PMC3123513_01
Admission electrocardiogram showing sinus rhythm and complete right bundle branch block
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F1
Electrocardiogram showed sinus rhythm and complete right bundle branch block [Figure 1].
Admission chest X-ray showing evidence of previous sternotomy (repaired tetralogy of Fallot), cardiomegaly and implanted cardioverter defibrillator in left pectoral region
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F2
Chest X-ray showed previous sternotomy wiring, cardiomegaly, and an implanted ICD device in the left pectoral region [Figure 2].
Transthoracic echocardiography showing no residual shunt at the ventricular septal defect patch and implantable cardioverter defibrillator lead seen traversing the tricuspid valve toward the right ventricular apex. a) Parasternal long axis view shows intact interventricular septum (IVS), (arrow); b) Parasternal long axis view with color Doppler shows no residual shunt at the ventricular septal defect; c) Implantable cardioverter defibrillator lead seen traversing the tricuspid valve towards the right ventricle (arrows)
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F3
A repeated antepartum echocardiographic study showed no residual shunt at the ventricular septal defect patch, a dilated right ventricle with normal systolic function, and an ICD lead seen traversing the tricuspid valve toward the right ventricular apex [Figure 3]; right ventricle systolic pressure was 44 mmHg, left ventricular ejection fraction (LVEF) 30%, left ventricular end-diastolic diameter (LVEDD) 56 mm, moderate tricuspid regurgitation (jet area of 4.5 cm2), and moderate pulmonary valve regurgitation [Figure 4].
Transthoracic echocardiography (M mode, 2 dimension and Doppler studies) showing the left ventricle, the tricuspid valve regurgitation and the pulmonary valve regurgitation. a) M mode taken at mid left ventricular level showing the dimensions; b) 4-chamber view with color Doppler shows moderate tricuspid regurgitation short axis view with pulse wave; c) Doppler at pulmonary valve shows moderate regurgitation
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F4
A repeated antepartum echocardiographic study showed no residual shunt at the ventricular septal defect patch, a dilated right ventricle with normal systolic function, and an ICD lead seen traversing the tricuspid valve toward the right ventricular apex [Figure 3]; right ventricle systolic pressure was 44 mmHg, left ventricular ejection fraction (LVEF) 30%, left ventricular end-diastolic diameter (LVEDD) 56 mm, moderate tricuspid regurgitation (jet area of 4.5 cm2), and moderate pulmonary valve regurgitation [Figure 4].