Gerbode defect, ebstein anomaly and wolff-parkinson-white in patient with down syndrome. never say never

We described a unique case of a 15-year-old Down Syndrome female patient with a Gerbode-type ventricular septal defect, Ebstein anomaly and Wolff-Parkinson-White Syndrome. Transthoracic echocardiography allowed to correctly diagnose the structural abnormalities; it revealed Ebstein anomaly with curtain-like appearance of the anterior tricuspid valve leaflet and dilated right atrium with atrialized right ventricle with small functional right ventricle. A peri membranous ventricular septal defect, partially covered by tricuspid tissue, with a shunt from the left ventricle (LV) to the atrialized portion of the right ventricle was found. LV showed normal diameters and good systolic function. The interatrial septum was aneurysmal with a small secundum atrial septal defect with bidirectional shunt. Electrophysiological study demonstrated an atrioventricular (AV) accessory pathway that was treated by ablation. According to the literature the patient was managed conservatively. The knowledge of this association of rare pathologies will lead the clinicians to careful look for the abnormalities reported when one of these has been diagnosed. Nevertheless, this combination was never described to the best of our knowledge in Down syndrome patients

Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging?

The role of two dimensional (2D) echocardiography (ECHO) for the diagnosis and clinical decision making in infective endocarditis (IE) has been extensively studied and described in the medical literature. Some reports have demonstrated the incremental value of three dimensional (3D) transesophageal (TE) ECHO in the setting of IE. However, a systematic review focusing on the role of 3D imaging is lacking. In this manuscript, we examine the role of 3D TE ECHO in the diagnosis of IE. IE is a challenging disease in which 2D transthoracic (TT) and TE ECHO have complementary roles and are unequivocally the mainstay of diagnostic imaging. Still, 2D imaging has important limitations. Technological advances in 3D imaging allow for the reconstruction of real-time anatomical images of cardiac structure and function. 3D imaging has emerged as a diagnostic technique that overcame some of the limitations of 2D ECHO. Currently, both transthoracic and transesophageal echocardiography transducers are able to generate 3D images. However, 3D TE ECHO provides images of a higher quality in comparison to 3D TT ECHO, and is the best echocardiographic modality able to allow for a detailed anatomical imaging. 3D TE ECHO may represent the key adjunctive echocardiographic technique being able to positively impact on IE-related surgical planning and intervention and to facilitate the interaction between the surgeon and the imaging specialist. Importantly, 3D TE ECHO is not the recommended initial modality of choice for the diagnosis of IE; however, in highly specialized centers, it has become an important complementary technique when advanced surgical planning is required. Furthermore, anatomical imaging has become the link between the different techniques that play a role in IE imaging. In fact, both computed tomography and magnetic resonance allow three dimensional reconstruction. An important future goal should allow for the fusion among various imaging modalities. Our review highlights the role of 3D TE ECHO in IE imaging and emphasize where it offers incremental value

Contrast transesophageal three-dimensional echocardiographic imaging for patent foramen ovale: A needful role?

The management of patent foramen ovale (PFO) still remains controversial. According to the newest scientific evidences, the assessment of the PFO size and the shunt has paramount importance for further management [1]. Although two-dimensional (2D) transesophageal (TE) echocardiography (E) contrast study has been considered to be the gold standard imaging modality for diagnosing PFO for a long time, new evidences underscore that its accuracy may have been over-valued [1,2]. Three-dimensional (3D) TEE imaging has emerged as a diagnostic technique that overcome some of the limitations of 2DE. 3D TEE allows an anatomical imaging for a comprehensive echocardiographic assessment of the left atrium, atrial septum and of PFO morphology [3,4]. However, it has never been reported about its diagnostic usefulness in detecting the bubbles passage during contrast study. We report a case where it has been possible to detect the passage of bubbles across the PFO thanks to 3D TEE