Shone syndrome revealed by treatment-resistant hypertension

Figures

• 

  Fig. 1. ECG showed a coronary sinus rhythm with a Heart Rate at 75 beats per minute, with left atrial hypertrophy.

• 

  Fig. 2. (A) Echocardiographic suprasternal view showed the presence of coarctation of the aorta with V max at 4.43 m/s with a mean gradient at 79 mmHg and an extended speed reduction during diastole. (B) Apical 4-chamber view, demonstrating sub-mitral membrane (yellow arrow), with a single sub-papillary muscle, two non-motile rounded hyper-echogenic formations in the right atrium (blue arrow), suggest embryonic residue, with a dilated coronary sinus (red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

• 

  Fig. 3. Trans esophageal echocardiography showed the same anomalies on The TTE a sub-mitral membrane, with a single sub-papillary muscle, an attachment defect of the mitral valves responsible of a mitral stenosis under the tight valve (the mean gradient at 12 mmHg) while the mitral surface was 2 cm 2 by planimetry on the TTE.

• 

  Fig. 4. (A) Computed Tomography Chest showing persistent left superior vena cava (Red arrow) (B) 3D reconstruction of Computed tomography image showing an aspect of the narrowed aortic arch with a diameter of 6 mm, measured 9 mm bellow the origin of the left subclavian artery. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)