Pulmonary Arterial Obstruction Due to a Huge Sinus Venosus Remnant
An otherwise healthy 1-year-old girl was referred for cardiac assessment because of an ejection systolic murmur. Echocardiography revealed a membranous, balloon-like structure attached to the right atrial wall extending through the tricuspid valve into the right ventricular outflow tract (Figure⇓, A, arrows inside the membrane. PV indicates pulmonary valve; MPA, main pulmonary artery). With each systole, the membrane crossed the pulmonary valve, reaching as far as the proximal part of the left pulmonary artery (B; arrows indicate the lateral border of the membrane; LPA, left pulmonary artery). Color flow imaging demonstrated diversion of the high-velocity flow on the outside of the membrane (C), causing a systolic pressure drop of 70 mm Hg. At surgery, a grossly enlarged (6-cm-long and 2-cm-wide) remnant of the right sinus venosus valve was removed uneventfully by cutting of three thin, cordlike attachments in the right atrium (D).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
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