Saq discussion

Qs
Outline anatomical defects and
imaging findings in
ASD
PDA
Coarctation of aorta
Mitral regurgitation

ASD
Commonest cong heart dx in
adults (80-90%)
abnormal opening in theatrial
septumallowing communication
between the RT and LT atria
Lt to Rt shunt
If longstanding, Eisenmenger
physiology R-L shunt

3x more in F
Types
Ostium secundum; 80%, interatrial
connection at fossa ovalis
-ostium primum (assoc with AVSD)
-Sinus venosus defect ( assoc PAPVD)
-Unrooofed coronary sinus

 Imaging
CXR
Enlarged rt atrium
( risk thromboemboli,
tachyarythmias)

Enlarged rt ventricle
Lateral-filling
retrosternal airspace

shunt vascularity
Marked central pulm A
dilatation, may become
aneurysmal and calcify

VSD

defects in
theinterventricular septum
that allow a haemodynamic
communication between
theRTandLT ventricles
Commonest cong heart dx
in childhood, only 10% in
adults
Types
Membranous/perimembranous;
80%
Muscular

Inlet
Outlet/subarterial
midmuscular

Findings
Shunt vascularity
Enlargement of RV, LA and LV
left ventricular apex projects
to the left, inferiorly and
posteriorly.
LA enlargement double
density sign behind the right
atrium, and straightening or
focal convexity of the left
mediastinal border is seen
below the pulmonary artery
shadow.
Normal or small size aorta

 cardiovascular
associations
tetralogy of Fallot
truncus arteriosus
double outlet right
ventricle
aortic coarctation
tricuspid atresia
aortic regurgitation
pulmonary stenosis

PDA
persistent patency of
theductus arteriosus a
normal connection of
thefetal circulation
between the aorta and the
pulmonary arterial system
that develops from the
6thaortic arch.
Associations

Premature neonates
tetralogy of Fallot
Eisenmenger syndrome
hypoplastic left heart
pulmonary atresia
Downs syndro

 Findings
Same as VSD
except may have
enlarged ascending
and arch of aorta
Ductus may clacify
in adults

 Krichenko classification
based on CT angiography
type A: 85% conical
ductus,prominent aortic
ampulla with narrowing at
pulmonary artery end
type B: window, short and wide
ductus with blending of
pulmonary artery
type C: long tubular ductus
with no constrictions
type D: multiple constrictions
with complex ductus
type E: elongated ductus with
remote constriction

Coarctation

Coarctation of the aorta is

a luminal narrowing of a
short section of the aorta
commonly at site of
insertion of the ductus
arteriosus
thought to develop due to
presence of excessively
integrated ductal tissue
around the aortic isthmus,
which contracts along with
the ductus arteriosus at
the time of birth.

If severe, systemic
perfusion is compromised
with ductal closure
If less severe,the body
maintains perfusion by
renal mechanisms,
resulting in systemic
hypertension proximal to
the coarctation. Collateral
arterial vessels develop
overtime to maintain lower
body perfusion as the
patientgrows

 the collateral
pathways (internal
mammary and
posterior
mediastinal
arteries

 associations
bicuspid aortic
valve: 75-80%
ventricular septal
defect (VSD)
truncus arteriosus
transposition of the
great arteries (TGA
),)
mitral valve defects
Turners syndrome
15-20%

CMR or CT may be
required postoperatively to
establish if there is recoarctation aneurysmal
dilatation, or LV
hypertrophy secondary to
hypertension

Mitral regurgitation
due to functional or
anatomical dysfunction
of themitral valve
acute causes
myocardial infarction
with papillary muscle
rupture
chordal rupture (seen in
myxomatous
degeneration
infective endocarditis
prosthetic mitral valve
dysfunction

Chronic causes
annularcalcification
myxomatous
degeneration
previous
infective/inflammat
ory illness
rheumatic heart
disease
infective
endocarditis

Findings
Marked Lt atrium
enlargement
Convexity/straightenin
g lt heart order
Doule density sign
Splaying carina
Mild Lt ventricle
enlargement
Moderate enlarged
RV and pulm trunk
Upper zone venous
enlargement