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P1493 Univentricular heart diagnosed by echocardiography in a patient with good functional capacity


 A 32 years old male without a history of cardiac disease or surgery was referred to our hospital due to abnormal findings on electrocardiography (ECG). He was a healthy active young man applying for private health insurance and did not have any symptoms. On physical examination he had normal vital signs and a systolic ejection murmur was present in the pulmonic area. His Oxygen saturation was 93% and had a functional capacity of 11 METs. On electrocardiography which is shown in part A and B of the figure, he had right axis deviation and poor R progression. On chest x-ray (part C of the figure) he had top normal cardiothoracic ratio and prominent main pulmonary artery (PA). On laboratory data he had normal complete blood count and normal electrolytes. Because of the murmur found in physical examination and the right axis deviation in ECG, transthoracic echocardiography was done for the patient which revealed single ventricle with left ventricle morphology and mild systolic dysfunction (part D of the figure). Abdominal and atrial situs were solitus. There was normal inferior vena cava continuity into the right atrium. Transesophageal echocardiography was also done for the patient which revealed thickening of the pulmonary valve and presence of a subvalvular web which resulted in severe subvalvular PS (part E and F of the figure). There were dilated main PA and its branches. The left sided atrioventricular valve had mild regurgitation while the right sided one had mild to moderate regurgitation. There was dilated coronary sinus due to persistent left superior vena cava. The case describes the role of echocardiography in diagnosing rare congenital heart disease in a patient without symptoms of cardiac disease.
 Abstract P1493 Figure