Case 2
A 41-year-old female patient (height: 163 cm, weight: 53 kg) was
admitted to our hospital due to chest pain, chest tightness, and
palpitations lastingfor 3 days. She presented with cyanosis of the mouth
and limb immediately after birth, with obvious cyanosis after crying but
without syncope or squatting signs. She was diagnosed with a congenital
heart disease at the local hospital but was not treated. Her growth and
development were not affected and daily activities were only slightly
limited. After catching a cold 3 days earlier, she experienced chest
tightness and shortness of breathafter general physical activities.
After symptomatic treatment at the local hospital, she was admitted to
our hospital due to a lack of obvious symptom relief.
Physical examination at our hospital revealed a temperature of 36.6℃, a
pulse of 62 beats/min, a respiratory rate of 20 breaths/min, a blood
pressure of 110/60 mmHg,clear consciousness, no yellowing of the skin
and sclera, and cyanosis of the mouth. In addition, the breath sounds in
both lungs were labored and moist rales could be heard in both lungs.Her
heart rate was 62 beats/min, the heart rhythm was uniform, and her
abdomen was flat and soft, without tenderness, rebound tenderness, or
muscle tension. Her New York Heart Association functional class was Ⅲ.
Echocardiography showed visceral antipositioning and dextrocardia as
well as a heart with a functional
single atrium and SV, ventricular hypertrophy, and a common
atrioventricular valve. The atrial and ventricular septa were not
explored but wereclearly defined. Two large arteries, the PA and the
aorta, were concomitant, both
starting from thefunctional SV. The PA was located on the anterior side,
the inferior valve had muscular stenosis, and
the aorta was located on the
posterior side. No obvious abnormalities were found in the aortic valve.
CDFI revealed
severe reflux in the
common atrioventricular valve in
the systolic stage, the neck of the valve orifice reflux was 13.4 mm,
the flow rate was 4.0 m/s, and the pressure gradient (PG) was 63
mmHg(Figure 2).Under three-dimensional ultrasonic examination, the
atrioventricular valves appeared to consist of four valves. The
echocardiographic diagnosis for this patient was congenital heart
disease complex deformity, dextrocardia, single atrium, SV, PS, and
severe common atrioventricular valve insufficiency. The patient was
discharged after 5 days of anti-infection and symptomatic treatments.
After discharge, we continued to follow up with the patient by telephone
and outpatient visits.
Case
3
A 13-year-old female patient (height: 137 cm; weight: 40 kg) came to our
hospital due to palpitations and chest tightness lasting for 2 days. She
was diagnosed with a complex congenital heart disease at the age of 6
months but was not treated. Physical examination on admission showed a
body temperature of 36.4℃, a pulse of 57 beats /min, a respiratory rate
of 21 breaths/min, and a blood pressure of 105/70 mmHg. Her New York
Heart Association functional class was II. Echocardiography showed the
following: the heart was located in the left thoracic cavity, the atrium
was in the normal position, the PA and the aorta were concomitant, and
the PA was located in front of the aorta, both starting from a
functional SV. The right atrium
was enlarged, no atrioventricular valve was found in the left
ventricular cavity parallel to the right
atrium, the middle echo of the
interventricular atrium was interrupted by 10.2 mm, and
the internal diameter of the SV
was 65 mm. CDFI showed a shunt in the atrial septal defect with a flow
rate of 2.6 m/s and a PG of 29 mmHg.Therewere severe reflux in the
atrioventricular valve in the
systolic stage, the regurgitation area of the atrioventricularvalve
orifice was 3.7 cm 2, the flow rate was 5.4 cm/s, and
the PG was 117 mmHg (Figure 3).The
length of the pulmonary valve regurgitation beam was 22.8 mm, the flow
rate was 3.5 m/s, the PG was 50 mmHg, and the average PA pressure was
estimated to be 55 mmHg. The echocardiographic diagnosis was congenital
heart disease (SV,atrial septal defect) , mild atrioventricular
valve insufficiency, mild pulmonary valve regurgitation, and pulmonary
hypertension (PHT). The patient was discharged after 3 days of
symptomatic treatment.