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  Indian J Med Microbiol
 

Figure 5: Apical 4 chamber view. (a) 1-year-old baby with PS. He underwent balloon pulmonary valvuloplasy for CrPS at 7th day of life (SPO2 = 67%). Restrictive VSD was missed then due to dynamic complete closure of VSD by prolapsing TV. Aneurysmal atrial septum (grey arrow), shifted towards left atrium (grey arrow). RV cavity muscle bound (yellow arrow)-TV measurement (hinge points marked with grey stars) Z-score was minus 2.1, tripartite RV, PV Z score minus 2. (b) 1-year post BPV SPO2 was 92%, TV Z score minus 1.2; (c) Parasternal short axis view from same child. Complete closure of dynamic TV accessory tissue, prominent septal and parietal band and hypoplastic PV annulus and MPA; (d) Classical spectral Doppler showing high velocity signal and hyper echoic dagger shape signal suggestive of dynamic subvalvar component. (Gradient across PV increased due to dysplastic PV and subvalvular obstruction; he underwent biventricular RVOT patch repair at the age of 2 years). PS: Pulmonary stenosis, CrPS: Critical pulmonary stenosis, VSD: Ventricular septal defect, TV: Tricuspid valve, RV: Right ventricular, PV: Pulmonary valve, BPV: Balloon pulmonary valvotomy, MPA: Main pulmonary artery, RVOT: Right ventricular outflow obstruction

Figure 5: Apical 4 chamber view. (a) 1-year-old baby with PS. He underwent balloon pulmonary valvuloplasy for CrPS at 7<sup>th</sup> day of life (SPO<sub>2</sub> = 67%). Restrictive VSD was missed then due to dynamic complete closure of VSD by prolapsing TV. Aneurysmal atrial septum (grey arrow), shifted towards left atrium (grey arrow). RV cavity muscle bound (yellow arrow)-TV measurement (hinge points marked with grey stars) Z-score was minus 2.1, tripartite RV, PV Z score minus 2. (b) 1-year post BPV SPO<sub>2</sub> was 92%, TV Z score minus 1.2; (c) Parasternal short axis view from same child. Complete closure of dynamic TV accessory tissue, prominent septal and parietal band and hypoplastic PV annulus and MPA; (d) Classical spectral Doppler showing high velocity signal and hyper echoic dagger shape signal suggestive of dynamic subvalvar component. (Gradient across PV increased due to dysplastic PV and subvalvular obstruction; he underwent biventricular RVOT patch repair at the age of 2 years). PS: Pulmonary stenosis, CrPS: Critical pulmonary stenosis, VSD: Ventricular septal defect, TV: Tricuspid valve, RV: Right ventricular, PV: Pulmonary valve, BPV: Balloon pulmonary valvotomy, MPA: Main pulmonary artery, RVOT: Right ventricular outflow obstruction