case_images: PMC11199785_01
case_images: PMC11199785_02
case_images: The transthoracic echocardiographic images before and after surgical repair. Preoperative RV inflow (A) and apical four-chamber views (B,C) showing dilation of RA/RV, systolic prolapse of AL/PL toward the RA (white arrows), and severe TR with right-to-left shunting through PFO (red asterisk). Postoperative echocardiogram (D-F) showing normalized RA/RV, complete edge-to-edge leaflet coaptation (white arrows), and trivial TR (green asterisk). RV, right ventricle; RA, right atrium; LA, left atrium; LV, left ventricle; AL, anterior leaflet; PL, posterior leaflet; SL, septal leaflet; TR, tricuspid regurgitation; PFO, patent foramen ovale.
case_images: fcvm-11-1335218-g001.jpg
case_images: PMC11199785_02_fcvm-11-1335218-g001.jpg
case_images: F1
case_images: Of note, the pulmonary trunk was narrowed (7.7 mm diameter) attributable to compromised antegrade flow from the RV toward the pulmonary artery, mimicking pulmonary atresia (Figures 1A-C). An echocardiogram on postoperative day 9 showed a trivial TR with complete edge-to-edge leaflet coaptation, favorable ventricular contractility, and normal size of the proximal main pulmonary artery and cardiac chambers (Figures 1D-F).
case_images: Intraoperative findings showing ruptures of the TV chordae tendineae (blue arrow), and head of anterior papillary muscle (green arrow). No fibromyxomatous changes were observed. TV, tricuspid valve.
case_images: fcvm-11-1335218-g002.jpg
case_images: PMC11199785_02_fcvm-11-1335218-g002.jpg
case_images: F2
case_images: During further exploration, the primary chordae tendineae was ruptured at the head of the anterior papillary muscle, conferring the absence of subvalvar apparatus supporting the involved leaflets (Figure 2).