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A 57-year-old man was evaluated by the pulmonologist because of dyspnoea. His past medical history included hypertension, hypercholesterolaemia, and an evaluation in 2018 because of syncope after intensive sports training. Transthoracic echocardiography at the time showed mild left ventricular hypertrophy and an anomaly which was noticed only in retrospect (Fig. 1a, asterisk). Holter monitoring and exercise electrocardiography were normal. In 2021 the patient was re-evaluated because of reduced exercise tolerance and palpitations. Holter monitoring showed frequent ventricular ectopic beats and some runs of non-sustained ventricular tachycardia (maximum 5 beats). Cardiac catheterisation showed diffuse coronary artery disease with multiple intermediate stenoses, all assessed as non-significant by fractional flow reserve. Treatment with aspirin, statin and beta-blocker was initiated.
Fig. 1
a Transthoracic echocardiography, parasternal long-axis view. The asterisk indicates an anomaly. b Computed tomography angiography performed to rule out pulmonary embolism. Contrast was administered via the right arm, coronal plane
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The pulmonologist performed computed tomography angiography to exclude pulmonary embolism. The contrast was administered via the right arm. However, in Fig. 1b no contrast can be seen in the pulmonary artery.
What is your diagnosis: which two congenital anomalies can be seen in Fig. 1?
Answer
You will find the answer elsewhere in this issue.
Conflict of interest
V.J.M. Baggen, L.J.P.M. van Woerkens, R.M. Kauling and A. Dirkali declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
