Mixed partial anomalous pulmonary venous drainage coexistent with an aortic valve abnormality – analysis of ultrasound diagnostics in a 10-year-old girl with Turner syndrome
The authors present a case of echocardiographic diagnosis of a rare congenital cardiovascular
anomaly in the form of mixed partial anomalous pulmonary veins connection
in a 10-year-old girl with Turner syndrome and congenital mild stenosis of insufficient
bicuspid aortic valve, made while diagnosing the causes of intestinal tract bleeding.
The article presents various diagnostic difficulties leading to the delayed determination
of a correct diagnosis, resulting from the absence of symptoms of circulatory failure
in the early stage of the disease and the occurrence of severe and dominant auscultatory
phenomena typical for congenital aortic valve defect which effectively masked the
syndromes of increased pulmonary flow. The authors discuss the role of the impact of
phenotypic characteristics of the Turner syndrome, in particular a short webbed neck
restricting the suprasternal echocardiographic access and the presence of psychological
factors associated with a long-term illness. The importance of indirect echocardiographic
symptoms suggesting partial anomalous pulmonary veins connection in the
presence of bicuspid aortic valve, e.g. enlargement of the right atrium and right ventricle,
and paradoxical interventricular septum motion were emphasized in patients
lacking ASD, pulmonary hypertension or tricupid and pulmonary valve abnormalities.
The methodology of echocardiographic examination enabling direct visualization of the
abnormal vascular structures was presented. Special attention was paid to the significance
of highly sensitive echocardiographic projections: high right and left parasternal
views in sagittal and transverse planes with patient lying on the side, with the use of
two-dimensional imaging and color Doppler. Finally, the limitations of echocardiography
resulting from the visualization and tracking of abnormal vascular structures hidden
behind ultrasound non-conductive tissues were indicated, as was the role of other
diagnostic modalities, such as angio-CT and/or nuclear magnetic resonance