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Detection of persistent ductus in hypoplastic left heart syndrome by contrast echocardiography.

1980; BMJ; Volume: 44; Issue: 5 Linguagem: Inglês

10.1136/hrt.44.5.596

2053-5864

Carlos Mortera, Gerardo Rodríguez León,

Vascular anomalies and interventions

A patient with hypoplastic left heart syndrome was studied using contrast echocardiography after peripheral venous injection of dextrose.The combination of the parasternal and suprasternal approach allowed for identification of the right ventricular cavity, excluded the presence of right-to-left intracardiac shunts, and established normal ventriculoarterial connections.From the abdominal approach, the abdominal aorta was identified as an echo-free space corres- ponding to this structure in position, which became opacified after peripheral injection of dextrose into the left-hand vein.In view of the suprasternal and parasternal findings opacification of the abdominal aorta could only have occurred in the presence of a pulmonary artery to descending aorta shunt through a persistent ductus arteriosus.Echocardiography is a reliable method for establish- ing the diagnosis of the hypoplastic left heart syndrome, and has the advantage of avoiding cardiac catheterisation in sick newborn babies.' 2The echocardiographic detection of a big right ventricular cavity in the presence of a small left ventricular cavity and aortic root, together with the hypoplastic or absent mitral valve, has been taken as diagnostic of the syndrome.3 4Peripheral venous injection of dextrose as an ultrasonic indicator has been used in the echocardio- graphic detection of right-to-left shunts,6 and as a complementary method in the echocardiographic assessment of ventriculoarterial connections.7The purpose of this paper is to present the characteristic filling patterns obtained from the parasternal, suprasternal, and abdominal approaches in this condition using peripheral venous injections of 5 per cent dextrose as ultrasonic indicator. Case reportA 24-hour-old baby who had been born at term and weighed 2850 g was admitted to hospital in severe heart failure.On clinical examination there was dyspnoea, tachypnoea, and subcostal recession.