Subxiphoid cross-sectional echocardiographic imaging of the "goose-neck" deformity in endocardial cushion defect.

Abstract

SUMMARY The cross-sectional echocardiographic demonstration of the "goose-neck" deformity is described in four patients with endocardial cushion defect. The diagnosis was confirmed in each patient by left ventricular angiocardiogram. The subxiphoid approach of cross-sectional echocardiography in diastole allowed visualization of an elongated, narrowed, and somewhat horizontally inclined configuration of the left ventricular outflow tract, which appeared almost identical to that obtained by angiocardiography. In systole, the right border of the left ventricle was composed of the cleft anterior mitral leaflet, the left-sided line of which was convex toward the left ventricular cavity. The mitral valvular echoes were thickened, jagged and irregular, which seemed to correspond to the scalloped appearance of the right border of the left ventricular silhouette in a systolic phase of the left ventricular angiocardiogram. There were no obvious differences between the gooseneck configuration of complete-type endocardial cushion defect and that of ostium primum atrial septal defect.FROM THE DIAGNOSTIC standpoint of endocardial cushion defect (ECD), the "goose-neck" deformity as seen on the frontal projection of the left ventricular angiocardiogram is a most important feature.1-7 M-mode echocardiography has been widely used as a diagnostic tool for various cardiac malformations. The narrowing of the left ventricular outflow tract, as judged from the distance between the left side of the interventricular septum and the mitral valve on echocardiogram at the onset of systole, and the prolonged mitral-septal apposition in diastole, corresponded to the angiographic feature of the gooseneck deformity.8"-4 Recently, cross-sectional echocardiography has been used to image a more precise delineation of anatomic details of ECD.16-19 However, imaging of the goose-neck deformity in ECD by crosssectional echocardiography has not been reported. In this report we demonstrate the ability of crosssectional echocardiography to show the goose-neck deformity and compare it in detail with that obtained by angiocardiographic study. cavity, 15 normal infants, 1-3 months of age, served as controls. The patients and control subjects were examined in the supine position using the subxiphoid technique.20 The scanner probe was placed at the subxiphoid region, tilting about 20°downward from the plane of the anterior chest wall. The sector beam was positioned through the heart in a plane parallel to a line between the patient's shoulders to allow simultaneous visualization of the left ventricular cavity and the aortic root. As this subxiphoid sector view is nearly identical to the frontal projection of the left ventricular angiogram, it is suitable for evaluating the configuration of the left ventricular outflow tract of ECD. We performed this study using a real-time mechanical sector instrument (Aloka SSD 1000 with ASU 25 Hand Scanner and USM 6B Amplifier). The scanner probe, which contained a 3-MHz transducer focused at 7.5 cm, was mechanically drive...

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“…These anatomic abnormalities create a narrow and elongated LVOT with an anormal acute angle classically described as the ''goose-neck'' deformity in angiography and echocardiography. 10 Although this particular anatomy is not directly responsible for LVOT obstruction, association with abnormal LAVV subvalvular and chordal apparatus may be a source of LVOT turbulence leading to subaortic stenosis.…”

Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total

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Surgery of the left atrioventricular valve and of the left ventricular outflow tract in atrioventricular septal defect

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