scholarly journals Intraoperative Echocardiographic Detection of Septal Aneurysm and Additional Ventricular Septal Defect in a Child with Tetralogy of Fallot

2017 ◽  
Vol 5 (1) ◽  
pp. 21-24
Author(s):  
Ashok Kumar ◽  
Sambhunath Das
Keyword(s):  
Ventricular Septal Defect ◽  
Tetralogy Of Fallot ◽  
Papillary Muscle ◽  
Septal Defect ◽  
Pulmonary Stenosis ◽  
Interventricular Septum ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Interatrial Septum ◽  
Valvular Pulmonary Stenosis

ABSTRACT A 2-year-old child was diagnosed with subaortic ventricular septal defect (VSD) with severe infundibular and valvular pulmonary stenosis (PS) by transthoracic echocardiography. Intraoperative transesophageal echocardiography (TEE) detected aneurysmal interventricular and interatrial septum (IAS), subaortic VSD, and right ventricular outflow tract (RVOT) with an additional midmuscular VSD. The aneurysmal interventricular septum (IVS) was repaired. An accessory tricuspid papillary muscle was attached to RVOT, which was augmented with a transannular pericardial patch to have minimal postoperative gradient without sacrificing the accessory papillary muscle (APM). This rare case poses a challenge to the anesthetist and surgeon in the form of diagnostic differences, severe right ventricle (RV) dysfunction with aneurysmal IVS, and difficulty in reconstruction of RVOT. Intraoperative TEE played a greater role to diagnose the IVS aneurysm, additional VSD and guide for appropriate surgery. How to cite this article Das S, Kumar A. Intraoperative Echocardiographic Detection of Septal Aneurysm and Additional Ventricular Septal Defect in a Child with Tetralogy of Fallot. J Perioper Echocardiogr 2017;5(1):21-24.

Post Melody valve implant in a conduit with regurgitant native outflow tract successful closure by Amplatzer muscular device

2014 ◽  
Vol 25 (2) ◽  
pp. 324-327
Author(s):  
Tarek S. Momenah ◽  
Motea T. El Houry ◽  
Muhammad A. Khan ◽  
Mohammed O. Galal
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Septal Defect ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Muscular Ventricular Septal Defect ◽  
Melody Valve ◽  
Tetralogy Of Fallot Repair

AbstractWe describe the technique of closure of native right ventricular outflow tract by Amplatzer muscular ventricular septal defect device because of severe regurgitation in a patient who had tetralogy of Fallot repair with conduit at 3 years of age followed by percutaneous Melody valve implant 6 years later.

scholarly journals 507 Heat failure in restrictive ventricular septal defect

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L T Lam ◽  
C M Tam ◽  
K Y Y Fan
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricular ◽  
Septal Defect ◽  
Continuous Wave ◽  
Color Doppler ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Three Dimension ◽  
Sinus Of Valsalva

