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Boulouiz S, Kossir A, Mouedder F, Miri C, Ismaili N, El Ouafi N. Shone syndrome revealed by treatment-resistant hypertension. Ann Med Surg (Lond) 2021; 71:102955. [PMID: 34729182 PMCID: PMC8545662 DOI: 10.1016/j.amsu.2021.102955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance: Shone complex is a congenital heart defect consisting of four obstructive defects in the left heart: a mitral supravalvular ring, sub-aortic stenosis, parachute mitral valve, and coarctation of the aorta (CoA), which affects only a small minority of people. Case presentation We report the case of a 25-year-old woman with a past medical history of moderate mitral stenosis, since she was 10-year-old with uncontrolled high blood pressure, treated with nicardipine. admitted to our emergency department with high blood pressure: 190/80 mmhg, in whom The transthoracic echocardiography (TTE) revealed: sub-mitral membrane, with a single sub-papillary muscle, and coarctation of the aorta and the CT scan showed narrowed aortic arch and a left superior vena cava allowing to retain shone syndrome as the main diagnosis. The patient was treated with an antihypertensive treatment combining (perindopril/indapamide/amlodipine) while waiting for surgery. Clinical discussion In this mini-review, we aim to describe this rare pathological condition its pathophysiological thoughts, and the way to diagnosis this complex early. Conclusion Treatment required the coordinated efforts of a team of specialists. It could be either surgical with different method or by Trans catheter treatments.
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Affiliation(s)
- Soumia Boulouiz
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Corresponding author.
| | - Amine Kossir
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Fadoua Mouedder
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Chaimae Miri
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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Nabati M, Parsaee H, Fattahian A. Semi-mobile rudimentary tissues attached to a congenital intramitral ring in a woman with previous history of embolic stroke: A rare case report. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2020; 27:191-195. [PMID: 32549899 DOI: 10.1177/1742271x19855103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/14/2019] [Indexed: 11/15/2022]
Abstract
Isolated congenital mitral ring is a very rare subtype of congenital mitral valve malformation, which accounts for about one-third of congenital cardiac anomalies associated with left ventricular inflow obstruction. A mitral ring may be easily missed unless the disease is suspected. The mitral valve repair should be considered in symptomatic patients with mitral stenosis. We report a rare case of a 43-year-old woman with an intramitral ring who experienced previous embolic stroke with left hemiplegia. However, stroke happened several years ago and it does not completely prove causality.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Homa Parsaee
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Fattahian
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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3
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Khajali Z, Rahimi S, Firouzi A, Harirforoosh I, Zangenehfar M. A Case Report of the Shone Syndrome in Association with Coronary Abnormality. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_33_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rajiah P, Fulton NL, Bolen M. Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormalities. Insights Imaging 2019; 10:83. [PMID: 31428880 PMCID: PMC6702502 DOI: 10.1186/s13244-019-0761-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there are two groups of papillary muscles, namely the anterolateral and the posteromedial groups. Cardiovascular magnetic resonance (CMR) is a valuable imaging modality in the evaluation of papillary muscles, providing both morphological and functional information. There is a remarkably wide variation in the morphology of papillary muscles. These variations can be asymptomatic or associated with symptoms related to LV outflow tract obstruction, often associated with hypertrophic cardiomyopathy. Abnormalities of the papillary muscles range from congenital disorders to neoplasms. Parachute mitral valve is the most common congenital abnormality of papillary muscles, in which all the chordae insert into a single papillary muscle. Papillary muscles can become dysfunctional, most commonly due to ischemia. Papillary muscle rupture is a major complication of acute myocardial infarction that results in mitral regurgitation and associated with high mortality rates. The most common papillary neoplasm is metastasis, but primary benign and malignant neoplasms can also be seen. In this article, we discuss the role of CMR in the evaluation of papillary muscle anatomy, function, and abnormalities.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | | | - Michael Bolen
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Mitral Inflow Obstruction Resulting From a Dilated Coronary Sinus: Role of Intraoperative Transesophageal Echocardiography in Diagnosis and Surgical Repair: A Case Report. ACTA ACUST UNITED AC 2017; 8:164-169. [PMID: 28114154 DOI: 10.1213/xaa.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mitral inflow obstruction caused by dilated coronary sinus is a rare congenital cardiac anomaly that must be differentiated from other causes of left ventricular inflow obstruction such as cor triatriatum, supramitral membrane, and supramitral ridge, because their surgical repair is different. Although preoperative transthoracic echocardiography is the primary imaging modality for diagnosis, intraoperative transesophageal echocardiography has a higher sensitivity and specificity over transthoracic echocardiography in differentiating these lesions. We report 2 cases of supramitral obstruction where the intraoperative transesophageal echocardiography has refined the preoperative diagnosis and changed the course of surgical repair.
