Trilogy of Fallot With a Large Right Atrial Thrombus: A Case Report

Figures

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  Figure 1. ECG showing right axis deviation, right atrial enlargement, and right ventricular hypertrophy with a strain pattern.

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  Figure 2. Chest X-ray (CXR) showing cardiomegaly with a cardiothoracic ratio of 0.66 and oligemic lung fields.

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  Figure 3. Transthoracic echocardiography (ECHO) in the parasternal short-axis view with continuous wave Doppler across the pulmonary valve, demonstrating severe valvular pulmonary stenosis with a pressure gradient of 94 mmHg.

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  Figure 4. Transesophageal echocardiography (ECHO) showing a large right atrial thrombus (white arrow) measuring 8.7 × 12.1 cm.

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  Figure 5. Right ventricular (RV) angiogram in the left lateral view showing the stenotic orifice (white line arrow) and the pulmonary valve annulus measuring 26 mm (black line arrow) with post-stenotic dilatation (black arrowhead).

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  Figure 6. Fluoroscopy in the left lateral view showing inflation of the Tyshak balloon positioned across the pulmonary valve. (A) Initially, a waist (black arrow) is seen at the level of the valve due to severe stenosis. (B) The waist disappears with further inflation of the balloon, indicating successful dilatation of the pulmonary valve.

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  Figure 7. Follow-up echocardiography (PLAX RV outflow view) showing a pulmonary valve gradient of 33 mmHg with mild pulmonary regurgitation. PLAX: parasternal long-axis; RV: right ventricular