Author + information
- Received June 10, 2010
- Revision received July 12, 2010
- Accepted July 23, 2010
- Published online April 5, 2011.
- Christian Jung, MD⁎,
- Bjoern Goebel, MD⁎,
- Hans R. Figulla, MD⁎,
- Florian Krizanic, MD⁎,
- Markus Ferrari, MD⁎ and
- Alexander Lauten, MD⁎
A 22-year-old patient presented with hemoptysis and dyspnea on exertion. When the patient was a child, an atrial septal defect and Ebstein's anomaly had been diagnosed. The parents and the patient refused any treatment. Physical condition was reduced, and lip cyanosis was present as well as clubbing of the fingers (A and B). A systolic murmur was audible at the lower left sternal border. Hematocrit was significantly elevated at 79%.
X-ray confirmed cardiomegaly (C), and electrocardiography revealed a complete right bundle branch block and right-axis deviation (D). Transthoracic echocardiography showed a dilated right atrium (RA) (85 mm) and an atrialized ventricle (E, Online Video 1). An atrial septal defect with a prominent right-to-left-shunt was visualized (E, arrow; Online Video 2). Severe tricuspid insufficiency with coaptation failure (F and G, arrowhead; Online Video 3) and hypermobile anterior leaflet (F, arrow) was confirmed.
The patient was put on sildenafil treatment, bloodletting decreased the hematocrit to 58%, and he was scheduled for combined heart and lung transplantation. LV = left ventricle.
- Received June 10, 2010.
- Revision received July 12, 2010.
- Accepted July 23, 2010.
- American College of Cardiology Foundation