Visualization of thrombosis on a prosthetic pulmonary valve using electrocardiogram-gated multidetector computed tomography.

We report a case of prosthetic valve thrombosis in an 18-year-old man. Total surgical repair of tetralogy of Fallot was performed at 3 years of age. At the age of 18, he underwent pulmonary valve replacement because of exacerbating pulmonary trunk obstruction. After surgery, valve malfunction was suspected. We attempted to employ electrocardiogram (ECG)-gated multidetector computed tomography (MDCT). The stuck valve was clearly visualized together with a thrombus within. Thrombolytic therapy was undertaken on these findings. ECG-gated MDCT allowed us to make a definitive diagnosis of valve thrombosis as the cause of valve malfunction, which led us to avoid surgical reintervention.

Urgent stenting via internal jugular vein for stabilization in critical neonates with total anomalous pulmonary venous connection and severe pulmonary venous obstruction.

Reducing obstruction in the vertical vein is significant for stabilizing the condition in neonates with total anomalous pulmonary venous connection (TAPVC). Stent implantation into the vertical vein is an alternative treatment for rescue in critical patients with TAPVC and severe pulmonary congestion. We performed a stent implantation into the supra-cardiac vertical vein for rescue and stabilization of a critical newborn with TAPVC. The internal jugular vein was selected for sheath insertion under echo guidance in an urgent procedure, which took 11 min from venous puncture to stent implantation. The internal jugular approach is optimal for stent implantation in patients with supra-cardiac TAPVC in a critical condition. .

Postpartum Deterioration of Hemodynamics in a Case of Uncorrected Ebstein's Anomaly.

Ebstein's anomaly is a rare congenital cardiac malformation that is characterized by abnormalities of the tricuspid valve and right ventricle. Pregnancy is usually well tolerated unless cyanosis or arrhythmia develops. We report a case with Ebstein's anomaly, whose condition was asymptomatic before pregnancy but remarkably deteriorated down during the postpartum period, even though a successful pregnancy and cardiac surgery were achieved. Women with Ebstein's anomaly should be carefully assessed and may need to be advised to have corrective surgery prior to pregnancy even if they were asymptomatic.

Imaging of aortico-left ventricular tunnel by three-dimensional echocardiography.

Aortico-left ventricular tunnel (ALVT) is a rare congenital heart disease presenting as congestive heart failure in the neonatal or early infantile period due to severe aortic regurgitation (AR). We presented a 1-month-old boy with ALVT, originally diagnosed by two-dimensional echocardiography; however, the detailed anatomical features were not ascertained. Real-time three-dimensional echocardiography (RT3DE) could provide clear images of the three-dimensional structures of ALVT, just the same as those of surgical findings. ALVT originated from the left coronary cusp and ran an oblique path to the subvalvular orifice, having a narrow segment in the middle. RT3DE is a clinically useful diagnostic tool to clarify the detailed anatomy of ALVT.