This document discusses several types of congenital heart diseases that cause cyanosis, including transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous connection, single ventricle, and double outlet right ventricle. Imaging modalities like CT and MRI play an important role in the diagnosis and surgical planning of these conditions by precisely demonstrating vascular anatomy and associated anomalies.
The mitral valve develops between the 5th and 15th weeks of gestation. It consists of an annulus, two leaflets, chordae tendineae and papillary muscles. Rheumatic fever is a leading cause of mitral stenosis, which results from repeated bouts of inflammation damaging the mitral valve over time. Mitral stenosis causes elevated left atrial pressure and left atrial enlargement, often resulting in pulmonary hypertension. Echocardiography is the primary imaging method used to evaluate the mitral valve anatomy and measure the severity of mitral stenosis.
Acquired valvular heart diseases with x ray findingsairwave12
This document discusses the role of chest x-rays in identifying various acquired valvular heart diseases. It describes the typical x-ray findings for several conditions: aortic stenosis shows left ventricular hypertrophy and post-stenotic aortic dilation; aortic regurgitation shows an enlarged left ventricle and aorta; mitral stenosis appears as an enlarged left atrium and pulmonary findings like cephalization; mitral regurgitation has markedly enlarged left atrium and ventricle; pulmonary stenosis presents with enlarged pulmonary arteries; tricuspid valve diseases can cause right atrial bulge. The document provides details on causes, pathophysiology and x-ray signs for each condition.
Valvular heart disease accounts for 10-20% of cardiac surgery procedures in the US. The document discusses the causes, symptoms, diagnosis and treatment of two common types: mitral stenosis and mitral regurgitation. Mitral stenosis is usually caused by rheumatic fever and results in obstruction of blood flow from the left atrium to ventricle. Symptoms range from mild shortness of breath to pulmonary edema. Diagnosis involves echocardiography and treatment may involve medications, balloon valvuloplasty or valve replacement surgery. Mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to flow back into the left atrium. It can be acute or chronic, with symptoms
Valvular heart disease affects the mitral, aortic, tricuspid, and pulmonary valves. Imaging plays an important role in assessing valve stenosis and regurgitation, effects on ventricular function, and associated pulmonary pathologies. Echocardiography is the main imaging modality and can evaluate valve structure and function, ventricular size, and pressures. Chest x-ray is also useful and can show valve calcification and chamber enlargement. Imaging is used to assess disease severity and guide management.
This document provides an overview of tricuspid and pulmonary valve diseases. It discusses the anatomy of the right atrium, right ventricle, and tricuspid valve. It then covers tricuspid stenosis, including causes, chest X-ray findings, echocardiography findings, and severity assessment. Tricuspid regurgitation is also discussed, including causes, chest X-ray findings, and echocardiography findings. MRI and CT imaging of tricuspid valve disease is briefly mentioned. The document concludes by stating that Ebstein anomaly is a myopathy.
The document discusses mitral stenosis and mitral regurgitation. For mitral stenosis, rheumatic heart disease is the leading cause and results in thickening and fusion of the mitral valve leaflets. This narrowing of the valve orifice leads to elevated left atrial pressures and pulmonary hypertension. Symptoms include dyspnea and palpitations. Mitral regurgitation can be acute or chronic, and has various etiologies such as rheumatic heart disease. Chronic mitral regurgitation results in left ventricular and left atrial enlargement, while acute mitral regurgitation can cause pulmonary edema due to a sudden rise in left atrial pressures. Echocardiography is important for evaluating
This document discusses various valvular heart diseases including global burden, aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Key points include: rheumatic heart disease is a leading cause in developing countries while age-related calcific disease is most common in developed nations; surgical options depend on severity and include valve repair/replacement; complications can include atrial fibrillation, pulmonary hypertension, and systemic embolism. Medical management focuses on symptom control through medications and lifestyle changes while surgery aims to correct valvular abnormalities.
