PATIENT: Breeze Thorpe 29478
HISTORY: asymptomatic murmur, systolic, grade 4, auscultated R>L and sternal
There are mutliple defects here – there is tricuspid dysplasia and also a type A pulmonic stenosis here with a severe pressure gradient of 100mmHg. There is associated increased right sided pressures with right ventricular hypertrophy and compression of the left side of the heart / septum. there is tricuspid regurgitation, moderate, with a velocity of 6m/s due to the increased right sided pressures. there is moderate right atrial enlargement. There is associated congestive heart failure (right sided) as evidenced by the presence of a pericardial effusion (moderate, not haemodynamically significant), and free abdominal fluid visible trans-diaphragmatically.
The prognosis here is guarded due to the extent of the cardiac remodelling and the presence of concurrent tricuspid dysplasia. This type of PS does respond well to balloon dilation however consultation with an interventional cardiologist would be required to ascertain whether the remodelling, congestive failure and concurrent tricuspid dysplasia are contra-indications to intervention in this case. Therapy for the congestive failure is advised in the interim.
Comments: the cardiac structure is quite markedly abnormal here. there is a moderate pericardial effusion which is not haemodynamically significant – no compression of right atrium currently. The right side of the heart is significantly larger than the left. there is right ventricular hypertrophy and the left ventricle is compressed with a flat septum. there is a dysplastic tricuspid valve with the free wall leaflet being tied-down to the septum and very elongated. the septal leaflet is barely visible. The right atrium is significantly enlarged at 3.4cm. The pulmonic valve is thickened and fused. diameters of the outflow tracts are 1.1cm (aorta), 1.1cm (pulmonic). The left side of the heart is unremarkable except for the compression of the left ventricle by the septum.
LA:Aortic ratio (RPS SA, normal <1.6) 1.5
LA:Ao ratio (RPS LA, normal <2.5) 2.0
FS 60%, EPSS 0.1cm.
WALL THICKNESS AND CHAMBER DIMENSIONS COMMENTS: lvdd 1.9cm
turbulent flow in pulmonic outflow tract with stricture at level of pulmonic valve. tricuspid regurgitation, moderate
MITRAL INFLOW: Mitral Regurgitation? no
AORTIC OUTFLOW: Max Velocity 1.2m/s. Aortic Insufficiency? no
TRICUSPID INFLOW: Tricuspid Insufficiency? yes moderate 6.1m/s
PULMONIC OUTFLOW Max Velocity 5.1m/s. Pulmonic Insufficiency? no