Presentation
Decreased exercise tolerance. Prior echocardiogram showed congenital heart disease.
Patient Data
The walls of the infundibulum is markedly thickened. A linear structure, likely a thin membrane, was seen attached to the anterior wall of the thickened infundibulum and the ventricular side of the interventricular septum. Cine images show a narrow jet across the narrowed infundibulum consistent with a severe infundibular pulmonary stenosis. The main pulmonary trunk is dilated.
The left brachiocephalic vein does not join the right and is seen to course inferiorly as a persistent left superior vena cava that drains into the dilated coronary sinus.
Case Discussion
This is a case of infundibular pulmonary stenosis, which is a congenital heart defect with an obstruction to the right ventricular outflow tract at the subvalvular level. An isolated pulmonary stenosis occurs in 8 to 12% of all congenital heart defects. Pulmonary stenosis is often associated with many other congenital heart disease, such as tetralogy of Fallot and single ventricle. An isolated infundibular pulmonary stenosis is rare.