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- Title
NON-INVASIVE DIAGNOSTIC APPROACH OF SINUS VENOSUS ATRIAL SEPTAL DEFECT AND PARTIAL ANOMALOUS PULMONARY VEINS CONNECTION: A CASE REPORT.
- Authors
Adrian, Vangheli; Maria, Opriş Mihaela; Timea, Szigyarto; Vadana, Ioana-Alexandra; Gheorghita, Mareş Răzvan; Dan Octavian, Nistor
- Abstract
Background: Sinus venosus atrial septal defect (SV-ASD) and partial anomalous pulmonary vein connection (PAPVC) are rare congenital heart diseases that usually coexist. Only the surgical treatment prevents disease progression, however, high operative mortality rates have been reported. Therefore, an appropriate imaging modality is needed to optimize preoperative planning in order to decrease surgical risk. Objective: We aim to present the preoperative evaluation and the diagnostic approach of SV-ASD associated with PAPVC using threedimensional transesophageal echocardiography (3D-TEE). Material and methods: A 41-year-old female with no history of cardiovascular diseases presented with symptoms of fatigue and dyspnea on minimal exertion. Examinations pointed out a systolic murmur and an incomplete right bundle branch block. Transthoracic echocardiography revealed right cardiac chambers enlargement with severe tricuspid regurgitation and high suspicion for ASD. Furthermore, TEE with real-time 3D acquisition was performed and the examination demonstrated the high position of ASD with the right pulmonary veins being connected to the superior vena cava. Right heart catheterization confirmed the diagnosis and revealed a pulmonary to systemic blood flow ratio (Qp/Qs) of 2.58:1 and normal mean pulmonary artery pressure. In addition, pulmonary vascular resistance (PVR) was calculated as 0.43 UWood with an elevated pulmonary cardiac output. Results: 3D-TEE in association with cardiac catheterization emphasized the diagnosis of SVASD and PAPVC with no hypertension and low PVR, suggesting a compensated physiological state. Thus, the patient was considered a good candidate for surgical treatment due to the normal PVR and significant left-to-right shunt. Importantly, in our case 3D-TEE provided optimal and accurate anatomical details of the congenital defects. Conclusions: Both SV-ASD and PAPVC are rare congenital heart defects with significant morbidity and mortality that are frequently undetected and difficult to diagnose. Although computed tomography angiography is the main diagnostic investigation in the preoperative assessment of SV-ASD, 3D-TEE is a promising non-invasive modality for a comprehensive preoperative imaging evaluation.
- Subjects
ATRIAL septal defects; PULMONARY veins; CONGENITAL heart disease; VENA cava superior; SURGICAL therapeutics; TRANSESOPHAGEAL echocardiography
- Publication
Acta Medica Marisiensis, 2019, Vol 65, p111
- ISSN
2068-3324
- Publication type
Article