Illustration of a 36-year-old woman with dextrocardia, a ventricular septal defect (VSD), double-outlet right ventricle, and pulmonary atresia. At 13 years.

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Presentation transcript:

Illustration of a 36-year-old woman with dextrocardia, a ventricular septal defect (VSD), double-outlet right ventricle, and pulmonary atresia. At 13 years of age, she underwent corrective surgery using the Rastelli procedure with baffling of the left ventricular (LV) blood via the VSD to the aorta and placement of a 22-mm valved Dacron conduit from the right ventricle to the main pulmonary artery. The right ventricle (RV) is connected to the pulmonary artery via a valved Dacron conduit. Note the grayish vegetation within this structure. The LV is the systemic ventricle. A baffle directs LV outflow to the aortic valve. The aortic valve has grayish vegetation on it that prolapses into the LV outflow tract and causes aortic regurgitation. A. CT angiogram at the level of the distal RV to pulmonary artery conduit (C). The arrow points to the grayish vegetation within the conduit. The ascending aorta is labeled (Ao). B. Transesophageal echocardiogram demonstrating the vegetation (arrow) prolapsing in diastole from the Ao to the LV. C. Warthin-Starry stain of the grayish vegetation demonstrates a cluster of Bartonella henselae that appear as black specks. D. Transesophageal echocardiogram with color-flow Doppler demonstrating aortic regurgitation around the area of vegetation. The arrow points to the vegetation. Source: Chapter 84. Congenital Heart Disease in Adults, Hurst's The Heart, 13e Citation: Fuster V, Walsh RA, Harrington RA. Hurst's The Heart, 13e; 2011 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/hurs13/hurs13_c084f007.jpg&sec=40294709&BookID=376&ChapterSecID=40279819&imagename= Accessed: October 24, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved