PMC5772109_01
Electrocardiogram showing normal sinus rhythm with right bundle branch block
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F1
Her electrocardiogram revealed the right bundle branch block [Figure 1] and her chest X-ray revealed right ventricular (RV) enlargement [Figure 2]; hence, a transthoracic echocardiogram was ordered for further evaluation.
Chest radiography in lateral view showing prominent right ventricle
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F2
Her electrocardiogram revealed the right bundle branch block [Figure 1] and her chest X-ray revealed right ventricular (RV) enlargement [Figure 2]; hence, a transthoracic echocardiogram was ordered for further evaluation.
Transthoracic echocardiogram (in apical 4-chamber view) showing moderately dilated right ventricle and right atrium
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F3
Later showed normal left ventricular systolic and diastolic function, moderately dilated RV and right atrium (RA) [Figure 3], and pulmonary artery (PA) systolic pressure was estimated at 50 mmHg.
Cardiac magnetic resonance angiography showing large anomalous RUPLV draining into the SVC-RA junction. RUPLV=Right upper pulmonary vein, SVC=Superior vena cava, RA=Right atrium, IVC=Inferior vena cava, Ao=Aorta, PA=Pulmonary artery, LV=Left ventricle
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F4
RV ejection fraction of 54%, large anomalous right upper pulmonary vein (RUPV) draining into the SVC-RA junction [Figure 4], and small anomalous right middle pulmonary vein draining into the left atrium (LA) with sinus venosus ASD [Figure 5]. Ratio of pulmonic to systemic blood flow (Qp:Qs) was 2.78:1.
Cardiac magnetic resonance imaging showing small anomalous RMPV draining into the LA with sinus venosus ASD. RMPV=Right middle pulmonary vein, ASD=Atrial septal defect, RA=Right atrium, RV=Right ventricle, LA=Left atrium, LV=Left ventricle
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F5
RV ejection fraction of 54%, large anomalous right upper pulmonary vein (RUPV) draining into the SVC-RA junction [Figure 4], and small anomalous right middle pulmonary vein draining into the left atrium (LA) with sinus venosus ASD [Figure 5]. Ratio of pulmonic to systemic blood flow (Qp:Qs) was 2.78:1.