"Ring’ in the left ventricular outflow tract – Diagnostic di
A four-year-old boy (weight 17.1 kg, height 107 cm) presented with feeding difficulty, shortness of breath, and cyanosis. The preoperative transthoracic echocardiography examination showed a small perimembraneous ventricular septal defect, severe right ventricular infundibular pulmonary stenosis with a peak gradient of 140 mmHg, right ventricular hypertrophy, right to left shunt, and good biventricular function. The pulmonary valve, main pulmonary artery, and branch pulmonary arteries were normal. The child was scheduled for right ventricular outflow tract infundibular resection and ventricular septal defect closure. After anesthetic induction, transesophageal echocardiography (TEE) examination in midesophageal long axis view showed a ring or parachute like echogenic structure in left ventricular outflow tract (LVOT). The structure was not obstructing blood flow as indicated by color flow and pulse wave Doppler. A midesophageal off-axis view (orthogonal plane to long axis view, 30O) showed attachment of the ‘ring-like’ structure to the under surface of anterior mitral leaflet. Mitral regurgitation and stenosis were absent.

Source: https://www.jcvaonline.com/article/S1053-0770(22)00367-6/fulltext?rss=yes