BEST OF EUROECHO 2010. destiné pour DEMSISTS...bon courage

1. Non cyanotic Congenital heart diseases
C Bussadori (Milano,IT)
Department of Pediatric Cardiology and Adult with Congenital Heart Disease
p gy g
IRCCS- Policlinico San Donato
San Donato Milanese – Milano Italy
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

2. ASD Ostium secundum
The Most Common atrial septal defect
– Various size
– Parasternal Short axis
– Subcostal view
• Suboptimal in adults
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

3. ASD Ostium secundum
The Most Common atrial septal defect
– Modified apical 4 ch
– Various size
– CFD
• Beware to high RA pressure
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

4. ASD Ostium secundum
The Most Common atrial septal defect
It seem circular but often it isn’t
– Measure from different views and consider
the largest
– 3D it helps
– TEE 2D or 3D offer ultimate sizing for ASD
and rim diameters
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

5. ASD Ostium secundum
The Most Common atrial septal defect
It seem circular but often it isn’t
– TEE 2D or 3D offer ultimate
information on ASD and rims
shape and dimension
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

6. ASD Differential Diagnosis: OS 1
Partial AV septal defect
AV valve at the same level: MR, goose neck deformity of LVOT
Post Surgical Complication: SAS Complete AV block
S gical Complication SAS,
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

7. ASD Differential Diagnosis:
Sinus Venous Defects
• Difficult to diagnose by TTE
• Modified parasternal
• Subcostal
• Often associate to
Anomalous pulmonary
venous drainage
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

8. Ventricular septal defect
• Perimembranous
– Various estension
• Muscular
–I l
Inlet, O l
Outlet, apical
i l
trabecular
– Doubly committed
Subarterial
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9. Perimembranous VSD
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10. Perimembranous VSD
TTE TEE
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11. Perimembranous VSD
2D TEE 3D TEE
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12. Perimembranous VSD
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13. Perimembranous VSD
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14. Perimembranous VSD
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15. Muscular VSD
•Apical Trabecular
Apical
•4 chamber
•Muscular Inlet
•Short Axis
•Multiple VSD
M lti l
•3D
EUROECHO CONGRESS - COPENHAGEN -
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16. Doubly committed Subarterial
Fibrous continuty
between aortic and
pulmonary valves
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17. PDA
• Most of adult cases of
PDA are small and
silent
• Parasternal short axis
view
• CFM Demonstrate L to
R Shunt from PDA to
Sh t f t
MPA
• CW Doppler reflects
PA pressure
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010

18. Aortic coarctation
• Between left subclavian and arterial
duct
• Frequently assoc ated to
eque t y associated
• PDA, VSD, Ao.Bic.
• Modified Bernoulli formula
• (ΔP=4(v
(ΔP 4( 22 – v12))
• CW peack gradient. Mean Gradient
• PW abdominal aorta
V1
V2
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TEACHING COURSE 2010

19. Aortic bicuspidia
p
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20. Aortic bicuspidia
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21. Aortic regurgitation
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22. Sinus of Valsalva Perforation

23. Pulmonic Stenosis
Various Morphology
*Milo S Heart 1988;60:128-133
80% are dome shaped
p

24. Pulmonic stenosis
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25. Pulmonic stenosis
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26. PS “hour-glass”

27. Take home a message
g
• Non cyanotic CHD could be an unexpected
y p
diagnosis in an adult cardiac patient
• Recognize the anatomical features and
pathophysiological changes t suggest
th h i l i l h to t
appropriate treatment and Follow UP
EUROECHO CONGRESS - COPENHAGEN -
TEACHING COURSE 2010