PMC1794404_01
The paraesternal minor axis view shows the large VSD, and a muscular band (arrow) witch shares the right ventricle into two chambers. The right ventricle outflow (RVOF) is free of lesions (panel A). Panel B shows the aliasing phenomena of color at the point of the muscular obstruction, with velocities and gradients represented in panel C.
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F1
Transthoracic echocardiography (Figure 1 and Figure 2) showed: a 17 mm perimembranous VSD associated to a slow velocity flow from left to right ventricle; aortic root was slightly deviated to the right.
The apical 5 chambers view (panel A) shows the large VSD and right chamber dilatation. The velocity of flow trough the VSD is low (panel B). The RV sistolic pressure elevation is detected trough the tricuspid regurgitation velocities (panel C). RV = right ventricle, RA = right atrium, LV = left ventricle, LA = left atrium
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F2
Transthoracic echocardiography (Figure 1 and Figure 2) showed: a 17 mm perimembranous VSD associated to a slow velocity flow from left to right ventricle; aortic root was slightly deviated to the right.
Intraoperatory findings (A and B): A- The transtricuspidic approach reveals the muscular obstructive band (arrow). B- The muscular band resected seemed an obstructive ring. TV = tricuspid valve. Post operatory findings: C- Paraesternal short axis view showing absence of right intraventricular obstruction as documented by color flow mapping.
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F3
VSD was closed and the right anomalous muscle band (Figure 3) was successfully removed.