A bicuspid pulmonary valve associated with tetralogy of fallot

Congenital anomalies of the pulmonary arteries: an imaging overview

Congenital pulmonary artery anomalies represent a diverse group of abnormalities, ranging from asymptomatic incidental findings to causes of sudden cardiac death. While some may be recognized in childhood, others may be found incidentally in adulthood. We review the clinical and imaging findings in patients with congenital anomalies of the pulmonary arteries, including valvular and perivavular anomalies as well as abnormal narrowing, course and communications of the pulmonary arteries. We also discuss the role of various imaging modalities in the evaluation of these patients. It is vital to be aware of the key radiologic manifestations and associated haemodynamic consequences in these conditions in order to facilitate accurate diagnosis and prognostic stratification.

A case of isolated bicuspid pulmonary valve

We present a 73 years old woman who presented with pelvic cancer, ongoing sepsis and presumably a new diastolic murmur. Her transthoracic echocardiogram, as part of a sepsis screen, showed an abnormal pulmonary valve with moderate regurgitation. Trans-oesophageal echocardiography using 3D imaging showed a bicuspid pulmonary valve as the cause for the moderate regurgitation, but with no clear source of infection. Bicuspid pulmonary valve as an isolated clinical entity is a rare finding in clinical practice. Bicuspid pulmonary valves tend to be more commonly associated with other congenital cardiac anomalies. Whereas, the incidence of bicuspid aortic valve is estimated to be about 1-2%, the incidence of bicuspid pulmonary valve is thought to be much lower at around 0.1%. This could be an underestimate due to difficulty in visualising the pulmonary valve en-face on standard two-dimensional echocardiography. The true prevalence of the condition may be uncovered by the routine use of 3D echocardiography.

Deformities of pulmonary and aortic annulus 42 years after repair of tetralogy of Fallot

We report an extremely rare case of deformity of the pulmonary sinus of Valsalva with pulmonary valvular stenosis 42 years after a pulmonary annular-sparing operation for tetralogy of Fallot. Aortic regurgitation with deformity of the sinus is also noted. At the previous operation, the right ventricular outflow tract was augmented by a prosthetic subvalvular patch. Through the years, the pulmonary valve and sinus were distorted because the patch was pulled over toward the right ventricle.