PMC4782481_01
Midesophageal four chamber view with color flow Doppler showing sub aortic ventricular septal defect with a left to right shunt
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F1
The midesophageal four chamber view with color flow Doppler showed a perimembranous VSD measuring 1.9 cm with left to right shunt [Figure 1].
Midesophageal right ventricular inflow outflow view in color compare mode showing the aortopulmonary window and the left to right flow across the defect into the main pulmonary artery
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F2
The RV inflow outflow view in color compare mode showed the APW 1.86 cm in size with flow across the defect into the main pulmonary artery (PA) [Figure 2] and the VSD with left to right shunt.
Intraoperative surgical image (a) external anatomy (b) after opening the window. Figure shows posterior margin of the aortopulmonary window (W), openings of the Right pulmonary artery (**), left pulmonary artery (LPA), aorta (Ao). Origin of the right coronary artery is also seen (C)
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F3
The window was then opened and the defect was identified [Figure 3].
Postoperative midesophageal four chamber view with color flow Doppler shows right to left shunt across the unidirectional flap valve used to close the ventricular septal defect
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F4
The simultaneous aortic pressure was 80/38 mmHg while the pressure in the right atrium was 7 mmHg. The flow across UVP showed right to left shunt that was limited to diastole [Figure 4]. The saturation in the postoperative period remained consistently above 95% although there were episodes of systemic desaturation with the saturation dipping to 85-90%; these episodes were transient and correlated with right to left shunting through the UVP on transthoracic echocardiography.