SYSTOLIC ANTERIOR MOTION OF THE MITRAL VALUE IN A ONE DAY OLD INFANT WITH DTRANSPOSITION OF THE GREAT VESSELS by Thomas G. DiSessa, MD; William Childs; Ching Ti, MD and William F. Friedman, MD
This is a 1 day old male infant referred to’. University Hospital for evaluation of persistent cyanosis. Single crystal M mode echocardiography established the diagnosis of D-transposition of the great vessels both by transducer angulation when recording the semilunar valves and measurement of systolic time intervals. The diagnosis of a ventricular septa1 defect was confirmed by an echo contrast study. When evaluating the single crystal study, it was noted that there was systolic anterior motion (SAM) of the mitral valve leaflet and the anterior leaflet apposed the septum in diastole (Fig. 1).There was only a’ 5 mm gradient from the pulmonary artery t o the left ventricle a t cardiac catheterization. The angiographic features of left ventricular outflow tract obstruction (LVOTO) in transposition of the great vessels (TGV) are described by SiLove and Taylor (1 ). The first description of the echocardiographic abnormalities of LVOTO seen with TGV was in a 7 month old infant by our group. (2) Subsequently Nanda et a1 described SAM in four of 11 patients with TGV and LVOTO older than one month. ( 3 ) One patient had SAM at two years of age but not at three and one half weeks of age. It may From the Division of Pediatric Cardiology. Department o f Pediatrics, University of California. San Diego, School of Medicine, La Jolla. California 92093. Received October 17. 1977; revision accepted January 3,
1978. For reprints c o n t a c t : T h o m a s G. DiSessa. M.D.. Assistant Clinical Professor, Division of Pediatric Cardiology. University Hospital, 225 West Dickinson Street, San Diego, California
92103.
186
F I G U R E 1 . CW = chest wall; R V W = right ventricular wall; R V C = right ventricular cavity; \ V S - lntraventricular septum; A L M V = Anterior leaflet of the mitral valve; P L M V = Posterior leaflet of the m i t r a l valve; PW = Posterior wall; S A M = systolic anterior motion.
indeed be unusual t o present with SAM as early as in this patient with TGV.
3
REFERENCES
1. SiLove ED, Taylor JFN: Angiographic and anatomic features of subvalvar left ventricular outflow obstruction in transposition of the great arteries. The possible role of the anterior mitral leaflet. Pediat Radio1 1:87, 1973. 2. Sahn DJ, Terry R, O’Rourke R , e t al: Multiple crystal cross sectional echocardiography in the diagnosis of cyanotic congenital heart disease. Circulation 50:230, 1974. 3. Nanda NC, Gramiak R, Manning J, et al: Echocardiographic features of subpulmonic obstruction in dextro transposition of the great vessels. Circulation 51: 515,1975.
JCU, Vol. 6, 143-214 (1978). @ 1978, John Wiley a n d Sons, Inc.. 0091-2751/78/0006-0186 $01.OO.
This is a 1 day old male infant referred to’. University Hospital for evaluation of persistent cyanosis. Single crystal M mode echocardiography established the diagnosis of D-transposition of the great vessels both by transducer angulation when recording the semilunar valves and measurement of systolic time intervals. The diagnosis of a ventricular septa1 defect was confirmed by an echo contrast study. When evaluating the single crystal study, it was noted that there was systolic anterior motion (SAM) of the mitral valve leaflet and the anterior leaflet apposed the septum in diastole (Fig. 1).There was only a’ 5 mm gradient from the pulmonary artery t o the left ventricle a t cardiac catheterization. The angiographic features of left ventricular outflow tract obstruction (LVOTO) in transposition of the great vessels (TGV) are described by SiLove and Taylor (1 ). The first description of the echocardiographic abnormalities of LVOTO seen with TGV was in a 7 month old infant by our group. (2) Subsequently Nanda et a1 described SAM in four of 11 patients with TGV and LVOTO older than one month. ( 3 ) One patient had SAM at two years of age but not at three and one half weeks of age. It may From the Division of Pediatric Cardiology. Department o f Pediatrics, University of California. San Diego, School of Medicine, La Jolla. California 92093. Received October 17. 1977; revision accepted January 3,
1978. For reprints c o n t a c t : T h o m a s G. DiSessa. M.D.. Assistant Clinical Professor, Division of Pediatric Cardiology. University Hospital, 225 West Dickinson Street, San Diego, California
92103.
186
F I G U R E 1 . CW = chest wall; R V W = right ventricular wall; R V C = right ventricular cavity; \ V S - lntraventricular septum; A L M V = Anterior leaflet of the mitral valve; P L M V = Posterior leaflet of the m i t r a l valve; PW = Posterior wall; S A M = systolic anterior motion.
indeed be unusual t o present with SAM as early as in this patient with TGV.
3
REFERENCES
1. SiLove ED, Taylor JFN: Angiographic and anatomic features of subvalvar left ventricular outflow obstruction in transposition of the great arteries. The possible role of the anterior mitral leaflet. Pediat Radio1 1:87, 1973. 2. Sahn DJ, Terry R, O’Rourke R , e t al: Multiple crystal cross sectional echocardiography in the diagnosis of cyanotic congenital heart disease. Circulation 50:230, 1974. 3. Nanda NC, Gramiak R, Manning J, et al: Echocardiographic features of subpulmonic obstruction in dextro transposition of the great vessels. Circulation 51: 515,1975.
JCU, Vol. 6, 143-214 (1978). @ 1978, John Wiley a n d Sons, Inc.. 0091-2751/78/0006-0186 $01.OO.