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Ganju NK, Kandoria A, Thakur S, Ganju SA. A Constellation of Cardiac Anomalies: Beyond Shone's Complex. Heart Views 2016; 17:23-6. [PMID: 27293526 PMCID: PMC4879801 DOI: 10.4103/1995-705x.182643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Shone's anomaly is a very rare congenital cardiac malformation characterized by four serial obstructive lesions of the left side of the heart (i) Supravalvular mitral membrane (ii) parachute mitral valve (iii) muscular or membranous subaortic stenosis and (iv) coarctation of aorta. We report a unique presentation of Shone's complex in a 14-year-old adolescent male. In addition to the four characteristic lesions the patient had bicuspid aortic valve, aneurysm of sinus of valsalva, patent ductus arteriosus, ventricular septal defect, persistent left superior vena cava opening into coronary sinus and severe pulmonary artery hypertension. This case report highlights the importance of a strong clinical suspicion of the coexistence of multiple congenital cardiac anomalies in Shone's complex and the significance of a careful comprehensive echocardiography.
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Affiliation(s)
- Neeraj K Ganju
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Arvind Kandoria
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Suresh Thakur
- Department of Radiodiagnosis and Imaging, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sunite A Ganju
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Bandyopadhyay S, Mandana K. Supramitral Ring: A Rare Anomaly Presenting with Mitral Inflow Obstruction in Association with an Atrial Septal Defect. Anesth Analg 2015; 121:1139-42. [PMID: 26484454 DOI: 10.1213/ane.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Saikat Bandyopadhyay
- From the Department of Cardiac Anesthesiology & Cardiac Intensive Care, and the Department of Cardiothoracic & Vascular Surgery, Fortis Hospital, Kolkata, India
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Baxi AJ, Tavakoli S, Vargas D, Restrepo CS. Bands, Chords, Tendons, and Membranes in the Heart: An Imaging Overview. Curr Probl Diagn Radiol 2015; 45:380-391. [PMID: 26433812 DOI: 10.1067/j.cpradiol.2015.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Crests, bands, chords, and membranes can be seen within the different cardiac chambers, with variable clinical significance. They can be incidental or can have clinical implications by causing hemodynamic disturbance. It is crucial to know the morphology and orientation of normal structures, aberrant or accessory muscles, and abnormal membranes to diagnose the hemodynamic disturbance associated with them. Newer generation computed tomographic scanners and faster magnetic resonance imaging sequences offer high spatial and temporal resolution allowing for acquisition of high resolution images of the cardiac chambers improving identification of small internal structures, such as papillary muscles, muscular bands, chords, and membranes. They also help in identification of other associated complications, malformations, and provide a road map for treatment. In this article, we review cross-sectional cardiac imaging findings of normal anatomical variants and distinctive imaging features of pathologic bands, chords, or membranes, which may produce significant hemodynamic changes and clinical symptomatology.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Sina Tavakoli
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Daniel Vargas
- Department of Radiology, University of Colorado Hospital, Denver, CO
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Yildirim O, Ozyuksel A, Avsar M, Yerebakan C, Zeybek C, Demiroluk S, Bilal MS. Mid-Term Results of Congenital Supravalvar Mitral Ring Resection. J Card Surg 2015; 30:591-4. [PMID: 25939849 DOI: 10.1111/jocs.12554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Supravalvar mitral ring is a rare congenital anomaly leading to left ventricle inflow obstruction. We present our surgical experience and mid-term results in patients operated for supravalvar mitral ring and associated congenital heart defects. MATERIALS AND METHODS A retrospective analysis was performed in order to evaluate the cases surgically treated with the diagnosis of supravalvar mitral ring between 2001 and 2014. Ten patients were identified, seven of whom had accompanying congenital heart defects. Median age at the operation was 4.5 years. RESULTS Ventricular septal defects were encountered in half of the cases. Two of the patients had mitral annular hypoplasia, another two had the components of Shone's complex. The mean preoperative gradient across the supravalvar mitral ring decreased from 14.1 ± 4.2 mmHg to 4.6 ± 2.2 mmHg. All patients are alive and remain in a good clinical condition after a mean follow-up of five years. CONCLUSION Supravalvar mitral ring is a surgically treatable cause of left ventricular inflow obstruction. Although residual gradients may be encountered in patients with mitral annular hypoplasia, surgical resection of the ring is encouraged.
