b
c
Fig. 24.2 The suprasternal long-axis view shows a left-sided aortic
arch ( a ). With a more pronounced left-sided tilting of the probe, the
superior vena cava ( SVC ) is visualized with a turbulent fl ow, which is in
favor of the drainage of the azygous vein into the left persistent SVC
(the left persistent SVC fl ow is usually laminar with a blue color in
color-Doppler fl ow study) ( b ). These are the left persistent SVC and the
azygous vein fl ow ( arrow ) in color-Doppler fl ow study ( c ) and continu-
ous Doppler study ( d ). RPA right pulmonary vein, SVC superior vena
cava, LSVC left persistent superior vena cava, DAO descending aorta.
This is a schematic illustration of the connection between the left azygous vein and the left persistent SVC ( e )
ab
Fig. 24.3 A common atrium with two atrioventricular valves and one annulus (intermediate form) with straddling are seen in this apical four-
chamber view in systole ( a ) and diastole ( b ). RV right ventricle, LV left ventricle
Case 24 Common Atrium, Atrioventricular Septal Defect, Interrupted Inferior Vena Cava
77
Fig. 24.4 The apical four-chamber view reveals mild left-sided atrio-
ventricular valve ( AV ) regurgitation. The arrow shows a ventricular sep-
tal defect ( VSD ). VSD ventricular septal defect
a
c
b
Fig. 24.5 The subcostal en face view demonstrates the right and left
ventricles ( a ) and the atrioventricular valve with its two orifi ces and one
annulus [intermediate type of the atrioventricular septal defect ( AVSD )
( b ) with relatively small left ventricle. This schematic illustration ( c )
shows the four types of the AVSDs according to Rastelli’s classifi ca-
tion. From left to right, the illustrations depict the complete, intermediate, transitional, and partial types, respectively. RA right atrium, LA left
atrium, LV left ventricle, RV right ventricle, MV mitral valve, TV tricus-
pid valve
Case 24 Common Atrium, Atrioventricular Septal Defect, Interrupted Inferior Vena Cava
78
ba
Fig. 24.6 The long-axis view reveals that the aorta is connected to the left ventricle (ventricular–arterial concordance) and that the left ventricular
outfl ow tract is elongated ( a ). A reversal of the long-axis view demonstrates the “gooseneck” deformity ( b )
Fig. 24.7 The short-axis view shows that the pulmonary artery is con-
nected to the right ventricle and that the pulmonary artery is severely
dilated. RV right ventricle, PA pulmonary artery
Case 24 Common Atrium, Atrioventricular Septal Defect, Interrupted Inferior Vena Cava
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