Author + information
- Received August 8, 2013
- Accepted August 13, 2013
- Published online March 11, 2014.
A 43-year-old woman presented with mild exertional dyspnea for multiple years. On examination, a grade 3/6 harsh systolic murmur was heard at the left sternal border (Online Audio 1), and there was no lip cyanosis or finger clubbing. Echocardiogram noted a right ventricular (RV) hypertrophy, a large ventricular septal defect (VSD), and a hypertrophied muscular band separating the RV into proximal and distal chambers (A, Online Video 1). A tight ring (formed by the hypertrophied outlet septum, septomarginal trabeculation, moderator band, and septoparietal trabeculations) encircled the RV outflow tract (B, Online Video 2) and caused subpulmonic obstruction (C, Online Video 3, Online Audio 1). An enface view of the RV depicted the cardinal feature of Tetralogy of Fallot, with an anterocephalad deviation of the outlet septum that “peeled off” the crista supraventricularis and resulted in a large ventricular septal defect, RV outflow tract obstruction, and an overriding aorta with a fibrous continuity with the tricuspid valve (D, Online Video 4).
- Received August 8, 2013.
- Accepted August 13, 2013.
- American College of Cardiology Foundation