Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 639-643
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.639
Right-heart contrast echocardiography reveals missed patent ductus arteriosus in a postpartum woman with pulmonary embolism: A case report
Jin-Ling Chen, Dan-E Mei, Cai-Gui Yu, Zhi-Yu Zhao
Jin-Ling Chen, Dan-E Mei, Cai-Gui Yu, Zhi-Yu Zhao, Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Author contributions: Chen JL designed the report; Zhao ZY collected the patient's clinical data; Mei DE and Yu CG analyzed the data and wrote the paper; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Yu Zhao, MD, Attending Doctor, Department of Echocardiography, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei Province, China. 2228661627@qq.com
Received: September 17, 2020
Peer-review started: September 17, 2020
First decision: November 26, 2020
Revised: December 6, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: January 26, 2021
Processing time: 124 Days and 23.9 Hours
Abstract
BACKGROUND

As an established, simple, inexpensive, and surprisingly effective diagnostic tool, right-heart contrast echocardiography (RHCE) might help in solving a vexing diagnostic problem. If performed appropriately and interpreted logically, RHCE allows for differentiation of various usual and unusual right-to-left shunts based on the site of injection and the sequence of microbubble appearance in the heart.

CASE SUMMARY

A 31-year-old woman was readmitted to hospital with a 2-mo history of worsening palpitation and chest distress. Two years prior, she had been diagnosed with postpartum pulmonary embolism by conventional echocardiography and computed tomography angiography. While the latter showed no sign of pulmonary artery embolism, the former showed pulmonary artery hypertension, moderate insufficiency, and mild stenosis of the aortic valve. RHCE showed microbubbles appearing in the left ventricle, slightly delayed after right-heart filling with microbubbles; no microbubbles appeared in the left atrium and microbubbles’ appearance in the descending aorta occurred nearly simultaneous to right pulmonary artery filling with microbubbles. Conventional echocardiography was re-performed, and an arterial horizontal bidirectional shunt was found according to Doppler enhancement effects caused by microbubbles. The original computed tomography angiography findings were reviewed and found to show a patent ductus arteriosus.

CONCLUSION

RHCE shows a special imaging sequence for unexplained pulmonary artery hypertension with aortic valve insufficiency and simultaneous patent ductus arteriosus.

Keywords: Right heart contrast echocardiography; Computed tomography angiography; Patent ductus arteriosus; Pulmonary embolism; Pulmonary artery hypertension; Case report

Core Tip: A 31-year-old woman diagnosed with postpartum pulmonary embolism was readmitted to hospital, when conventional echocardiography found pulmonary artery hypertension. Right-heart contrast echocardiography showed microbubbles appearing in the left ventricle, with a slight delay after right-heart filling with microbubbles but no microbubbles in the left atrium; microbubbles also appeared in the descending aorta almost simultaneously to the right pulmonary artery. Computed tomography angiography showed no sign of pulmonary artery embolism but did show a patent ductus arteriosus. Ultimately, right-heart contrast echocardiography showed a special imaging sequence for unexplained pulmonary artery hypertension with aortic valve insufficiency and simultaneous patent ductus arteriosus.