This is a chapter from Grainger and Allison. I have Coolected all images from chapter 20 with caption in this presentation. In my opinion it will be very benificial to have this in your android. ,

1. DR. MUHAMMAD BIN ZULFIQAR
PGR IV FCPS SIMS/SHL
radiombz@gmail.com
20 Congenital Heart Disease:
General Principles and Imaging Grainger and Allison

2. • FIGURE 20-1 ■ Perioperative CXR. (A) A 3-year-old patient
following total cavopulmonary connection surgery, postoperative
CXR demonstrating tube positions in intensive care. Note two chest
and one mediastinal drains, endotracheal tube and veno-venous
collateral occluder device (right upper zone). (B) Third
postoperative day following extubation and removal of mediastinal
drain. Note change in cardiomediastinal contour caused by large
pericardial clot, requiring evacuation.

3. • FIGURE 20-2 ■ Physiological assessment using CXR.
(A) Pulmonary plethora in a patient with a VSD. Note
the increased number and size of discrete vessels
without haziness. (B) Pulmonary oedema in a supine
patient with cor triatriatum (membranous obstruction
to LA outflow) resulting in increased pulmonary venous
pressure. Note cardiomegaly, perihilar alveolar
haziness/consolidation and peribronchial cuffing

4. • FIGURE 20-3 ■ Pulmonary oligaemia. (A) Supine AP CXR, in an 8-
week-old patient with tetralogy of Fallot with severe pulmonary
stenosis and cyanosis. Note black lungs with sparse, small-calibre
vessels. (B) Supine AP CXR, in the same patient following
construction of a right modified Blalock–Taussig (BT) shunt on the
next day. Note the increased size of the left cardiac contour due to
increased LV filling, increased pulmonary vascular markings, now
plethoric, suggestive of high pulmonary blood flow arising from the
shunt. Indeed, the patient had compromised systemic perfusion
due to redistribution of cardiac output to the lungs, necessitatin
clipping the shunt to reduce its calibre

5. • FIGURE 20-4 ■ Atrial septal defects. (A) Schematic drawing of ASD positions. (B)
b-SSFP CMR image. Four-chamber view showing a large secundum ASD with
posterior extension. The absence of a posterior rim (arrow) precludes insertion of
an ASD closure device. Note the dilated right atrium (RA), and right ventricle (RV),
and flattened interventricular septum. (C) b-SSFP CMR image. Axial view showing a
large superior sinus venosus defect, with PAPVD of the right upper and right
middle pulmonary veins, straddling the deficient atrial septum (arrow). (D) Plot of
instantaneous flow (measured by velocity-encoded phase-contrast MRI) as a
function of time showing a left-to-right shunt through an ASD; note increased
pulmonary blood flow

6. • FIGURE 20-4 ■ Atrial septal defects. (A) Schematic drawing of ASD
positions. (B) b-SSFP CMR image. Four-chamber view showing a large
secundum ASD with posterior extension. The absence of a posterior rim
(arrow) precludes insertion of an ASD closure device. Note the dilated
right atrium (RA), and right ventricle (RV), and flattened interventricular
septum. (C) b-SSFP CMR image. Axial view showing a large superior sinus
venosus defect, with PAPVD of the right upper and right middle pulmonary
veins, straddling the deficient atrial septum (arrow). (D) Plot of
instantaneous flow (measured by velocity-encoded phase-contrast MRI) as
a function of time showing a left-to-right shunt through an ASD; note
increased pulmonary blood flow

7. • FIGURE 20-5 ■ Atrioventricular septal defects. (A) Schematic
drawing of orthogonal views of a common atrioventricular valve:
shortaxis view from below (left), long-axis (top right), 4-chamber
(bottom right). (B) Valve view showing a complete AVSD in a patient
with right atrial isomerism and double outlet RV. Valve leaflets: SB =
superior bridging leaflet, RAS = right anterosuperior leaflet, RI =
right inferior (mural) leaflet, IB = inferior bridging leaflet, LM = left
mural leaflet. (C) b-SSFP CMR image showing 4-chamber view of a
balanced complete AVSD. There are large atrial and ventricular
components. Note the VSD (arrow) and moderate left AV valve
regurgitation (arrowhead).

8. • FIGURE 20-6 ■ Ventricular septal defects. (A)
Schematic drawing of VSD positions viewed
from the right ventricular aspect. (B) b-SSFP
CMR image of a VSD (arrow) with overriding
aorta in a patient with tetralogy of Fallot. (C)
Coronal oblique view following correction
with VSD patch (arrowhead).

