Crochetage

Report:

Sinus rhythm 91/min

SVEBs

Right atrial abnormality

P > 2mm in V2

Right axis deviation +112o

Right ventricular hypertrophy

qR V2 + RAD

Comment:

This is a very interesting case in that her ASD was discovered in the course of a CABG procedure: the surgeon observed the shunt (from the colour of the atria) and the abnormally large pulmonary artery, proceeding to close a 1.5 cm secundum ASD! The patient had two cardiac catheterisations and multiple visits to her Cardiologists over the years55.

It was all there, in the ECG. There is a marked crochetage in all 3 inferior leads, said to be 100% specific for ASDs (like in Case 78; see also Case 33).

Even without the crochetage, there is the unexplained RVH... An echocardiogram in competent hands would have made the correct diagnosis preoperatively (if the ECG didn’t). As a distinguished Boston radiologist56 once put it, you only see what you look for, you recognize only what you know.

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