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Affiliation(s)
- Ozgur Yildirim
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Arda Ozyuksel
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - Mustafa Avsar
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Can Yerebakan
- Department of Pediatric Cardiac Surgery, Children's Heart Center, Giessen, Germany
| | - Cenap Zeybek
- Department of Pediatric Cardiology, Medicana International Hospital, Istanbul, Turkey
| | - Sener Demiroluk
- Department of Anesthesiology, Medicana International Hospital, Istanbul, Turkey
| | - Mehmet Salih Bilal
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
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Almeida I, Caetano F, Trigo J, Mota P, Cachulo MDC, Antunes M, Leitão Marques A. When what appears to be mitral stenosis is not: diagnostic and therapeutic implications. Rev Port Cardiol 2014; 33:471.e1-6. [PMID: 25108561 DOI: 10.1016/j.repc.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 11/24/2022] Open
Abstract
The authors report the case of a 53-year-old man, with a long-standing history of mild mitral stenosis, admitted for worsening fatigue. Transthoracic echocardiography (limited by poor image quality) showed mitral annular calcification, leaflets that were difficult to visualize and an estimated mitral valve area of 1.8 cm(2) by the pressure half-time method. However, elevated mean transmitral and right ventricle/right atrium gradients were identified (39 and 117 mmHg, respectively). This puzzling discrepancy in the echocardiographic findings prompted investigation by transesophageal echocardiography, which revealed an echogenic structure adjacent to the mitral annulus, causing severe obstruction (effective orifice area 0.7 cm(2)). The suspicion of supravalvular mitral ring was confirmed during surgery. Following ring resection and mitral valve replacement there was significant improvement in the patient's clinical condition and normalization of the left atrium/left ventricle gradient. Supravalvular mitral ring is an unusual cause of congenital mitral stenosis, characterized by an abnormal ridge of connective tissue on the atrial side of the mitral valve, which often obstructs mitral valve inflow. Few cases have been reported, most of them in children with concomitant congenital abnormalities. Diagnosis of a supravalvular mitral ring is challenging, since it is very difficult to visualize in most diagnostic tests. It was the combination of clinical and various echocardiographic findings that led us to suspect this very rare condition, enabling appropriate treatment, with excellent long-term results.
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Affiliation(s)
- Inês Almeida
- Serviço de Cardiologia do Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Francisca Caetano
- Serviço de Cardiologia do Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Trigo
- Serviço de Cardiologia do Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Mota
- Serviço de Cardiologia do Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria do Carmo Cachulo
- Serviço de Cardiologia do Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Manuel Antunes
- Serviço de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Leitão Marques
- Serviço de Cardiologia do Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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11
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Almeida I, Caetano F, Trigo J, Mota P, Cachulo MDC, Antunes M, Marques AL. When what appears to be mitral stenosis is not: Diagnostic and therapeutic implications. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Liao CP, Hsiung MC, Yuzbas B, Gok G, Sharma R, Nanda NC, Chen FL. Incremental Value of Three-Dimensional over Two-Dimensional Transthoracic Echocardiography in the Assessment of Cor Triatriatum Sinister in a Child. Echocardiography 2014; 31:669-73. [DOI: 10.1111/echo.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chung P. Liao
- Division of Pediatric Cardiology; Department of Pediatrics; Chung Shan Medical University Hospital; Taichung Taiwan
| | - Ming C. Hsiung
- Department of Cardiology; Cheng Hsin Medical Center; Taipei Taiwan
| | - Burcu Yuzbas
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Gulay Gok
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Rohit Sharma
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Fong L. Chen
- Division of Pediatric Cardiology; Department of Pediatrics; Chung Shan Medical University Hospital; Taichung Taiwan
- School of Medicine; Chung-Shan Medical University; Taichung City Taiwan
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13
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Congenital supravalvular mitral stenosis in 14 cats. J Vet Cardiol 2012; 14:281-92. [DOI: 10.1016/j.jvc.2011.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 10/16/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
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15
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Pagel PS. A thin structure attached to the atrial septum: what is propping up the tent? J Cardiothorac Vasc Anesth 2010; 26:346-8. [PMID: 21146424 DOI: 10.1053/j.jvca.2010.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA.
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Popescu BA, Jurcut R, Serban M, Parascan L, Ginghina C. Shone's syndrome diagnosed with echocardiography and confirmed at pathology. ACTA ACUST UNITED AC 2008; 9:865-7. [PMID: 18621780 DOI: 10.1093/ejechocard/jen200] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The Shone's complex, defined by four cardiovascular defects such as a supravalvular mitral membrane, valvular mitral stenosis by a parachute mitral valve, subaortic stenosis, and aortic coarctation, is a rare entity, which occurs most frequently in its incomplete form. We report the case of a 19-year-old female patient who presented at the emergency room for progressively worsening dyspnoea, orthopnoea, fever, and productive cough, due to bronchopneumonia. Echocardiography revealed the co-existence of aortic coarctation with bicuspid aortic valves, mitral supravalvular ring, and dysplastic mitral valves producing severe mitral stenosis and severe pulmonary hypertension. Although wide spectrum antibiotics were administered from the first day of hospitalization, the patient developed severe sepsis and died. The components of the Shone's complex diagnosed by echocardiography were confirmed at pathology.
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Affiliation(s)
- Bogdan A Popescu
- 'Prof. Dr. C. C. Iliescu' Institute of Cardiovascular Diseases, Bucharest, Romania.
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