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Congenital heart disease part 3.pptx
- 1. CONGENITAL HEART DISEASE ECHO FINDINGS PART 3
- 2. • Segmental approach • Abnormalities of RV inflow • Abnormalities of LV inflow • Abnormalities of RV outflow • Abnormalities of LV outflow • Coarctation of Aorta • Abnormalities of cardiac septations (ASD, VSD, ECC) • Abnormalities of vascular connections and structure • Abnormalities of systemic venous connection • Abnormal coronary circulation • TOF, TGA, Truncus arteriosus, HLHS, TAPVC
- 3. ABNORMALITIES OF CORONARY CIRCULATION • Anomalous origin of coronary artery • Coronary artery fistula • Coronary artery aneurysm
- 4. • CT Angiography is the gold standard for non- invasive imaging of coronaries • On ECHO – PSAX at base • Size and initial course • TEE better • What if not seen…..
- 9. • Coronary anatomy imp. for Cong. Heart disease • Implication in prognosis and surgical repair • ALCAPA
- 12. • Coronary artery fistula Abnormal connection b/w coronary artery and another blood vessel or chamber
- 13. • Coronary artery aneurysm Kawasaki disease • Diameter of artery – Prognostic implication
- 16. • PLAX view - VSD and overriding of Aorta PSAX view - extent and size of VSD, RVOT 50 % rule
- 21. TRASPOSITION OF GREAT VESSELS • RV -----> Aorta • LV -----> Pulmonary artery • Easiest way to identify is SC 4-C (in children) • In adults – - PSAX - A4C
- 34. Postoperative assessment in a TGA includes • Myocardial dysfunction or regional wall motion abnormalities (RWMA) • Any residual defects (VSDs) • Pulmonary hypertension • Neoaortic valve regurgitation, neoaortic root dilatation • Supravalvar aortic stenosis • Supravalvar and branch PA stenosis.
- 35. TRICUSPID ATRESIA • Imperforate TV • Hypoplasia of RV • Inter atrial communication (m.c. PFO) • Normally developed MV and LV • A4C , Doppler study, PLAX
- 40. THANK YOU
Editor's Notes
- TOF mein LAD from RCA TGA mein LCX from RCA
- Greater the over-riding of aorta , more is the subvalvular PS as septum is shifted more anteriorly
- A 23-year-old patient post repaired Tetralogy of Fallot. (a) Parasternal long axis view demonstrating dilated RV, overriding aortic valve with a VSD patch. (b) Apical 4 chamber view showing dilated, apex forming RV. (c) Parasternal short axis view showing free PI. (d) Continuous wave Doppler of the RVOT showing free PI and no pulmonary stenosis
- 25-40 RVD 1 20-35 RVD 2 Proximal RVOT - 20-35 59-83 Length of RV Distal RVOT - 17-27 RV EDA – 11-28
- Parasternal short axis view in TGA demonstrating the LCx coronary artery arising as a branch from RCA from Sinus 2 and coursing posterior to the pulmonary artery to reach the left atrioventricular groove. Note the LAD coronary artery arising from its respective sinus (Sinus 1).
- Anterior vessel arching posteriorly and posterior vessel bifurcates --- Diagnosis of TGA established
- Subcostal coronal view showing VA discordance along with parallel arrangement of great arteries.
- Parasternal long-axis image of transposition of the great arteries (TGA) with ventricular septal defect. Because admixture of arterial and venous blood is mandatory for survival
- Left Anterior and superior to pulmonary valve
- A common sequeal of L-TGA is dev. Of systemic (right) ventricular dysfunction with dilation and hypokinesia Association with TV into LA is also common