9. • FIGURE 20-7 ■ Severe coarctation of the aorta. (A) PA CXR showing characteristic
bilateral rib-notching (arrow), secondary to the development of collateral
circulation. (B) Black-blood, spin-echo, oblique sagittal image through the aorta
showing a tight discrete coarctation (arrow). (C) Volume-rendered 3D
reconstruction of MR angiography showing a tight coarctation (arrowhead), and
multiple enlarged collateral vessels. (D) Echocardiographic continuous-wave
Doppler profile of the coarctation region, demonstrating increased velocity across
the stenosis, 4.18 m/s (blue cross), corresponding to a pressure gradient of 70
mmHg from the simplified Bernoulli equation. There is also markedly increased
diastolic velocity, characteristic in coarctation, termed ‘diastolic tail’ (red star

10. • FIGURE 20-7 ■ Severe coarctation of the aorta. (A) PA CXR showing characteristic
bilateral rib-notching (arrow), secondary to the development of collateral
circulation. (B) Black-blood, spin-echo, oblique sagittal image through the aorta
showing a tight discrete coarctation (arrow). (C) Volume-rendered 3D
reconstruction of MR angiography showing a tight coarctation (arrowhead), and
multiple enlarged collateral vessels. (D) Echocardiographic continuous-wave
Doppler profile of the coarctation region, demonstrating increased velocity across
the stenosis, 4.18 m/s (blue cross), corresponding to a pressure gradient of 70
mmHg from the simplified Bernoulli equation. There is also markedly increased
diastolic velocity, characteristic in coarctation, termed ‘diastolic tail’ (red star

11. • FIGURE 20-8 ■ Coronary artery anomalies. Schematic diagram of
the coronary arteries viewed in the axial oblique plane on CMR.
RA = right atrium, LA = left atrium, LV = left ventricle, RVOT = right
ventricular outflow tract, LAD = left anterior descending artery, RCA
= right coronary artery, LCX = left circumflex artery. (A) Anomalous
LCX from RCA. (B) Anomalous RCA from left main stem (LMS), with
interarterial course between pulmonary artery and aorta. (C)
Anomalous RCA from LMS passing posteriorly between the aorta
and atria. (D) Anomalous left coronary artery arising from RCA with
interarterial course between the pulmonary trunk and aorta. (E)
Anomalous left coronary artery arising from RCA passing anterior to
pulmonary trunk. (F) Anomalous left coronary artery arising from
RCA passing posteriorly between aorta and atria

12. • FIGURE 20-8 ■ Coronary artery anomalies. Schematic diagram of
the coronary arteries viewed in the axial oblique plane on CMR.
RA = right atrium, LA = left atrium, LV = left ventricle, RVOT = right
ventricular outflow tract, LAD = left anterior descending artery, RCA
= right coronary artery, LCX = left circumflex artery. (A) Anomalous
LCX from RCA. (B) Anomalous RCA from left main stem (LMS), with
interarterial course between pulmonary artery and aorta. (C)
Anomalous RCA from LMS passing posteriorly between the aorta
and atria. (D) Anomalous left coronary artery arising from RCA with
interarterial course between the pulmonary trunk and aorta. (E)
Anomalous left coronary artery arising from RCA passing anterior to
pulmonary trunk. (F) Anomalous left coronary artery arising from
RCA passing posteriorly between aorta and atria

13. • FIGURE 20-9 ■ Tetralogy of Fallot. (A, B) Right ventricular outflow
tract, morphological specimen and corresponding black-blood
spin-echo image in coronal view. The deviated outlet septum
(asterisk), aortic root (arrowhead) and hypertrophied septoparietal
trabeculations (arrow) are shown. (C) b-SSFP images of unrepaired
tetralogy of Fallot: inflow/outflow view of the left ventricle (LV)
shows a VSD with overriding aorta (Ao)—note the severe
hypertrophy of the right ventricle (RV). (D) Black-blood, spin-echo
image of right modified Blalock–Taussig shunt; 3.5-mm gortex tube
from innominate artery to right pulmonary artery (arrow).

14. • FIGURE 20-9 ■ Tetralogy of Fallot. (A, B) Right ventricular outflow
tract, morphological specimen and corresponding black-blood
spin-echo image in coronal view. The deviated outlet septum
(asterisk), aortic root (arrowhead) and hypertrophied septoparietal
trabeculations (arrow) are shown. (C) b-SSFP images of unrepaired
tetralogy of Fallot: inflow/outflow view of the left ventricle (LV)
shows a VSD with overriding aorta (Ao)—note the severe
hypertrophy of the right ventricle (RV). (D) Black-blood, spin-echo
image of right modified Blalock–Taussig shunt; 3.5-mm gortex tube
from innominate artery to right pulmonary artery (arrow).

