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25 year old male with infundibular pulmonary stenosis (PS) and a ventricular septal defect(VSD). Both the VSD and the PS are seen particularly well in this case. Note the endocardial fibrosis around the infundibular os and the ease at which it could have been mistaken for a VSD. The last frame shows the VSD patch and after infundibular resection with excision of a hypertrophied septal band.The RVOT gradient dropped to 9 mm Hg on echo with laminar flow and the peak RV pressure was 32 mm Hg after resection on direct recording versus a systemic of 102 mm Hg. It is not often that we can get a photographable intracardiac anatomy in this subset !!