The mitral valve develops between the 5th and 15th weeks of gestation. It consists of an annulus, two leaflets, chordae tendineae and papillary muscles. Rheumatic fever is a leading cause of mitral stenosis, which results from repeated bouts of inflammation damaging the mitral valve over time. Mitral stenosis causes elevated left atrial pressure and left atrial enlargement, often resulting in pulmonary hypertension. Echocardiography is the primary imaging method used to evaluate the mitral valve anatomy and measure the severity of mitral stenosis.
Acquired valvular heart diseases with x ray findingsairwave12
This document discusses the role of chest x-rays in identifying various acquired valvular heart diseases. It describes the typical x-ray findings for several conditions: aortic stenosis shows left ventricular hypertrophy and post-stenotic aortic dilation; aortic regurgitation shows an enlarged left ventricle and aorta; mitral stenosis appears as an enlarged left atrium and pulmonary findings like cephalization; mitral regurgitation has markedly enlarged left atrium and ventricle; pulmonary stenosis presents with enlarged pulmonary arteries; tricuspid valve diseases can cause right atrial bulge. The document provides details on causes, pathophysiology and x-ray signs for each condition.
Valvular heart disease accounts for 10-20% of cardiac surgery procedures in the US. The document discusses the causes, symptoms, diagnosis and treatment of two common types: mitral stenosis and mitral regurgitation. Mitral stenosis is usually caused by rheumatic fever and results in obstruction of blood flow from the left atrium to ventricle. Symptoms range from mild shortness of breath to pulmonary edema. Diagnosis involves echocardiography and treatment may involve medications, balloon valvuloplasty or valve replacement surgery. Mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to flow back into the left atrium. It can be acute or chronic, with symptoms
Valvular heart disease affects the mitral, aortic, tricuspid, and pulmonary valves. Imaging plays an important role in assessing valve stenosis and regurgitation, effects on ventricular function, and associated pulmonary pathologies. Echocardiography is the main imaging modality and can evaluate valve structure and function, ventricular size, and pressures. Chest x-ray is also useful and can show valve calcification and chamber enlargement. Imaging is used to assess disease severity and guide management.
This document provides an overview of tricuspid and pulmonary valve diseases. It discusses the anatomy of the right atrium, right ventricle, and tricuspid valve. It then covers tricuspid stenosis, including causes, chest X-ray findings, echocardiography findings, and severity assessment. Tricuspid regurgitation is also discussed, including causes, chest X-ray findings, and echocardiography findings. MRI and CT imaging of tricuspid valve disease is briefly mentioned. The document concludes by stating that Ebstein anomaly is a myopathy.
The document discusses mitral stenosis and mitral regurgitation. For mitral stenosis, rheumatic heart disease is the leading cause and results in thickening and fusion of the mitral valve leaflets. This narrowing of the valve orifice leads to elevated left atrial pressures and pulmonary hypertension. Symptoms include dyspnea and palpitations. Mitral regurgitation can be acute or chronic, and has various etiologies such as rheumatic heart disease. Chronic mitral regurgitation results in left ventricular and left atrial enlargement, while acute mitral regurgitation can cause pulmonary edema due to a sudden rise in left atrial pressures. Echocardiography is important for evaluating
This document discusses various valvular heart diseases including global burden, aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Key points include: rheumatic heart disease is a leading cause in developing countries while age-related calcific disease is most common in developed nations; surgical options depend on severity and include valve repair/replacement; complications can include atrial fibrillation, pulmonary hypertension, and systemic embolism. Medical management focuses on symptom control through medications and lifestyle changes while surgery aims to correct valvular abnormalities.
The document describes the anatomy and function of the heart. It discusses the four chambers of the heart, including the right and left atria separated by the interatrial septum and the right and left ventricles separated by the interventricular septum. It also describes the four heart valves - the mitral and tricuspid valves between the atria and ventricles, and the aortic and pulmonary valves at the exits of the ventricles.
Valvular heart disease can be caused by stenosis, which is a narrowing of the valve that prevents forward blood flow, or insufficiency/regurgitation, which is a failure of the valve to close completely allowing reverse blood flow. Common causes mentioned include rheumatic fever, which can cause thickening and fusion of valves, calcification due to aging, and myxomatous degeneration of the mitral valve. Infective endocarditis is an infection of the heart valves that can be acute and destructive or subacute with lower virulence, and is commonly caused by bacteria entering the bloodstream from procedures or infections elsewhere in the body.
