RESUMO
A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle. The lead was extracted, and a new lead was placed in the pulmonary (anatomic left) ventricle. A bidirectional baffle shunt persisted. The iatrogenic baffle leak was percutaneously closed with an Amplatzer septal occluder device using both intracardiac echocardiography (ICE) and three-dimensional transesophageal echocardiography (3D-TEE). We report the first use of ICE for baffle leak closure, which provided a good definition of the complex anatomy and guided the procedure.
Assuntos
Ecocardiografia/métodos , Eletrodos Implantados/efeitos adversos , Átrios do Coração/lesões , Átrios do Coração/cirurgia , Cirurgia Assistida por Computador/métodos , Transposição dos Grandes Vasos/cirurgia , Adulto , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Transposição dos Grandes Vasos/complicações , Resultado do TratamentoAssuntos
Dispneia/etiologia , Ventrículos do Coração , Marca-Passo Artificial/efeitos adversos , Transposição dos Grandes Vasos/cirurgia , Adulto , Dispneia/diagnóstico , Ecocardiografia Tridimensional , Eletrodos/efeitos adversos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Fatores de Risco , Tromboembolia/epidemiologia , Tomografia Computadorizada por Raios XRESUMO
A 56-year-old woman was evaluated for dyspnea in the emergency department. She had no risk factors for venous thromboembolism except hormone replacement therapy; however, pulmonary embolism was suspected and subsequently confirmed via computed tomographic angiogram. An echocardiogram was conducted to further assess right ventricular function, revealing marked right ventricular enlargement and a mobile mass in the left atrium (initially suspected to be an atrial myxoma). After subsequent embolization to the left axillary artery, thrombolysis was administered, and embolectomy confirmed this to be thrombus. A repeat echocardiogram showed resolution. This case highlights that although echocardiography can be helpful in risk stratification when assessing patients with pulmonary embolism, unexpected findings may be encountered. When clinicians identify multiple clinical findings, Occam's razor suggests that these multiple findings are most likely related.