Introduction: Presentation of the importance of using three-dimensional transesophageal echocardiography (3DTOE) in assessing the morphology and functionality of the shunt.

Case report: Figure 1 shows a bicuspid aortic valve with a persistent raphe between the non-coronary cusp (NCC) and right coronary cusp (RCC), and the coaptation line positioned between 11 o’clock and 5 o’clock. In the right sinus of Valsalva projection, a residual minimal fistulous communication (4.57x3.62 mm 3D reconstruction) is seen, allowing a connection between the left ventricle (LV) and right atrium (flow direction towards the LV, clearly identified by Color – Gerbode ventricular septal defect (VSD)). (1-3) The patient’s findings additionally include anterior mitral leaflet prolapse at the A2 segment, along with several minor semi-clefts on the posterior mitral leaflet and mild mitral regurgitation (MR) with four jets. No thrombotic mass is observed in the left atrial appendage (LAA). The tricuspid valve is trileaflet, with prolapsing segments, leading to mild functional tricuspid regurgitation (TR). The interatrial septum shows slight aneurysmal dilation, with multiple perforations and detected flow.

Conclusion: The use of 3DTOE improves the understanding of complex cardiac structures by providing a more realistic and detailed visualization. It is becoming increasingly recommended for the identification, monitoring, and management of grown-up congenital heart (GUCH) patients.