Вальсальва

.."He was big and strong like russian crazy love machine.."
Now he is 70 and has insuff.circulatoria of uknown reason.He has inerstitial lung desease.pro NTBNP- 1000, torasemid-40 mg/daily.
ECG- LBBB
Imaging Aortic Arch-left sided
Left side of aortic arch:
Nearly 200 cm height and 110 kg weight, he was national polish team wrestler until unknown cardiomyopathy was diagnosed.
Urban legend tells he was wrestling with four or five strong man against him simultanously succesfully.
He was a legend but now times has changed,unfortunatelly

so much younger than today
(I never needed) I never needed anybody's help in any way
(Now) but now these days are gone (these days are gone) I'm not so self-assured (and now I find)
Now I find I've changed my mind, I've opened up the doors
Help me if you can, I'm feeling down
And I do appreciate you being 'round
Help me get my feet back on the ground
Won't you please, please help me?

Вы говорите о кардиомиопатии неясной, но демонстрируете нисходящую аорту Там какой-то сосуд с обратным кровотоком).. аберрантная подключичная артерия?
Mówisz o niejasności kardiomiopatii, ale pokazujesz zstępującą aortę Jest jakieś naczynie z odwrotnym przepływem krwi ... z nienormalną tętnicą podobojczykową? Jak wygląda serce? - To rozwiązuje wiele (machine translate)

Whole heart Echo,nothing impressive too much,LV diastolic- 64mm,IVS-14 mm,EF-40-45%,Diastolic dysfonction/relaxation- I degree.Nothing special
I think the secret is in inherited arch anomaly, double lumen aortic arch ?double barreled aorta desc? Persistent V th arch?
I think about this superior vessel as LSCA,but something in a course is strange.
PW flow pattern is very like in both vessel,not similiar to subclavian artery flow pattern

может я и не прав, но когда имеется любая сердечная недостаточность - всегда сердце будет отражать проблему (преднагрузка- постнагрузка). наличие левой вены, абберантной подключичной артерии скорее всего не могут проявляться одышкой.

vascular picture/
In heart nothing severe problem only ASD secundum left to right shunt.... suprasternal view

Left o right sided aortic arch?
PDA is for sure,if no intervention there were.Normal, left sided aortic arch?

normal arch . There is no PDA

descending ao in left - anatomic orientation picture

any intervention?
Surgical or endovascular intervention? Flow from left innominate vein to right BCV and SVC ?

Перерыв нижней полой вены гемиазигоз продолжение НПВ, синдром левой гетеротаксии (полисплении), ДМПП (был закрыт эндоваскулярно через яремную вену).

Amazing, I have never seen it before.Alexandr could you spell it in English,pls?
These four possibilities:
- Left upper pulmonary vein-> vertical vein-> BCV sin
- Left intercostalis superior vein-> BCV sin
- Left internal thoracis vein-> BCV sin
- Hemiazygos ,accessory HAZ vein-> BCV sin direction
Who gives more possibility?
I suppose from subcostal view: there is IVC and Aoabd on the left side of columnae vertebralis
Is there left sided isomerism? Asplenia or polisplenia,understood now,here is polisplenia.What about appendage isomerism in this case, present?

In my opinion prof Sokolov had visualized normal, but trurbulent flow from left subclavian or left vena jugularis flow to left innominative. There is no evidence that there is so big vana azygos accesoria. This red flow is very often seen in descendens aorta on this place and very often er misleading to estimate AR grade. This is known Coanda phenomenon in arteries especially on bends and bifurcations ...

In my opinion subcostale view with isomerism of IVC left sided and polisplenia is a evidence.
Accessory evidence maybe presence of atrial appendage isomerism, I think about left atrial appendage isomerism of right atrial.
https://www.youtube.com/watch?v=TnfHdZrmMAw

This patient have two left atria (i can see by TEE 2 LA append) , there is no sinuse node (low atrial rhythm in ECG- negative P-wave in 2 -3 leads), and polysplenia- left heterotaxia and ASD...( hemiazygos (azygos-hemiazigos - always confuse them(( by echo )we satisfacted in cath during ASD occluding. It was third patient with polysplenia and ASD whom we closed ASD by jugular way.

Wojtek Guzowski писал(а): ↑

Вт окт 02, 2018 8:38 am

In my opinion subcostale view with isomerism of IVC left sided and polisplenia is a evidence.
Accessory evidence maybe presence of atrial appendage isomerism, I think about left atrial appendage isomerism of right atrial.
https://www.youtube.com/watch?v=TnfHdZrmMAw

))-- it's cruel reality- not illusion. Left isomerism is very rare situation in patients without CHD or " light chd like ASD"