Image in Cardiology
Long-term survival in a patient with single ventricle
Sobrevivência a longo prazo num paciente com um único ventrículo
Manuel Barreiro
, Cecília Corros, Laura García, Alfredo Renilla, María Martin, Ana García
Corresponding author
Cardiology Departament, Hospital Universitario Central de Asturias, Oviedo, Spain
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M-mode revealed a dilated left atrium (56 mm) (A), an enlarged left ventricular cavity (58.47 mm) with wall thickening (15.11 mm) and a small pericardial effusion (B). Doppler showed diastolic transmitral flow with an E/A-wave ratio of 2.39 and a deceleration time of 147 ms (C).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Oliveira Santos, Dulce Brito" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Oliveira Santos" ] 1 => array:2 [ "nombre" => "Dulce" "apellidos" => "Brito" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913002493?idApp=UINPBA00004E" "url" => "/21742049/0000003200000009/v1_201312060118/S2174204913002493/v1_201312060118/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Long-term survival in a patient with single ventricle" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "735" "paginaFinal" => "736" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel Barreiro, Cecília Corros, Laura García, Alfredo Renilla, María Martin, Ana García" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Manuel" "apellidos" => "Barreiro" "email" => array:1 [ 0 => "manuelbarreiroperez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Cecília" "apellidos" => "Corros" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "García" ] 3 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Renilla" ] 4 => array:2 [ "nombre" => "María" "apellidos" => "Martin" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Departament, Hospital Universitario Central de Asturias, Oviedo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Sobrevivência a longo prazo num paciente com um único ventrículo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1268 "Ancho" => 1584 "Tamanyo" => 244423 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Echocardiogram in apical 4-chamber view showing double-inlet dominant left ventricle (A), separated from the accessory right ventricle (B) by a hypoplastic intraventricular septum. The atrioventricular connection is discordant: mitral (C) and tricuspid (D) valves. Pacemaker electrode (E), right atrium (F) and left atrium (G).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 58-year-old man with complex congenital heart disease who had undergone a classic Blalock-Taussig (left subclavian artery [SA]-left pulmonary artery [PA]) shunt operation at the age of five. Because of limiting dyspnea he underwent reoperation at the age of 29. A double-inlet ventricle, transposition of the great arteries, severe pulmonary valve stenosis and a classic Blalock-Taussig shunt with suture stenosis were described in the report of this operation. At that time a modified Blalock-Taussig shunt (Gore-Tex graft between right SA and right PA) was performed. During follow-up a cardiac pacemaker (VVI-R) was implanted. He now presented with exercise intolerance.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The transthoracic echocardiogram (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>) revealed a double-inlet dominant left ventricle, separated from the accessory right ventricle by a hypoplastic intraventricular septum; the atrioventricular connection was discordant. Color Doppler echocardiography showed a small right pulmonary fistula with slow bidirectional flow (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). Computed tomography angiography revealed pulmonary valve stenosis and a hypoplastic right ventricular outflow tract (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>), as well as systemic–pulmonary collateral circulation via bronchial artery branches (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">With these palliative operations, the patient survived with an acceptable quality of life, probably due to the suture stenosis of the first graft and the small caliber second graft. These and the systemic–pulmonary collateral circulation had delayed the appearance of pulmonary hypertension by hyperflow, which is now suspected because of the bidirectional flow in the graft.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-01-21" "fechaAceptado" => "2013-02-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Barreiro M, Corros C, García L, Renilla A, Martin M, García A. Sobrevivência a longo prazo num paciente com um único ventrículo 2013. http://dx.doi.org/.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1268 "Ancho" => 1584 "Tamanyo" => 244423 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Echocardiogram in apical 4-chamber view showing double-inlet dominant left ventricle (A), separated from the accessory right ventricle (B) by a hypoplastic intraventricular septum. The atrioventricular connection is discordant: mitral (C) and tricuspid (D) valves. Pacemaker electrode (E), right atrium (F) and left atrium (G).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1074 "Ancho" => 1584 "Tamanyo" => 253496 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Echocardiogram in color Doppler view showing right pulmonary fistula with slow bidirectional flow.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1267 "Ancho" => 1584 "Tamanyo" => 219742 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Computed tomography angiography showing pulmonary valve stenosis and hypoplastic right ventricular outflow tract.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1268 "Ancho" => 1584 "Tamanyo" => 251806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Computed tomography angiography showing systemic–pulmonary collateral circulation via bronchial artery branches.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000009/v1_201312060118/S217420491300250X/v1_201312060118/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000009/v1_201312060118/S217420491300250X/v1_201312060118/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491300250X?idApp=UINPBA00004E" ]
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