Transposition: Biventricular Hypertrophy
Report:
Sinus rhythm 76/min
Borderline first degree AV block
PR 0.18”
Right atrial abnormality, P congenitale type
Right bundle branch block
Right ventricular hypertrophy
QRV1 + RAA
Biventricular hypertrophy
Katz-Wachtel phenomenon
Comment:
Again, it is better not to comment on the ST/T changes like the obvious ST segment depression in several leads: it does not contribute to the diagnosis.
The RAA is particularly prominent in V1, although it has to be said that it rarely occurs without other evidence of RAA58.
The large equiphasic voltages in V3-4 (Katz-Wachtel phenomenon) are, at 97 mm, the largest I have seen so far. But what does “biventricular” hypertrophy mean in a patient with “single ventricle”? The request form stated the patient had practically a single ventricle and a single atrium, with cyanosis. Would a purist allow the term single ventricle for a child who had septostomy followed by Blalock and Glenn shunts? None of this matters from the point of view of ECG reporting: a Cardiologist reports what is present and leaves the inferences to those who own the patient.
Below (Fig 82a) is another patient, aged 23, with a true single ventricle, on a transplant list, on home oxygen. Here is an LVH with ST/T changes and RVH with RAA in V1. The LAHB tends to increase the frontal plane voltage while diminishing the precordial ones and various modifications of the LVH criteria used to make for easy production of new papers. The one I like best is S3 + maximum precordial voltage > 30 mm, with supposed specificity of 87% and sensitivity of 96%59.
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