Abstract Introduction Patients with small restrictive ventricular septal defect are usually asymptomatic. This case report presented a case of shortness of breath in a patient with known restrictive ventricular septal defect. Case report A 51 years old woman was diagnosed to have a small supra-cristal ventricular septal defect in early twenties. She enjoyed good functional state since the diagnosis. Routine echocardiogram assessment one year ago found normal left ventricular size and systolic function. However, she presented with exertional shortness of breath and severe bilateral lower limbs edema for two weeks. Transthoracic echocardiogram found both left and right ventricles were dilated. Left ventricular ejection fraction was 50%. The right ventricular systolic pressure(RVSP) was 70mmHg from tricuspid regurgitation peak velocity estimation. It was significantly raised compared with the RVSP 35mmHg measured last year. This caused right ventricular pressure overload with systolic flattening of interventricular septum. On color doppler examination, apart from the known ventricular septal defect flow, there was an abnormal turbulent flow at the right ventricular outflow tract. The two jets was close to each other and the nature of the abnormal jet could not be clearly identified. During trans-esophageal echocardiogram, in order to differentiate the two different jets, the baseline of the color doppler was shifted towards the directions of the jets to look for the proximal isovelocity surface area (PISA). Finally there were two PISA could be clearly seen. One was the PISA of the ventricular septal defect while the other one was due to ruptured right coronary sinus with shunting from aorta to right ventricular outflow tract. The findings was supported by continuous wave doppler examination. The ventricular septal defect flow was predominantly systolic whereas the aorto-right ventricular shunting was a continuous flow. Moreover, three dimension echocardiogram also showed the two closely related holes. Finally the patient underwent percutaneous closure of the ruptured sinus of valsalva. And the patient recovered well afterwards. Discussion Small ventricular septal defect with restrictive physiology usually will not lead to heart failure. When patient presented with heart failure while having a small ventricular septal defect, other pathology should be carefully looked for. Ruptured sinus of valsalva was known to associate with ventricular septal defect. However, the jet of ruptured sinus of valsalva may be missed in view of the close proximity with the ventricular septal defect jet as in this case. Methods to better delineate the different jets including demonstration of double PSIA, continuous flow on continuous wave doppler and three dimension echocardiogram. Nowadays, ruptured sinus of valsalva could also be closed percutaneously with success. Abstract 507 Figure.

scholarly journals Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated

2019 ◽  
Vol 56 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Margaux Pontailler ◽  
Chloé Bernard ◽  
Régis Gaudin ◽  
Anne Moreau de Bellaing ◽  
Mansour Mostefa Kara ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mortality Rate ◽  
Tetralogy Of Fallot ◽  
Pressure Ratio ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Early Mortality ◽  
Abnormal Coronary Artery

AbstractOBJECTIVESRepair of tetralogy of Fallot (ToF) can be challenging in the presence of an abnormal coronary artery (CA) in 5–12% of cases. The aim of this study was to report our experience with ToF repair without the systematic use of a right ventricle-to-pulmonary artery (RV-PA) conduit.METHODSWe conducted a monocentric retrospective study from 2000 to 2016, including 943 patients with ToF who underwent biventricular repair, of whom 8% (n = 76) presented with an abnormal CA. Mean follow-up time was 50 months (1 month–18 years).RESULTSThe most frequent CA anomaly was the left descending artery arising from the right CA (n = 47, 61.8%). The median age at repair was 7.7 months (1.8 months–16 years). Thirteen patients (17%) required prior palliation, mostly systemic pulmonary shunts for anoxic spells in the neonatal period. Surgical repair allowed us to preserve the annulus in 40 patients (53%) by combining PA trunk plasty, commissurotomy and infundibulotomy under the abnormal CA. If the annulus had to be opened (n = 35, 46%), a transannular patch was inserted after a vertical incision of the PA trunk and extended obliquely on the RV over the anomalous crossing CA (with an infundibulotomy under the abnormal CA). Three patients (4%) required the insertion of an RV-PA conduit (1 valved tube and 2 RV-PA GORE-TEX tubes with annulus conservation). The early mortality rate was 4% (n = 3); none of the deaths was coronary related. Four patients (5%) required reoperation (2 early and 2 late reoperations) for residual pulmonary stenosis, 3 of whom had annulus preservation during the initial repair. The mean RV/left ventricle (LV) pressure ratio and an RV/LV pressure ratio >2/3 were identified as risk factors for right ventricular outflow tract (RVOT) reinterventions (P = 0.0026, P = 0.0085, respectively), RVOT reoperations (P = 0.0002 for both) and reoperation for RVOT residual stenosis (P = 0.0002, P = 0.0014, respectively). Two patients underwent pulmonary valve replacement. Freedom from late reoperation was 100% at 1 year, 97% at 5 years and 84% at 10 and 15 years.CONCLUSIONSRepair of ToF and abnormal CA can be performed without an RV-PA conduit, with an acceptable low reintervention rate. The high early mortality rate in this series remains a concern. If any doubt remains about the surgical relief of the RVOT obstruction, the RV/LV pressure ratio should always be measured in the operating room.

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