Download - Saq Discussion
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Saq discussion
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Qs
• Outline anatomical defects andimaging ndings in – ASD
– PDA
– Coarctation of aorta
– Mitral regurgitation
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ASD
• Commonest cong heart dx inadults (80!0"#
• a%normal o&ening in the atrialse&tum allo'ing communication%et'een the ) and *) atria
• *t to t shunt – +f longstanding, -isenmenger
&h.siolog. * shunt
• /x more in
• ).&es – Ostium secundum1 80", interatrial
connection at fossa o2alis
ostium &rimum (assoc 'ith A3SD#
Sinus 2enosus defect ( assoc PAP3D#
4nrooofed coronar. sinus
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• +maging
• C5 – -nlarged rt atrium
• ( ris6 throm%oem%oli,
tach.ar.thmias#
– -nlarged rt 2entricle• *aterallling
retrosternal airs&ace
–
shunt 2ascularit.• Mar6ed central &ulm A
dilatation, ma. %ecomeaneur.smal and calcif.
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3SD
• defects inthe inter2entricular se&tumthat allo' a haemod.namiccommunication %et'eenthe ) and *) 2entricles
• Commonest cong heart dxin childhood, onl. 70" inadults
• ).&es – Mem%ranous&erimem%ranous1
80" – Muscular
• +nlet
• Outletsu%arterial
• midmuscular
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• indings – Shunt 2ascularit.
– -nlargement of 3, *A and *3
– left 2entricular a&ex &ro9ectsto the left, inferiorl. and&osteriorl.:
– *A enlargement ;dou%ledensit. sign %ehind the rightatrium, and straightening orfocal con2exit. of the leftmediastinal %order is seen%elo' the &ulmonar. arter.
shado': –
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• cardiovascularassociationstetralog. of allot
•
truncus arteriosus• dou%le outlet right
2entricle
• aortic coarctation
• tricus&id atresia
• aortic regurgitation
• &ulmonar. stenosis
http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/coarctation-of-the-aortahttp://radiopaedia.org/articles/tricuspid-atresiahttp://radiopaedia.org/articles/missing?article%5Btitle%5D=aortic-regurgitationhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=aortic-regurgitationhttp://radiopaedia.org/articles/tricuspid-atresiahttp://radiopaedia.org/articles/tricuspid-atresiahttp://radiopaedia.org/articles/coarctation-of-the-aortahttp://radiopaedia.org/articles/coarctation-of-the-aortahttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1
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PDA
• &ersistent &atenc. of
the ductus arteriosus anormal connection ofthe fetal circulation
%et'een the aorta and the
&ulmonar. arterial s.stemthat de2elo&s from the>th aortic arch:
• Associations – Premature neonates
– tetralog. of allot – -isenmenger s.ndrome
– h.&o&lastic left heart
– &ulmonar. atresia
– Do'ns s.ndro
http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/eisenmenger-syndromehttp://radiopaedia.org/articles/hypoplastic-left-heart-syndromehttp://radiopaedia.org/articles/hypoplastic-left-heart-syndromehttp://radiopaedia.org/articles/hypoplastic-left-heart-syndromehttp://radiopaedia.org/articles/eisenmenger-syndromehttp://radiopaedia.org/articles/eisenmenger-syndromehttp://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1
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• indings – Same as 3SD
exce&t ma. ha2e
enlarged ascendingand arch of aorta
– Ductus ma. clacif.in adults
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• Krichenko classifcation
based on CT angiography• t.&e A? 8@" conical
ductus,&rominent aorticam&ulla 'ith narro'ing at&ulmonar. arter. end
• t.&e ? 'indo', short and 'ide
ductus 'ith %lending of&ulmonar. arter.
• t.&e C? long tu%ular ductus'ith no constrictions
• t.&e D? multi&le constrictions
'ith com&lex ductus• t.&e -? elongated ductus 'ith
remote constriction
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Coarctation• Coarctation of the aorta is
a luminal narro'ing of a
short section of the aortacommonl. at site ofinsertion of the ductusarteriosus
• thought to de2elo& due to
&resence of excessi2el.integrated ductal tissuearound the aortic isthmus,'hich contracts along 'iththe ductus arteriosus at
the time of %irth:
• +f se2ere, s.stemic&erfusion is com&romised'ith ductal closure
• +f less se2ere,the %od.maintains &erfusion %.renal mechanisms,resulting in s.stemich.&ertension &roximal tothe coarctation: Collateralarterial 2essels de2elo&o2ertime to maintain lo'er%od. &erfusion as the
&atientgro's
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• the collateral
&ath'a.s (internalmammar. and
• &osteriormediastinalarteries
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• associations – %icus&id aortic
2al2e? B@80"
–
2entricular se&tal defect (3SD#
– truncus arteriosus
– trans&osition of the
great arteries ()A#,#
– mitral 2al2e defects
– )urners s.ndrome7@0"
http://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valve
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• CM or C) ma. %erequired &osto&erati2el. toesta%lish if there is recoarctation aneur.smaldilatation, or *3h.&ertro&h. secondar. toh.&ertension
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Mitral regurgitation• due to functional or
anatomical d.sfunctionof the mitral 2al2e
• acute causes – m.ocardial infarction
'ith &a&illar. muscle
ru&ture
– chordal ru&ture (seen inm.xomatousdegeneration
– infecti2e endocarditis
– &rosthetic mitral 2al2ed.sfunction
• Chronic causes – annular calcication
– m.xomatousdegeneration
– &re2ious
infecti2einEammator. illness
– rheumatic heartdisease
– infecti2eendocarditis
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indings
• Marked Lt atriumenlargement – Con2exit.straightenin
g lt heart order
– Doule densit. sign
– S&la.ing carina
– Mild Lt ventricleenlargement
–Moderate enlargedRV and pulm trunk
– Upper zone venousenlargement
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