Unusual Type of Pulmonary Stenosis Evaluated by 2D and 3D Transesophageal Echocardiography

Abstract

A 19-year-old male patient was referred to our echocardiography department for a better evaluation of his pulmonary stenosis. His chief complaint was dyspnea on exertion (New York Heart Association functional class II). Physical examinations revealed the presence of pectus excavatum and systolic murmurs at the right parasternal border with II/VI severity. Transthoracic echocardiography was not significantly informative due to the chest deformity; accordingly, 2D and 3D transesophageal echocardiography was done, which demonstrated thickening of the pulmonary valve cusps and restriction of their motion. Additionally, the tip of the posterolateral pulmonary cusp was attached to the sinotubular junction, resulting in the malcoaptation of the pulmonary valve cusp, moderately severe pulmonary regurgitation, and stenosis (peak pressure gradient=62 mmHg) (Figures 1 & 2). In some cases, evaluation of the pulmonary valve via transesophageal echocardiography is more informative and comprehensive than that via transthoracic echocardiography.