Staged interventional solution for a diagnostic dilemma caused by hypoplastic left ventricle with severe aortic arch hypoplasia

Figures

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  Figure 1. Apical four-chamber echocardiographic view (a) shows hypoplastic left ventricle, dilated right ventricle, left atrium decompressed by foramen ovale to right atrium. The transverse aortic arch and isthmic narrowing is seen in the suprasternal long-axis view (b)

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  Figure 2. A large left ventricular thrombus occupying three-fourth of the cavity is seen on apical four chamber view. The foramen ovale between the right atrium and left atrium is spontaneously closed. Right ventricle is comparatively smaller than the dysfunctional left ventricle

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  Figure 3. The Doppler gradient (a) between the left atrium and right atrium increased to 11 mmHg due to reduction in size of the atrial septal communication (b) to 2 mm on sibxiphoid view. The increased preload improved the long axis of left ventricle from 2.6 cm in neonatal period (c) to 6.2 cm at 2 years (d) on apical view

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  Figure 4. Severe transverse arch and isthmic narrowing seen on lateral view aortogram (a) is relieved after stent angioplasty of aorta (b) and large patent duct closed (c) on a staged sitting with a duct occluder device

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  Figure 5. The severely dysfunctional left ventricle with global longitudinal strain of −6.3% and ejection fraction of 15% before the stenting (a) improved to values of −18.6% and 65% after the interventions (b)