FIGURE LEGEND
Figure 1 . Panel A: 12-leads ECG showing sinus rhythm (52 bpm), left and right ventricular hypertrophy and repolarization abnormalities. Panel B: Posterior-anterior Chest X-ray documenting situs solitus and levocardia with significant cardiac enlargement and abnormal cardiothoracic ratio (greater than 50%).Figure 2 . Echocardiogram. Panel A: diastolic frame of parasternal short axis view at the level of the papillary muscles. Panel B: diastolic frame of apical 4 chamber view. Severe RV hypertrophy and small LV cavity size, due to the ventricular interdependence and RV overload, are evident. Panel C: parasternal short axis at the level of great vessels with color-Doppler twin view and measurement of the severely narrowed right ventricular outflow-tract (RVOT) diameter at infundibular level. Panel D: CW Doppler interrogation of the obstructed RVOT with maximum gradient of 185 mmHg.Figure 3 . Coronary-CT Angiography (CCTA). Panel A: Coronal oblique multi-planar reconstruction (MPR) well shows the right partial anomalous pulmonary venous return (PAPVR) with the right superior pulmonary vein draining into the superior Vena Cava (SVC) (green arrow). Panel B-C: MPR (B) and 3D (C) volume rendering (VR) of the RVOT well depict the significant infundibular stenosis (yellow arrows). Panel D: 3D VR-slab along the vertical long axis (VLA) of the RV well shows the significant hypertrophy of the RV walls (>13mm), papillary muscles, and the severe obstruction of the RVOT (infundibular stenosis).
Supplementary Material: The following supplementary material is available online - Movie Clips AVI:
Video 1. Transthoracic echocardiogram video clips. Panel A: parasternal long axis view. Panel B: short axis view at the level of the papillary muscles. Both clips show the severe RV hypertrophy with anomalous muscle bundles and ventricular septum flattening, causing small LV cavity size due to ventricular interdependence. Panel C: parasternal short axis at the level of great vessels and
color-Doppler twin views focused on RVOT with Color flow Doppler mosaic pattern consistent with severe RVOT obstruction. Panel D: parasternal short axis at the level of great vessels and color-Doppler twin views focused on VSD documenting the right-to-left shunt.
Video 2 . 3D VR video along the VLA of the RV shows the right PAPVR with the right superior pulmonary vein draining into the SVC, the right atriomegaly, hypertrophy of RV walls (>13mm), papillary muscles, and the severe narrowing of RVOT (infundibular stenosis).
Video 3 . MPR video of the RVOT well shows the significant infundibular stenosis.