Figure 1 Serial transthoracic echocardiography findings(A) Definitive diagnosis of Berry syndrome. Short-axis view of the great vessels shows an echo-free space measuring Φ7.9 mm between the aortic root and pulmonary artery. Parasternal high short-axis view reveals a Φ2.7-mm communication between the pulmonary artery and descending aorta. The aortic arch and descending aorta are separated by an 11-mm gap. (B) After first-stage corrective surgery for Berry syndrome. Parasternal view shows enhanced echogenicity at the aortic-pulmonary septum repair site, without echo interruption. The proximal right pulmonary artery inner diameter is 2.0 mm, with a slightly more distal inner diameter of approximately 3.4 mm. The distal ascending aorta diameter is approximately 4.3 mm, anastomotic site diameter is around 4.0 mm, and descending aorta inner diameter is approximately 8.0 mm. (C) Before the secondary cardiovascular interventional procedure. The proximal right pulmonary artery inner diameter is 2.6 mm, with a slightly distal inner diameter of approximately 4.5 mm. Right ventricular enlargement is present, with a transverse diameter of 32 mm and anterior wall thickness of 7.8 mm. A blue blood flow jet is observed at the tricuspid valve level, flowing from the right ventricle into the right atrium, with a pressure gradient of 96 to 136 mmHg. (D) After the secondary cardiovascular interventional procedure. The right pulmonary artery origin has an inner diameter of approximately 4.6 mm, with a mid-segment diameter of 2.1 mm and subsequent segment width of approximately 4.3 mm. Right heart enlargement with ventricular wall thickening is present; right ventricular free wall thickness is approximately 5.3 mm. A blue blood flow jet is observed at the tricuspid valve level, flowing from the right ventricle into the right atrium, with a pressure gradient of 71 mmHg.