PMC5337462_01
The chest X-ray upon admission. A: The chest X ray film showed normal lungs and a normal cardiac silhouette. B: ECG showed a normal sinus rhythm with normal atrio-ventricular conduction, a normal QRS width and a normal QT interval: 200 ms, 80 ms and 436 ms1/2, respectively. Counterclockwise rotation is visible.
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A chest X-ray revealed no lung abnormalities and a normal cardiac silhouette (Fig. 1A). Counterclockwise rotation was observed in the precordial leads (Fig. 1B).
A marked decrease in the oxygen saturation was observed when the patient changed to a sitting position from a supine position (red line). After the surgical closure of the ASD, her symptoms were cleared and the oxygen saturation no longer decreased (blue line).
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The oxygen saturation was observed to markedly decrease when the patient changed from the supine position to a sitting or standing position (Fig. 2). After surgery, the patient's POS symptoms were completely resolved, and her oxygen saturation no longer decreased during sitting or standing (Fig. 2).
Transesophageal echocardiography. A typical four-chamber view was difficult to obtain, but a shunting flow was observed through the atrial septum when the patient was in the supine position. The flow increased upon the assumption of a sitting position. The blood appeared to be flowing directly from the inferior vena cava to the ASD.
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The shunt flow increased when the patient changed to a sitting position, flowing from the inferior vena cava directly to the ASD (Fig. 3).
Chest computed tomography (CT). Chest CT showed the elongation of the aorta, which caused the compression of the right atrium and ventricle. A trans-section view of the left ventricular cavity was obtained in the coronary view and revealed the abnormal position of the left ventricle due to the elongated aorta.
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Computed tomography (CT) showed the elongation of the aorta, which was compressing the right atrium and the right ventricle and distorting the heart position (Fig. 4).