Echo quiz 1

Echo quiz 1

A large subaortic ventricular septal defect is seen and the ventricular septum is mal aligned so that aorta is overriding the ventricular septal defect. Less than half of the aortic diameter is committed to the right ventricle. When the override is less than half it is in favour of Tetralogy of Fallot while override more than half is in favour of double outlet right ventricle. Overriding great vessel can also be truncus arteriosus, which can only be differentiated in other views. There is also a suggestion of a subaortic conus as there seems to be a bit of tissue separating the hinge points of the non coronary cusp of the aortic valve and the anterior mitral leaflet. Subaortic conus also favours double outlet right ventricle rather than Tetralogy of Fallot. Other views and a moving video is needed to comment further on these aspects. Free wall of the right ventricle appears hypertrophied, though it is not very clear in this image.