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Image in Cardiology
All that bifurcates is not pulmonary artery
Tudo o que bifurca não é artéria pulmonar
Arun Gopalakrishnan
Autor para correspondência
arungopalakrishnan99@gmail.com

Corresponding author.
, Walse Rohit Sunil, Deepa Sasikumar, Harikrishnan K.N. Kurup, Kavassery Mahadevan Krishnamoorthy
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Right aortic sinus-to-right atrium fistula&#58; Multimodality imaging and percutaneous closure with a septal occluder device"
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            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Three-dimensional &#40;3D&#41; transesophageal echocardiographic defect assessment before and after percutaneous closure&#46; Left-to-right shunt assessment before &#40;A and D&#41; and after procedure &#40;B&#8211;C and E&#8211;F&#41; can be easily compared on the same 3D echocardiography views&#46; A&#8211;C&#58; top view from proximal ascending aorta&#59; D&#8211;F&#58; en face views of the defect from the right atrium&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Transthoracic color Doppler echocardiographic still&#44; parasternal short-axis projection&#44; showing the main pulmonary artery &#40;MPA&#41; continuing as left pulmonary artery &#40;LPA&#41; and &#40;b&#41; pulsed wave Doppler from the descending aorta showing pandiastolic flow reversal &#40;yellow arrow&#41;&#46; AO&#58; aortic valve&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 10-day-old term neonate with tachypnea and peripheral oxygen saturation of 90&#37; was referred to us with a diagnosis of transposition of the great arteries with intact ventricular septum for early arterial switch operation&#46; The child weighed 2&#46;8 kg and was not dysmorphic&#46; Precordial examination revealed cardiomegaly&#44; loud second sound and a grade 2 mid-systolic murmur in the upper left sternal border&#46; Clinical examination and transthoracic echocardiography suggested usual arrangement of the visceroatrial structures and normal leftward cardiac apex&#46; Systemic and pulmonary venous drainage were normal&#46; A stretched open foramen ovale shunted right-to-left&#46; The atrioventricular relationship was concordant&#46; The parasternal long-axis view showed intact interventricular septum&#44; good left ventricular function and a bifurcating great artery arising from the left ventricle &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> and <a class="elsevierStyleCrossRef" href="#sec0030">Video 1</a>&#41;&#46; The great artery relationship was noted to be normal with an unobstructed anterior and leftward located main pulmonary artery&#46; The right pulmonary artery was not seen to arise from the main pulmonary artery&#44; unlike the left pulmonary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>a&#41;&#46; The anomalous origin of the right pulmonary artery from the ascending aorta gave the appearance of bifurcation&#46; Pan-diastolic flow reversal in the descending aorta was confirmative of the aortic runoff &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>b&#41;&#46; The arterial duct was not patent&#46; The right ventricle was dilated and dysfunctional&#46; The estimated left pulmonary artery systolic pressure was 105 mmHg from the tricuspid regurgitation jet&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Careful echocardiographic assessment is crucial to distinguish isolated right pulmonary artery from the aorta with severe pulmonary hypertension from transposition&#46; Hemitruncus is primarily an acyanotic congenital heart disease&#44; with two separate semilunar valves&#46; However&#44; a stretched open foramen ovale may cause systemic desaturation following right ventricular dysfunction and advanced heart failure in hemitruncus&#46; Reimplantation of the right pulmonary artery is curative&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its amendments&#46; Written informed consent was obtained from the parent of the patient concerned&#46; No patient identity particulars have been disclosed&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Concept&#44; data collection&#44; and drafting article &#8211; AGK&#46; AGK&#44; WRS&#44; DS&#44; HKN&#44; KMK critically reviewed the manuscript&#46; All authors approved the final version&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transthoracic two-dimensional echocardiographic still&#44; parasternal long-axis projection&#44; showing the bifurcating great artery arising from the left ventricle &#40;asterisks&#41;&#46; LA&#58; left atrium&#59; LV&#58; left ventricle&#59; RV&#58; right ventricle&#46;</p>"
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