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[echocardiography] Marked RV enlargement

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  • jkovach
    The fairly normal PA pressure in this patient with right heart enlargement does suggest to me that this is more likely to be ARVD. HOWEVER, ASD cannot be
    Message 1 of 2 , Dec 1, 1999
      The fairly normal PA pressure in this patient with right heart
      enlargement does
      suggest to me that this is more likely to be ARVD. HOWEVER, ASD cannot
      be excluded without a TEE even if a contrast study is unremarkable.
      Both sinus venosus type ASD's (to either the SVC or IVC) and unroofed
      coronary sinus are often missed on TTE. Other left to right shunts
      should be considered and evaluated by physical exam and echo as well,
      e.g., PDA, etc. Finally, gated cardiac MRI can often delineate the
      specific fatty replacement of the RV myocardium that is typical of
      ARVD. Let us know what you find!

      Julie Kovach, MD
      University of Michigan
    • Patrick D. Coon
      I would agree with your assessment of SVASD. I don t remember hearing anything about PA dilation?!? However, wouldn t a PDA,VSD or CSASD cause left sided
      Message 2 of 2 , Dec 1, 1999
        I would agree with your assessment of SVASD.  I don't remember hearing anything about PA dilation?!? However, wouldn't a PDA,VSD or CSASD cause left sided dilation?
          If it is ARVD, echo would be useless other than to look at sequelae.
        Patrick
         

        jkovach wrote:

         
        The fairly normal PA pressure in this patient with right heart
        enlargement does 
        suggest to me that this is more likely to be ARVD. HOWEVER, ASD cannot
        be excluded without a TEE even if a contrast study is unremarkable.
        Both sinus venosus type ASD's (to either the SVC or IVC) and unroofed
        coronary sinus are often missed on TTE. Other left to right shunts
        should be considered and evaluated by physical exam and echo as well,
        e.g., PDA, etc. Finally, gated cardiac MRI can often delineate the
        specific fatty replacement of the RV myocardium that is typical of
        ARVD. Let us know what you find!
        
        Julie Kovach, MD
        University of Michigan
        
        


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