Figure 10  .

Pulmonary stenosis in a patient who had been misdiagnosed as having a ventricular septal defect 30 years earlier. The short axis view (A) shows the triangular orifice of a tricuspid aortic valve (see fig 8). Doming of the pulmonary leaflets (arrows) is seen in A and B. This relatively subtle feature is easy to miss but was indicative of severe pulmonary stenosis in this case. There is "post-stenotic" dilatation of the main pulmonary artery. The right ventricular wall is hypertrophied but the infundibulum is not narrowed. The transgastric view (C) allows good alignment of the Doppler signal with flow. A peak gradient of 84 mm Hg was obtained in this case. RA, right atrium; RV, right ventricle.