15. • FIGURE 20-10 ■ Transposition of the great arteries. (A) b-SSFP CMR image
showing an oblique sagittal outlet view of the aorta arising from the right
ventricle (RV) and pulmonary artery arising posteriorly from the left ventricle (LV).
(B) Schematic drawing of the arterial switch repair of TGA, showing the Le Compte
manoeuvre with the translocation of the aorta and pulmonary artery. Note sites of
coronary artery ‘button’ removal and subsequent reimplantation into the neo-
aortic root. (C) b-SSFP CMR image showing the pulmonary arteries straddling the
aorta following the arterial switch procedure with Le Compte manoeuvre. (D)
Volume-rendered 3D reconstruction of a contrast-enhanced MRA showing bilateral
proximal branch pulmonary artery narrowing.

16. • FIGURE 20-10 ■ Transposition of the great arteries. (A) b-SSFP CMR
image showing an oblique sagittal outlet view of the aorta arising from
the right ventricle (RV) and pulmonary artery arising posteriorly from the
left ventricle (LV). (B) Schematic drawing of the arterial switch repair of
TGA, showing the Le Compte manoeuvre with the translocation of the
aorta and pulmonary artery. Note sites of coronary artery ‘button’ removal
and subsequent reimplantation into the neo-aortic root. (C) b-SSFP CMR
image showing the pulmonary arteries straddling the aorta following the
arterial switch procedure with Le Compte manoeuvre. (D) Volume-
rendered 3D reconstruction of a contrast-enhanced MRA showing bilateral
proximal branch pulmonary artery narrowing.

17. • FIGURE 20-11 ■ Congenitally corrected
transposition of the great arteries. (A) b-SSFP
CMR image of CCTGA showing the discordant
atrioventricular connection, with anterior LV.
Note the apical offset of the left-sided tricuspid
valve. (B) Schematic drawing of CCTGA and
frequent associated lesions.

18. • FIGURE 20-11 ■ Congenitally corrected transposition of the great
arteries. (A) b-SSFP CMR image of CCTGA showing the discordant
atrioventricular connection, with anterior LV. Note the apical offset
of the left-sided tricuspid valve. (B) Schematic drawing of CCTGA
and frequent associated lesions.

19. • FIGURE 20-12 ■ Total anomalous pulmonary venous drainage. (A)
PA CXR in a patient with unobstructed supracardiac TAPVD. Note
dilated ascending vein (arrow) returning all pulmonary blood to the
brachiocephalic vein. The arrowhead shows the dilated SVC. (B)
Volume-rendered 3D reconstruction of MR angiography showing
total anomalous infracardiac drainage of the pulmonary veins. Note
the narrowing of the veins as they pass through the diaphragm
(arrow) before draining into the portal vein (arrowhead).

20. • FIGURE 20-13 ■ Single ventricle. (A) b-SSFP CMR image showing
hypoplastic left heart syndrome, with severe hypertrophy of the systemic
RV. Note the large interatrial communication (arrowed), allowing mixing of
systemic and pulmonary venous return. (B) Volume-rendered 3D
reconstruction of an MR angiogram showing the Glenn, bidirectional
cavopulmonary anastomosis (arrow) and (C) a lateral tunnel total
cavopulmonary anastomosis (arrow) to the right pulmonary artery
(arrowhead). (D) b-SSFP CMR image showing severe ascites (arrow), and
right pleural effusion (arrowhead) in a patient with a failing TCPC
circulation and protein-losing enteropathy.

21. • FIGURE 20-13 ■ Single ventricle. (A) b-SSFP CMR image showing
hypoplastic left heart syndrome, with severe hypertrophy of the systemic
RV. Note the large interatrial communication (arrowed), allowing mixing of
systemic and pulmonary venous return. (B) Volume-rendered 3D
reconstruction of an MR angiogram showing the Glenn, bidirectional
cavopulmonary anastomosis (arrow) and (C) a lateral tunnel total
cavopulmonary anastomosis (arrow) to the right pulmonary artery
(arrowhead). (D) b-SSFP CMR image showing severe ascites (arrow), and
right pleural effusion (arrowhead) in a patient with a failing TCPC
circulation and protein-losing enteropathy.

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