case_images: PMC1283745_01
case_images: Panel A: transthoracic echocardiography, modified four chamber subscostal view showing the dissecting tract through right ventricular free wall forming an intramural neo-cavity (asterisk), the arrow indicates the re-entry point of dissecting tract into right ventricle chamber. Panel B: transthoracic echocardiography, modified short axis subcostal view showing rupture of the inferobasal septum at the point that originates the right ventricular wall dissection (arrow), asterisk indicates the dissected neo-cavity. Panel C: postoperative transesophageal echocardiography, transgastric short axis view showing thickened basal segments of the right ventricle and inferobasal septum without visible dissecting tract (black arrow), note increased echoreflectivity at this site. Acoustic shadow caused by prosthetic patch has been indicated (asterisk). Abbreviations: LV, left ventricle, RA, right atrium, RV, right ventricle.
case_images: 1476-7120-3-33-1.jpg
case_images: PMC1283745_01_1476-7120-3-33-1.jpg
case_images: F1
case_images: Transthoracic echocardiography was immediately performed showing complex ventricular septal defect with a dissection tract that originated on left side of the basal inferoseptal akinetic segments, extended beyond the septum dissecting the right ventricular wall, and subsequently re-entered into the right ventricle chamber (figures 1, 2 and 3). One month later transesophageal echocardiography was performed (figure 1, Panel C) showing neither right ventricle dissecting tract or residual shunt.
case_images: Panel A: transthoracic echocardiography, modified short axis subcostal view with color flow Doppler mapping showing left ventricular entry site of septal rupture (white arrow). Panel B: transthoracic echocardiography, modified four chamber subscostal view with color flow Doppler mapping showing septal rupture exit site in the right ventricular free wall (black arrow). Asterisk indicates the intramural neo-cavity in the right ventricular free wall. Abbreviations: LV, left ventricle, RA, right atrium, RV, right ventricle.
case_images: 1476-7120-3-33-2.jpg
case_images: PMC1283745_01_1476-7120-3-33-2.jpg
case_images: F2
case_images: Transthoracic echocardiography was immediately performed showing complex ventricular septal defect with a dissection tract that originated on left side of the basal inferoseptal akinetic segments, extended beyond the septum dissecting the right ventricular wall, and subsequently re-entered into the right ventricle chamber (figures 1, 2 and 3).
case_images: Schematic short axis (panel A) and four chamber subcostal (panel B) echocardiographic views showing the septal rupture location and dissecting tract trajectory through right ventricular wall. Blood flows from left ventricle (panel A, inferior arrow) into right ventricular wall creating an intramural neo-cavity (panel A and B, asterisk), and re-enters the right ventricle chamber (panel A, superior arrow, panel B arrow). Abbreviations: LV left ventricle, LA left atrium, RA right atrium, RV right ventricle.
case_images: 1476-7120-3-33-3.jpg
case_images: PMC1283745_01_1476-7120-3-33-3.jpg
case_images: F3
case_images: Transthoracic echocardiography was immediately performed showing complex ventricular septal defect with a dissection tract that originated on left side of the basal inferoseptal akinetic segments, extended beyond the septum dissecting the right ventricular wall, and subsequently re-entered into the right ventricle chamber (figures 1, 2 and 3).