Abstract
The diagnosis of tricuspid atresia can be well established by 2D echocardiography allowing the discrimination between patients with absence of atrioventricular connection and membranous atresia. Further classification of tricuspid atresia is based on concordant or discordant ventriculoarterial connection and on the size of the VSD. Possible obstruction at the level of the VSD and right ventricle can be detected by colour Doppler interrogation in the parasternal and subcostal short axis. Quantification of possible gradients across the VSD or stenotic pulmonary artery is a domain of pulsed and continuous wave Doppler. Patients with tricuspid atresia and transposition of the great arteries should be screened carefully for potential obstruction of the aortic arch. All patients should be followed for possible obstruction at the level of the atrial septum.
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9.1 Electronic Supplementary Material
Video 9.1
The apical four-chamber view in a newborn with tricuspid atresia and absent right atrioventricular connection shows fibro-fatty tissue interposed between right atrium and right ventricle connection. The large left ventricle is connected with the hypoplastic right ventricle by a VSD (AVI 6463 kb)
Video 9.2
Colour Doppler in the four-chamber view shows absence of flow across the tricuspid valve in diastole, while there is turbulent flow from the left ventricle to the right ventricle across the VSD in systole (same patient as in Video 9.1) (AVI 2082 kb)
Video 9.3
The parasternal long-axis view in a patient with tricuspid atresia and normal connection of the great arteries shows origin of the aorta from the left ventricle. The hypoplastic right ventricle is connected to the left ventricle by a large VSD (AVI 1204 kb)
Video 9.4
Parasternal short-axis view of the base of the heart in a neonate with tricuspid atresia shows absent connection of the right atrium and right ventricle. The hypoplastic right ventricle is connected to the pulmonary artery (AVI 5071 kb)
Video 9.5
Colour Doppler in the parasternal short-axis view of the base of the heart (same patient as in Video 9.4) shows acceleration of flow due to a small restrictive VSD and obstruction of flow in the midportion of the hypoplastic right ventricle. Note continuous flow in the main pulmonary in the presence of a large ductus arteriosus (AVI 2816 kb)
Video 9.6
The apical four-chamber view in a newborn with tricuspid atresia, normal connection of the great arteries and large unrestrictive VSD shows absent right atrioventricular connection. Left atrium and left ventricle are significantly increased due to excessive pulmonary blood flow (AVI 12213 kb)
Video 9.7
Colour Doppler in the apical four-chamber view (same patient as in Video 9.6) shows significantly increased flow in the pulmonary veins and left atrium confirming excessive pulmonary blood flow (AVI 2341 kb)
Video 9.8
The parasternal long-axis view in a newborn with tricuspid atresia and ventriculoarterial discordance shows origin of the large pulmonary artery from the left ventricle, while the smaller aorta originates anterior from the right ventricle (same patient as in Videos 9.9 and 9.10) (AVI 8060 kb)
Video 9.9
The sweep in a more cranial position (same patient as in Videos 9.8 and 9.10) shows transition of the anterior ascending aorta to a hypoplastic aortic arch. Pulmonary artery and aorta are connected by a large ductus arteriosus (AVI 19806 kb)
Video 9.10
Colour Doppler in the suprasternal long-axis view (same patient as in Videos 9.8 and 9.9) shows hypoplasia of the aortic arch distal to the innominate artery. Some acceleration of flow is found distal to the left subclavian artery. At that time the ductus arteriosus was small and restrictive (AVI 2737 kb)
Video 9.11
Subcostal short-axis view in a neonate with tricuspid atresia shows the unobstructed pulmonary artery origination from the right ventricle, which is connected to the left ventricle via a large VSD (AVI 16252 kb)
Video 9.12
Colour Doppler in the subcostal short-axis view (same patient as in Video 9.11) confirms unobstructed flow across the large VSD and right ventricular outflow tract in a patient with tricuspid atresia and normal connection of the great arteries (AVI 3954 kb)
Video 9.13
In a newborn with restrictive VSD, colour Doppler in the subcostal short-axis view reveals accelerated and turbulent flow both across the VSD and in the hypoplastic right ventricle (AVI 2879 kb)
Video 9.14
The subcostal short-axis view in this newborn with tricuspid atresia and ventriculoarterial discordance shows origin of the aorta from the right ventricle and the parallel course of the aorta and enlarged pulmonary artery (AVI 6444 kb)
Video 9.15
Right to left shunting across the patent foramen ovale is displayed by colour Doppler in the subcostal short-axis view of the atria in a newborn with tricuspid atresia. Normal inflow from the superior vena cava into the right atrium (directed towards the transducer) is displayed in red (AVI 2047 kb)
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Hofbeck, M., Deeg, KH., Rupprecht, T. (2017). Tricuspid Atresia. In: Doppler Echocardiography in Infancy and Childhood. Springer, Cham. https://doi.org/10.1007/978-3-319-42919-9_9
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DOI: https://doi.org/10.1007/978-3-319-42919-9_9
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