Transesophageal and intracardiac ultrasound in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Figures

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  Figure 1. Transesophageal echography using a multiplanar probe. (A) Midesophageal view 4°: in the upper part of the image the left atrium can be seen- this is the closest anatomical structure to the esophagus. Separated by the interatrial septum, in the inferior part of the image lies the right atrium. The interatrial septum is convex towards the left atrium as the pressure inside the right atrium is high, given by the dilation of the right ventricle, tricuspid ring with subsequent tricuspid regurgitation. (B) Artwork with the structures seen in TEE. (C) Midesophageal view 36°: at the level of the right ventricle the moderator band (MB) can be visualized passing the ventricular cavity from the interventricular septum to the lateral wall where the anterior papillary muscle can be found. (D) Artwork with the moderator band as seen in TEE. TEE = transesophageal echocardiography.

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  Figure 2. Intracardiac echography using a rotational probe. (A) The ViewFlex probe is inserted near the apex of the right ventricle. Please note the normal trabeculations which are present at the level of the lateral wall (yellow arrow). (B) The ViewFlex probe is inserted between the tricuspid valve and the apex of right ventricle. Please note the absence of normal trabeculations at the level of the lateral wall (yellow arrow). The regional absence of the trabeculations at the level of the “triangle of dysplasia” could not be seen with 2D echo and transesophageal echocardiography. 2D = 2-dimensional.

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  Figure 3. Intracardiac echocardiography using a sectorial probe. (A) Chest X-ray: the ICE probe is inserted in the middle of the right atrium. (B) The RA (44 mm), RV (52 mm), and RVOT (48 mm) are dilated. (C) As the tricuspid ring is dilated, a moderate tricuspid regurgitation is present. (D) Chest X-ray: Intracardiac echography with the probe inserted inside the right ventricle. (E) Near the apex of the right ventricle the moderator band can be visualized (yellow arrow). (F) Chest X-ray: Intracardiac echography with the probe inserted inside the right ventricle. (G) The patient is implanted with an ICD (red arrow) for the secondary prevention of sudden cardiac death as he presented many episodes of ventricular tachycardia. At the apex of the right ventricle a localized aneurysm can be seen with a pediculated thrombus (yellow arrow). ICD = internal cardiac defibrillator, ICE = intracardiac echocardiography, RV = right ventricle, RVOT = right ventricular outflow tract.