Multiple Color Doppler Flow Jets Into The Atria In A Child W
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A 9 -month-old-girl [weight: 7.92 kg; height:70cms] was taken to the operating room for the creation of a bilateral bidirectional Glenn shunt and atrial septectomy. Patent ductus arteriosus stenting had been done when the child was 4-days old. Transthoracic echocardiography showed heterotaxy (left atrial isomerism) with situs inversus; discordant atrioventricular and concordant ventriculoarterial connections (ventricular ‘non-inversion’); large ventricular septal defect; membranous pulmonary atresia with a hypoplastic main pulmonary artery; confluent branch pulmonary arteries; aorta anterior and to the right of pulmonary artery and bilateral superior vena cava with no bridging vein.

The left superior vena cava was draining into the left sided atrium [morphological right atrium] while the right superior vena cava was draining into the same atrium via a massively dilated coronary sinus.

The inferior vena cava was interrupted, with hemiazygos continuation to the left superior vena cava. A computerized tomography scan revealed a right sided stomach with a midline liver, and demonstrated the complex vascular communications.

Transesophageal echocardiography confirmed the preoperative diagnosis. Color Doppler blood flow mapping in the mid-esophageal view demonstrated multiple jets into both the atria and the right sided ventricle. Pulse wave Doppler of a dominant jet revealed a biphasic flow. The intramyocardial origin of the jets was traced towards the aorta.