case_images: PMC4782481_01
case_images: Midesophageal four chamber view with color flow Doppler showing sub aortic ventricular septal defect with a left to right shunt
case_images: APC-9-90-g002.jpg
case_images: PMC4782481_01_APC-9-90-g002.jpg
case_images: F1
case_images: The midesophageal four chamber view with color flow Doppler showed a perimembranous VSD measuring 1.9 cm with left to right shunt [Figure 1].
case_images: Midesophageal right ventricular inflow outflow view in color compare mode showing the aortopulmonary window and the left to right flow across the defect into the main pulmonary artery
case_images: APC-9-90-g003.jpg
case_images: PMC4782481_01_APC-9-90-g003.jpg
case_images: F2
case_images: The RV inflow outflow view in color compare mode showed the APW 1.86 cm in size with flow across the defect into the main pulmonary artery (PA) [Figure 2] and the VSD with left to right shunt.
case_images: Intraoperative surgical image (a) external anatomy (b) after opening the window. Figure shows posterior margin of the aortopulmonary window (W), openings of the Right pulmonary artery (**), left pulmonary artery (LPA), aorta (Ao). Origin of the right coronary artery is also seen (C)
case_images: APC-9-90-g004.jpg
case_images: PMC4782481_01_APC-9-90-g004.jpg
case_images: F3
case_images: The window was then opened and the defect was identified [Figure 3].
case_images: Postoperative midesophageal four chamber view with color flow Doppler shows right to left shunt across the unidirectional flap valve used to close the ventricular septal defect
case_images: APC-9-90-g005.jpg
case_images: PMC4782481_01_APC-9-90-g005.jpg
case_images: F4
case_images: The simultaneous aortic pressure was 80/38 mmHg while the pressure in the right atrium was 7 mmHg. The flow across UVP showed right to left shunt that was limited to diastole [Figure 4]. The saturation in the postoperative period remained consistently above 95% although there were episodes of systemic desaturation with the saturation dipping to 85-90%; these episodes were transient and correlated with right to left shunting through the UVP on transthoracic echocardiography.