case_images: PMC4782477_01
case_images: (a) Tricuspid inflow pattern was taken in end expiration during quite breathing showing elevated e wave velocity and deceleration time of 180 ms. (b) Tissue Doppler velocity taken across the tricuspid valve. (c) Two-dimensional echocardiography with continuous wave Doppler applied across the right ventricular outflow tract showing the characteristic pandiastolic antegrade flow across the right ventricular outflow tract. (d) Two-dimensional echocardiography with continuous wave Doppler applied across the right ventricular outflow tract showing the systolic antegrade flow into the right ventricular outflow tract with complete disappearance of the pandiastolic antegrade flow across the right ventricular outflow tract
case_images: APC-9-82-g001.jpg
case_images: PMC4782477_01_APC-9-82-g001.jpg
case_images: F1
case_images: Pulsed Doppler of the tricuspid valve during diastole showed higher velocities during the early filling phase (e>a) [Figure 1a] and on tissue Doppler velocities assessment e'> a' [Figure 1b] inferior vena cava (IVC) size was 2.59 cm on inspiration and IVC variation with respiration was 30%. The antegrade diastolic flow was detected [Figure 1c] which started after a gap, which correlated with isovolumic relaxation time phase. TDI a > e) suggestive of pseudonormalization. There was no diastolic antegrade flow seen across RVOT [Figure 1d] as was seen preoperatively, left ventricular ejection fraction was normal.
case_images: (a) Computerized tomography scan with sagittal cut showing the severely stenosed right ventricular to pulmonary artery conduit (marked by arrow) with dilated right ventricle. (b) Computerized tomography scan with axial cut showing the severely stenosed right ventricular to pulmonary artery conduit (arrow) with adequate sized distal branch pulmonary arteries
case_images: APC-9-82-g002.jpg
case_images: PMC4782477_01_APC-9-82-g002.jpg
case_images: F2
case_images: The anatomical features were defined by computerized tomography scan [Figure 2a and b].