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

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.

Dynamic left atrial echo contrast in rheumatic mitral stenosis

“…'Traffic jam' sign may also be seen in conditions with high right atrial pressure like constrictive pericarditis and severe pulmonary valvular stenosis with right ventricular dysfunction. 5 Contributors RV and CP were involved in the conceptualisation and writing of the manuscript. SB was involved in patient care, data collection and editing of the manuscript.…”

“…The increasing echogenicity of LASEC is associated with a proportionate increase in the risk of left atrial thrombus formation and systemic embolisation. ‘Traffic jam’ sign may also be seen in conditions with high right atrial pressure like constrictive pericarditis and severe pulmonary valvular stenosis with right ventricular dysfunction 5…”