Echocardiographic diagnosis of congenital left ventricular-right atrial communication

The clinical diagnosis of congenital left ventricular-right atrial (LV-RA) communication is difficult. Echocardiography appears to be a useful method in the diagnosis of this congenital cardiac defect. In previous reports authors have described M-mode echocardiographic findings of this anomaly. We present here two-dimensional echo findings in a patient with congenital LV-RA communication. A 12 year old boy presented the following echocardiographic findings. A perimembranous septal defect and an abnormal tricuspid septal leaflet were seen. The defect was located at the membranous atrioventricular septum, resulting in a communication between the RA and the LV. Pulsed Doppler echocardiography demonstrated turbulent flow through the defect during systole, suggesting an LV-RA communication. M-mode echo examination of the septal tricuspid leaflet revealed systolic fluttering of the tricuspid valve. Peripheral vein contrast echocardiography showed passage of the echo contrast material from the RA to the LV (positive contrast effect). At the same time there was a negative contrast effect during ventricular systole, indicating a left to right shunt from the LV to the RA. After surgical repair of the anomaly, systolic flutter of the tricuspid valve and the other findings disappeared echocardiographically, as they did in the other reported cases. We can conclude that two-dimensional echocardiography with M-mode evaluation is a reliable method for the diagnosis of congenital LV-RA communication, and that this method should be applied to all cases where this anomaly is suspected clinically.