Author + information
- Received July 6, 2011
- Accepted July 20, 2011
- Published online February 28, 2012.
- Santokh S. Dhillon, MD, MBBS⁎,
- Walter J. Duncan, MD†,
- Kevin C. Harris, MD, MHSc† and
- George G.S. Sandor, MB, ChB, DCH†
A 6-year-old girl was seen for cardiac murmur, exercise intolerance, and oxygen desaturation with moderate exercise. Transthoracic (A and B, red arrows; Online Video 1) and transesophageal echocardiography (TEE) with color Doppler (C and D, arrows indicate blood flow; Online Videos 2 and 3) demonstrated excessive trabeculations, fibrous chords, and muscle bundles creating a circular accessory inlet with flow acceleration in a double-chamber right ventricle (RV). There was bidirectional shunting across a patent foramen ovale. Cardiac catheterization with angiography (E, red arrows) recorded a pressure gradient of 20 mm Hg across the accessory inlet and confirmed the findings. Intraoperatively, there was an indentation on the external surface of the RV (F, arrows) caused by traction from the thick fibromuscular accessory inlet (G, arrow). Post-operative TEE showed a complete resection of the accessory tissue (Online Video 4). This case demonstrated right-to-left shunting across the atrial septum during exercise in a dysplastic right ventricular myocardium. LV = left ventricle; PV = pulmonary vein; RVOT = right ventricular outflow tract; TV = tricuspid valve.
- Received July 6, 2011.
- Accepted July 20, 2011.
- American College of Cardiology Foundation