case_images: PMC11811637_01
case_images: Transthoracic echocardiogram image. Four-chamber view in end-diastole showing biventricular dilatation with displacement of the interventricular septum towards the morphologically right ventricle in systemic position.
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case_images: TTE showed a dilated systemic right ventricle (RV) with preserved global systolic function, an end-diastolic volume of 177 mL (152 mL two years earlier), an end-systolic volume of 74 mL, and an ejection fraction (EF) of 58% by the Simpson method, with mild left AV valve regurgitation. The subpulmonary LV was dilated, with an end-diastolic diameter of 60 mm (previously 51 mm) and a midventricular diameter of 43 mm, maintaining a preserved shortening fraction (mitral annular plane systolic excursion of 33 mm) (Figure 1 and Supplementary material).
case_images: Transthoracic echocardiogram image of subpulmonary ventricular septal defect (VSD). (A) Parasternal long-axis plane with colour Doppler showing interventricular shunt with unidirectional flow from the subaortic right ventricle to the subpulmonary left ventricle. (B) Continuous Doppler flow of the VSD with a maximum velocity of 6 m/s.
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case_images: The known subpulmonary VSD had a peak velocity of 6 m/s and a maximum gradient of 144 mmHg (Figure 2).
case_images: Contrast-enhanced CT image, apical four-chamber plane showing atrioventricular discordance and dilatation of both ventricular cavities.
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case_images: Given the excessive magnitude of the shunt relative to the VSD dimensions and its restrictive behaviour, a cardiac computed tomography (CT) scan (Figure 3) was performed to rule out anomalous venous drainage and evaluate a probable atrial septal defect suspected from the analysis of 4D-flow MRI sequences.