Вальсальва

6 years old girl, atypical stenocardia,a murmur and dyspnoea

clip

Wojtek, what does the left ventricle look like, is it enlarged? How does it work? is there fibroelastosis of papillary muscles? Is it ALCAPA or fistula? Is RCA dilated?

It seems to me RCA not dilated, a it possible to conclude- fistula. And what was shown Holter, exercise ECG?

Переформатировал клипы в gif для наглядности:

Правая коронарная артерия отходит в типичном месте и не дилатирована. Левая коронарная артерия не показана. Будете направлять на КТ-ангиографию? Холтер конечно нужно выполнить. Не уверен,что нужно проводить невизуализирующий стресс-тест 6 летнему ребенку...

Приседания))

Thx for an attention and clips conversion.Chambers,all chambers not oversized,no collaterals, no fibrosis or m.papillaris hypertrophy.The one thing is: EF- 66%,I think borderline? She was observed year by year for PFO- the last clip from RPP(right parasternal projection)- no PFO or ASD

Here is LMCA wide open in a normal position from Left Sinus of Valsalva with orthogonal tilt modo Paolo Angelini->a novel selective coronarography

RPP view, red flow from down->IVC,from left-> SVC(outside of a colour doppler gate).Above-> crista terminalis and RAA, horizontal railway- not dilated RCA.No signs of PFO or ASD.

Теперь видно место отхождения левой коронарной артерии.

yes, exactly, sir

Какой план?

NO TO CO?
What about angina? Real diagnosis?
when I was a student (about 70th ) there was rock group from Poland NO TO CO (so what) )))