Figure 13-117: A. Transesophageal image (transverse plane) from a patient with persistent left superior vena cava. The coronary sinus (CS) is dilated. B. After injection of agitated saline into the left antecubital vein, contrast is seen entering the right atrium (RA) via the CS. TV = tricuspid valve; RV = right ventricle; LV = left ventricle. (From Blanchard DG, DeMaria AN. Cardiac and extracardiac masses: Echocardiographic evaluation. In: Skorton DJ, Schelbert HR, Wolf GL, Brundage BH, eds. Marcus' Cardiac Imaging, 2d ed. Philadelphia: Saunders; 1996:452-480, with permission.)

Conotruncal and Aortic Abnormalities

Tetralogy of Fallot is one of the more common conotruncal abnormalities, and affected individuals may sometimes survive to adulthood without surgical intervention. The classic echocardiographic features include a large perimembranous VSD, an anteriorly displaced aorta which overrides the VSD, RV enlargement and dysfunction, and pulmonic stenosis (either infundibular, valvular, or suprevalvular) (Fig. 13-118).589 590 The VSD and aorta are well visualized in the parasternal long-axis view, while the RV outflow tract and proximal PA are best seen in the parasternal short-axis view at the base of the heart. Doppler interrogation can provide evaluation of the severity of pulmonic stenosis, both before and after surgery. Echocardiography may aid detection of infants with tetralogy who will require early surgical intervention as well as patients who are at high risk for sudden death after surgical repair.591,592

Parasternal Short Axis Pleural EffusionAorta Interrograted

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Essentials of Human Physiology

Essentials of Human Physiology

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