Obstruction of right ventricular inflow and outflow in corrected transposition of the great arteries (S,L,L): two-dimensional echocardiographic diagnosis

Double Outlet Right Ventricle With Right-Sided Aorta From the Left-Sided Morphologically Right Ventricle in the Setting of Discordant Atrioventricular Connections

We describe the anatomic findings in a 2-year-old patient with double outlet right ventricle with right-sided aorta in the setting of usual atrial arrangement and discordant atrioventricular connections, making comparison with a specimen from the pathological archive of the Birmingham Children's Hospital in the United Kingdom having this rare combination of anatomic features. We discuss the challenges involved in diagnosis and management.

Supratricuspid obstructive membrane in congenitally corrected transposition of the great arteries

Obstructive lesions in the inflow of the systemic ventricle in congenitally corrected transposition of the great arteries are rare. It is important to identify such lesion which could alter the surgical outcome if not recognized. We report the echocardiographic findings in a patient with supratricuspid obstructive membrane with corrected transposition of the great arteries.

Three-dimensional transthoracic echocardiographic assessment of supramitral ring in a young child

Three-dimensional echocardiography is an increasingly used method to accurately depict congenital heart disease in children. We report the case of a 2-month-old girl with supramitral ring. Three-dimensional echocardiography allowed perfect visualisation of the fibrous shelf before surgery.

Right Ventricular Inflow Obstruction Caused by Supratricuspid Ring after the Conventional Biventricular Repair of Congenitally Corrected Transposition of Great Arteries - A case report -

A seventeen-month-old male baby, who had received conventional biventricular repair for congenitally corrected transposition of the great arteries, underwent excision of supratricuspid ring. Although tricuspid valve annulus was marginally small on direct inspection in the operating theater, circumferential excision of supratricuspid ring alone completely relieved the right ventricular inflow obstruction.

Echocardiography for Discordant Atrioventricular Connections

An understanding of the nomenclature of discordant atrioventricular connections is necessary to understand the corresponding anatomy and hence physiology of this rare, and complex heart defect. Echocardiography is an important imaging modality for the diagnosis of discordant atrioventricular connections. The morphology of the atria, ventricles and great arteries can be determined by echocardiography. A precise and organized segmental approach to the echocardiographic examination can establish the diagnosis and associated abnormalities. Such an approach is essential for the initial diagnosis, to help guide medical and surgical intervention, and evaluate the corresponding response to intervention in these patients.

An unusual case of tricuspid lesion in congenital corrected transposition of the great arteries

An unusual case of severe supravalvular stenosing ring of the left atrium associated with tricuspid valve dysplasia in an adult symptomatic patient affected by congenitally corrected transposition and unrestrictive ventricular septal defect is reported. The stenosis of the systemic atrioventricular valve possibly prevented the development of obstructive pulmonary vascular disease; removal of the membrane, attached to the tricuspid annulus, together with pulmonary banding was carried out. Clinical conditions improved after surgery. The unusual stenotic lesion of the systemic right ventricular inflow allowed conservative surgical palliation in this adult patient.

[Cerebellum abscess: first demonstration of undiagnosed infective endocarditis in an adult with corrected transposition arteries]

Neurological complications occur in approximately 30% of all patients with infective endocarditis and represent a major factor associated with an increased mortality rate. Third of these complications is represented by cerebral embolism, followed by mycotic aneurysm, meningitis or meningoencephalitis. Brain abscesses are rare; their localization to the cerebellum is exceptional. A case of cerebellum abscess occurring in a 34-year-old patient with non-operated corrected transposition of the great arteries is reported. Occurrence of this abscess was the first demonstration of undiagnosed infective endocarditis.

Double-outlet right ventricle associated with discordant atrioventricular connection and dextrocardia in a cat

The prevalence of congenital cardiac disease in cats varies from 0.2 to 1 per cent, with males being more affected than females. This is probably an underestimate due to the fact that not all affected kittens are presented. Discordant atrioventricular connection (where the morphological right atrium connects to the morphological left ventricle, and the morphological left atrium connects to the morphological right ventricle) is an uncommon condition in humans and, to the authors' knowledge, has not to date been described in animals. The association between this anomaly and the double-outlet right ventricle (where both great arteries arise entirely or partially from the morphological right ventricle) is extremely rare in children. This report describes a case of a cat which presented with this association of cardiac defects.

Pathologic elucidation of the echocardiographic features of Ebstein's malformation of the morphologically tricuspid valve in discordant atrioventricular connections

We defined the morphology of the left atrioventricular valve in Ebstein's malformation associated with congenitally corrected transposition to elucidate the approach to diagnosis by echocardiography. We found 14 unequivocal cases out of a total of 3,720 specimens. We noted the atrial arrangement, displacement, and nature of the tricuspid leaflets, and axis of the plane of the tricuspid orifice. We constructed ratios of volume of the atrialized to the functional right ventricle, and of the right to left ventricle, as well as distances of the septal attachments of the atrioventricular junctions to the respective ventricular apices. Three specimens had abnormalities of cardiac position, and 8 had ventricular septal defect. The tricuspid valve plane was rotated 47 +/- 21 degrees from its usual position into the ventricle. The tricuspid valvar tissue was variably attached to the underlying myocardium, with the most severely affected lesion being the mural leaflet followed by the septal leaflet, and the anterior leaflet attachment the least affected. Abnormalities of the tendinous cords and the effective valvar orifice occurred in 3 specimens. The ratio of the atrialized to the functional right ventricular volume was 0.74 +/- 0.49; the ratio of the fetal right to left ventricular volume was 1.18:1 +/- 0.70:1. These data suggest that plastic repairs of the right ventricle would leave a small functional right ventricle, but that valve replacement could restore the volume of the ventricle. Thus, the plane of displacement of the valve in corrected transposition appears less amenable to 4-chamber echocardiography than other forms of Ebstein's malformation. Changes in the echocardiographic planes should display the morphology and also provide some hemodynamic information.