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A Tight Ring of Fallot
Journal of the American College of Cardiology Ó 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 63, No. 9, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.08.1661
IMAGES IN CARDIOLOGY
A Tight Ring of Fallot Ming-Ming Sim, MD Ping-Chen, Taiwan
From the Department of Cardiology, Landseed Hospital, Ping-Chen, Taiwan. Manuscript received August 8, 2013; accepted August 13, 2013.
43-year-old woman presented with mild exertional dyspnea for multiple years. On examination, a grade 3/6 harsh systolic murmur was heard at the left sternal border (Online Audio 1), and there was no lip cyanosis or finger clubbing. Echocardiogram noted a right ventricular (RV) hypertrophy, a large ventricular septal defect (VSD), and a hypertrophied muscular band separating the RV into proximal and distal chambers (A, Online Video 1). A tight ring (formed by the hypertrophied outlet septum, septomarginal trabeculation, moderator band, and septoparietal trabeculations) encircled the RV outflow tract (B, Online Video 2) and caused subpulmonic obstruction (C, Online Video 3, Online Audio 1). An enface view of the RV depicted the cardinal feature of Tetralogy of Fallot, with an anterocephalad deviation of the outlet septum that “peeled off” the crista supraventricularis and resulted in a large ventricular septal defect, RV outflow tract obstruction, and an overriding aorta with a fibrous continuity with the tricuspid valve (D, Online Video 4).
A
Vol. 63, No. 9, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.08.1661
IMAGES IN CARDIOLOGY
A Tight Ring of Fallot Ming-Ming Sim, MD Ping-Chen, Taiwan
From the Department of Cardiology, Landseed Hospital, Ping-Chen, Taiwan. Manuscript received August 8, 2013; accepted August 13, 2013.
43-year-old woman presented with mild exertional dyspnea for multiple years. On examination, a grade 3/6 harsh systolic murmur was heard at the left sternal border (Online Audio 1), and there was no lip cyanosis or finger clubbing. Echocardiogram noted a right ventricular (RV) hypertrophy, a large ventricular septal defect (VSD), and a hypertrophied muscular band separating the RV into proximal and distal chambers (A, Online Video 1). A tight ring (formed by the hypertrophied outlet septum, septomarginal trabeculation, moderator band, and septoparietal trabeculations) encircled the RV outflow tract (B, Online Video 2) and caused subpulmonic obstruction (C, Online Video 3, Online Audio 1). An enface view of the RV depicted the cardinal feature of Tetralogy of Fallot, with an anterocephalad deviation of the outlet septum that “peeled off” the crista supraventricularis and resulted in a large ventricular septal defect, RV outflow tract obstruction, and an overriding aorta with a fibrous continuity with the tricuspid valve (D, Online Video 4).
A