DK2985_C000 1..28 - AlSharqia Echo Club

532 Transesophageal EchocardiographyOutlet VSDs are also referred to as supracristal, infundibular,conal, doubly committed, or subarterial ventriculardefects. They lie proximal to the right coronary cusp andpulmonic valve (PV) in the LVOT ceiling, are usuallylarge and do not close spontaneously (Fig. 24.18). Theyare often associated with prolapse of the right aortic cuspdue to decreased structural aortic valvular support ordamage from a high velocity impinging jet.The VSDs persisting to adulthood are usually relativelysmall, and restrictive, that is, with a systolic pressure gradientbetween the left and right ventricles (LV, RV). Surgicalmanagement will be required if there is volume overload orif complications have developed, mainly bacterial endocarditis,or aortic cusp prolapse into the VSD with developmentof significant aortic regurgitation (AR) (6).Figure 24.9 A 48-year-old man is scheduled for closure of asinus venosus atrial septal defect (ASD). The right pulmonaryveins are here connected to the left atrium (LA) and can beseen through the ASD (RA, right atrium; SVC, superior venacava). (Courtesy of Dr. Nancy Poirier.)Transesophageal Echocardiography for VSD(Table 24.2)Because of the complex anatomical characteristics ofthe ventricular septum due to its longitudinal twisting(A)(B)LAASDRARVLVFigure 24.10 Ostium primum atrial septal defect (ASD). Mid-esophageal four-chamber view showing, in addition to the ASD, theinsertion of the two atrioventricular valves at the same level on the superior aspect of the ventricular septum (LA, left atrium; LV,left ventricle; RA, right atrium; RV, right ventricle).(A) (B) (C)LAASDRARVLVFigure 24.11 Ostium primum atrial septal defect (ASD) with a cleft anterior mitral valve leaflet. (A) Mid-esophageal four-chamberview: the lower part of the atrial septum is missing near the insertion of the atrioventricular valves. (B, C) Color-flow Doppler showsleft-to-right shunting at the atrial level as well as left atrioventricular valve regurgitation through a cleft in the anterior leaflet(LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle).