Andersons pediatric cardiology 1065
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interrogationusingcontinuouswaveDoppleridentifiesbothsystolicand
diastolicflowimmediatelydistaltothesiteofstenosis.Suprasternalsectionscan
alsobeusedtoidentifytheoriginofthepulmonaryarteriesfromthecommon
trunk(Video40.11).Thesecuts,inaddition,willdemonstrateanyinterruptionof
theaorticarch,thesideoftheaorticarch,andadditionalanomaliessuchas
presenceofanarterialductoraorticcoarctation.Retrogradediastolicflowis
observedquitefrequentlyintheaorticarch,reflectingthelowdiastolicpressure
inthepulmonaryarteries.
FIG.40.14 Obliqueimageofthehearttakenfromasubcostalwindow
demonstratingthetruncalvalveoverridingaventricularseptaldefect
(asterisk)andtheoriginoftheleftpulmonaryartery(LPA).
FIG.40.15 Obliqueimageofthehearttakenfromasubcostalwindow
demonstratingthetruncalvalveandtheoriginofthecommonpulmonary
artery(PA),inapatientwithcommonarterialtrunk(Tr)ofthetypeIvariety.
FIG.40.16 Obliqueimageofthehearttakenfromasubcostalwindow
demonstratingtheright(RPA)andleft(LPA)pulmonaryarteries.Itwas
consideredthatthispatientmayhavehadashortsegmentofcommon
pulmonaryartery.
FIG.40.17 Obliqueimageofthehearttakenfromasubcostalwindow
demonstratingthearterialtrunk,theoriginofthepulmonaryarteryfromit,
andtheintegrityoftheaorticarch.
FIG.40.18 Imageofthehearttakenfromasubcostalwindowwith
anteriorangulationofthetransducer.Theoriginsoftheright(RPA)andleft
(LPA)pulmonaryarteriesarewidelyseparated,andtheoriginoftheleft
pulmonaryarteryishypoplastic.Colormappingdemonstratesmild
regurgitationofthetruncalvalve(asterisk).
Itisnotunusualforinterruptionoftheaorticarchtobeassociatedwith
commonarterialtrunk,oftenincombinationwithsignificantdysplasiaofthe
truncalvalvarleafletsproducinginsufficiencyand/orstenosis.Almostalways
theascendingaortaisrelativelyhypoplastic,beingsmallerthantheproximal
pulmonaryarteries,withthecommontrunkitselfshowingpulmonary
dominance.Theinterruptioncanoccuratanyoftheclassicalsites.Atthetimeof
