



CASE REPORT Year : 2016 | Volume : 26 | Issue : 2 | Page : 56-60

Use of dobutamine stress echocardiography for periprocedural evaluation of a case of critical valvular pulmonary stenosis with delayed presentation



Ramachandra Barik, Siva Prasad Akula, Sheshagiri Rao Damera

Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India



Date of Web Publication 9-Jun-2016

Correspondence Address:

Dr. Ramachandra Barik

Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad - 500 082, Telangana

India

Source of Support: None, Conflict of Interest: None Check

DOI: 10.4103/2211-4122.183758



Abstract

We report a case illustrating a 39-year-old man with delayed presentation of severe pulmonary valve (PV) stenosis, clinical evidence of congestive right heart failure in the form of enlarged liver, raised jugular venous pressure, and anasarca without cyanosis. Echocardiography (echo) was used both for diagnosis and monitoring this patient as main tool. The contractile reserve of the right ventricle (RV) was evaluated by infusion of dobutamine and diuretic for 4 days before pulmonary balloon valvotomy. Both the tricuspid annular peak systolic excursion and diastolic (diastolic anterograde flow through PV) function of RV improved after percutaneous balloon pulmonary valvotomy. These improvements were clinically apparent by complete resolution of anasarca, pericardial effusion, and normalization albumin-globulin ratio. The periprocedural echo findings were quite unique in this illustration.

Keywords: Dobutamine stress echocardiography, percutaneous balloon pulmonary valvotomy, pulmonary valve stenosis, right heart failure

How to cite this article:

Barik R, Akula SP, Damera SR. Use of dobutamine stress echocardiography for periprocedural evaluation of a case of critical valvular pulmonary stenosis with delayed presentation. J Cardiovasc Echography 2016;26:56-60

How to cite this URL:

Barik R, Akula SP, Damera SR. Use of dobutamine stress echocardiography for periprocedural evaluation of a case of critical valvular pulmonary stenosis with delayed presentation. J Cardiovasc Echography [serial online] 2016 [cited 2020 Sep 20];26:56-60. Available from: http://www.jcecho.org/text.asp?2016/26/2/56/183758

Introduction

Case Report

Atlas

More Details

Swan-Ganz catheter

More Details

Figure 1: (a) 12-lead electrocardiogram shows right ventricular hypertrophy with strain but no deep S-wave in V4-V6 leads; (b) V4-V6 leads in V7-V9 position showed diminished R-wave amplitude in posterior most leads representing left ventricle with deep S-wave



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Figure 2: (a) Echocardiography shows right atrial enlargement, right ventricular hypertrophy with dilatation, small left ventricle, inconspicuously left atrium because of leftward shifted right atrial septum significant pericardial effusion without right atrium or right ventricle diastolic collapse due to higher diastolic pressure in these two chambers; (b) Parasternal short axis showed critically stenosis of tricuspid pulmonary valve in the annular plane; (c) Parasternal short axis showed doming and pliable pulmonary valve in the systole in the long axis of pulmonary artery; (d) Multiple irregular tears in the doming pulmonary valve quite apparent after percutaneous balloon pulmonary valvotomy



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Figure 3: (a) Continous wave Doppler showed pan diastolic anterograde flow across pulmonary valve due to high right ventricular end diastolic pressure as was seen at the time of presentation; (b) After 4 days of dobutamine and diuretic infusion and blood transfusion, the anterograde diastolic flow across the pulmonary valve is limited to atrial contraction (correlates with tagged 12 lead electrocardiogram); (c) no more diastolic anterograde flow across the pulmonary valve after percutaneous balloon pulmonary valvotomy, some amount of pulmonary valve regurgitation and the gradient across the pulmonary valve is <20 mmHg after percutaneous balloon pulmonary valvotomy



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Table 1: Periprocedural hemodynamic changes of critical valvular pulmonary stenosis with right ventricular dysfunction undergoing percutaneous balloon pulmonary valvotomy





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Discussion

Conclusion

References

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Figures