case_images: PMC10328131_01
case_images: Apical four-chamber view. Right ventricular dilation seen at February's evaluation
case_images: JCE-33-43-g001.jpg
case_images: PMC10328131_01_JCE-33-43-g001.jpg
case_images: jcecho.jcecho_13_23-f001
case_images: RV dysfunction (Tricuspid Annulus Systolic Excursion [TAPSE] 11 mm, Tricuspid annulus S' wave [S' tric] 7 cm/s, Fractional Area Change [FAC] 29%; RV Stroke Volume Indexed [RV SVi] 28 ml/mq; RV Strain-6.6%) with severely reduced TAPSE/PAsP ratio (0.13) Presence of both McConell sign and normal right atrium area (14 cmq) was suggestive of an acute failure. RV was also extremely dilated in comparison to the left ventricle (LV), which was D-shaped with flattening of the interventricular septum (LV Eccentricity index 1.74, and a RV/LV ratio of 1.5) [Figures 1 and 2].
case_images: Parasternal short axis view
case_images: JCE-33-43-g002.jpg
case_images: PMC10328131_01_JCE-33-43-g002.jpg
case_images: jcecho.jcecho_13_23-f002
case_images: RV dysfunction (Tricuspid Annulus Systolic Excursion [TAPSE] 11 mm, Tricuspid annulus S' wave [S' tric] 7 cm/s, Fractional Area Change [FAC] 29%; RV Stroke Volume Indexed [RV SVi] 28 ml/mq; RV Strain-6.6%) with severely reduced TAPSE/PAsP ratio (0.13) Presence of both McConell sign and normal right atrium area (14 cmq) was suggestive of an acute failure. RV was also extremely dilated in comparison to the left ventricle (LV), which was D-shaped with flattening of the interventricular septum (LV Eccentricity index 1.74, and a RV/LV ratio of 1.5) [Figures 1 and 2].
case_images: Pulmonary valve acceleration time (a) and flying W sign (b)
case_images: JCE-33-43-g003.jpg
case_images: PMC10328131_01_JCE-33-43-g003.jpg
case_images: jcecho.jcecho_13_23-f003
case_images: Pulmonary pressure assessment showed high PAsP values (72 mmHg, tricuspid valve Vmax 3.8) and high mean pulmonary artery pressure value (assessed by both Chemla and Mahan methods, respectively >45 mmHg and >47 mmHg), pulmonary valve Acceleration Time was very short (65 ms) and mid-systolic notched [Figure 3]. "Flying W" sign was also appreciable in M-mode on the Pulmonary valve [Figure 3].