Didier, Dominique

Kalangos, Afksendiyos

Myers, Patrick O.

Tissot, Cécile

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usually temporary reduction in MR without changing significantlythe long-term prognosis. The future role of new adjunctive surgicaltechniques and of percutaneous interventions is not yet deter-mined. Importantly, clinical randomized trials are mandatory toprovide guidelines with improved level of evidence.Conflict of interest: none declared.ReferencesThe list of references is available in the online version of this paper.CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehq312Online publish-ahead-of-print 2 September 2010Tetralogy of Fallot with absent pulmonary valve, supracardiac totalanomalous pulmonary venous connection, and infradiaphragmatic systemicto pulmonary collateral arteryPatrick O. Myers1,2*, Afksendiyos Kalangos1, Dominique Didier3, and Ce´cile Tissot41Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospital and Geneva University Medical School, 24, rue Micheli-du-Crest, 1211 Geneva 14,Switzerland; 2Division of Cardiac Surgery, Children’s Hospital Boston and Harvard Medical School, Boston, MA, USA; 3Division of Cardiovascular Radiology, GenevaUniversity Hospital, Geneva, Switzerland; and 4Division of Pediatric Cardiology, Children’s University Hospital, Geneva, Switzerland* Corresponding author. Tel: +41 22 372 7624, Fax: +41 22 372 7634, Email: patrick.myers@hcuge.chA 2-year-old boy was referred for cya-nosis and clinical heart failure. Trans-thoracic echocardiography showedTetralogy of Fallot (TOF) with a largemalalignment type ventricular septaldefect (VSD) and features typical ofabsent pulmonary valve syndrome(APVS). There was severe pulmonarystenosis (Sten) (peak systolic gradientof 85 mmHg) with diastolic regurgita-tion, associated with aneurysmal dilata-tion of the pulmonary artery branches.There was also supracardiac total anom-alous pulmonary venous connection(TAPVC) to a non-obstructed confluentpulmonary vein (CPV) leading to theright atrium (RA) at the junction ofsuperior vena cava (SVC) and a secun-dum atrial septal defect (ASD). Atubular structure was visualizedbetween the abdominal aorta and theinferior vena cava, with continuous high-velocity systolo-diastolic flow. Cardiac magnetic resonance imaging confirmed all these anomalies and showed that this structure wasan aorto-pulmonary collateral artery (APCA) originating from the abdominal aorta and vascularizing a pulmonary sequestration. Per-cutaneous embolization of the infradiaphragmatic APCA was done using a vascular plug followed by surgical transatrial patent foramenovale enlargement, redirection of the TAPVC to the left atrium using a pericardial patch, VSD patch closure, and right ventricularoutflow tract reconstruction using a valved conduit.Post-operatively, the patient presented transient junctional ectopic tachycardia and low cardiac output syndrome in the setting of arespiratory syncytial virus infection, treated successfully.Absent pulmonary valve syndrome is a relatively rare variant of TOF and has been reported in only four patients in association withTAPVC. The association of TOF/APVS with TAPVC and APCA has never been previously reported to our knowledge.Published on behalf of the European Society of Cardiology. All rights reserved.& The Author 2010. For permissions please email: journals.permissions@oxfordjournals.org.Ischaemic mitral regurgitation 3005

Tetralogy of Fallot with absent pulmonary valve, supracardiac total anomalous pulmonary venous connection, and infradiaphragmatic systemic to pulmonary collateral artery

Tetralogy of Fallot with absent pulmonary valve, supracardiac total anomalous pulmonary venous connection, and infradiaphragmatic systemic to pulmonary collateral artery

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