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
This document discusses the management of end-stage mitral stenosis. It begins with the anatomy and pathology of mitral stenosis, then covers the clinical presentation, diagnosis, complications and treatment options. Surgical intervention is indicated for symptomatic patients who are not candidates for percutaneous mitral balloon valvuloplasty. The options for surgery include open commissurotomy or valve replacement, with the choice of prosthetic or bioprosthetic valve depending on the patient's characteristics and risk of anticoagulation. Intraoperative echocardiography helps guide surgical decisions. Postoperative management focuses on pulmonary hypertension, heart failure and arrhythmias.
The document discusses various heart conditions and their appearances on an x-ray. It describes findings for conditions such as heart failure, valvular heart diseases including mitral stenosis and regurgitation, aortic stenosis and regurgitation, congenital heart diseases like atrial septal defect and ventricular septal defect, pulmonary stenosis, coarctation of the aorta, and tetralogy of Fallot. For each condition, it lists abnormalities that may be seen on an x-ray such as enlarged heart chambers, valve calcification, pulmonary edema or hypertension, and post-stenotic dilatation of vessels.
Eisenmenger syndrome is a condition where a congenital heart defect causes a long-standing left-to-right shunt, resulting in pulmonary hypertension and eventual reversal of blood flow into a right-to-left shunt. Over time, the increased blood pressure in the lungs causes damage that leads to pulmonary vascular disease and cyanosis. Patients experience clinical manifestations such as cyanosis, clubbed fingers, fainting, heart failure, abnormal heart rhythms, and bleeding disorders.
This document contains 7 figures and their captions that describe various types of cyanotic congenital heart disease characterized by increased pulmonary blood flow. The figures show imaging findings for conditions such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, endocardial cushion defect, aorticopulmonary window, ruptured sinus of Valsalva aneurysm, coronary artery fistula, and partial anomalous pulmonary venous return. The images demonstrate features such as cardiomegaly, increased pulmonary vascularity, and vascular shunts.
This document discusses valvular heart diseases, including causes, types, and pathology. It focuses on rheumatic fever as a common cause of acquired valvular diseases. Key points include:
- Valvular diseases include stenosis (impaired opening) and insufficiency (impaired closing), producing murmurs. Common sites are mitral and aortic valves.
- Rheumatic fever results from an autoimmune response to Group A streptococcal infection, causing inflammation in heart, joints, and other tissues through molecular mimicry.
- Rheumatic fever most commonly causes mitral stenosis through fibrosis and scarring. Acute rheumatic carditis is characterized by scattered inflammatory foci (
This document discusses diseases of the heart valves, including causes, pathophysiology, clinical features, investigations, and management. It focuses on rheumatic heart disease as a common cause of valve disease. Rheumatic fever results from an immune response to streptococcal infection and can cause inflammation of the heart valves and tissues. Over time, this leads to valve stenosis or regurgitation. The major valves affected are the mitral and aortic valves. Clinical exam findings and imaging tests like echocardiogram are used to diagnose valve disease and determine severity. Treatment involves medications for symptoms as well as surgical procedures like valve repair or replacement in severe cases.
This document discusses the development of the heart and fetal circulation. It then provides guidance on evaluating plain radiographs of congenital heart disease. Key findings include:
- Increased pulmonary vascularity can indicate increased venous or arterial flow, such as from left-to-right shunts in atrial septal defect (ASD) or ventricular septal defect (VSD).
- Decreased pulmonary vascularity suggests outflow tract issues as in Tetralogy of Fallot.
- Conditions like hypoplastic left heart present with pulmonary edema due to the left ventricle's inability to handle venous return.
- Fetal circulation has three shunts (ductus venosus, foramen
The anatomy of the cardiac valves and their abnormalitiesIbrahim Tawfeeq
The document discusses the anatomy of the four cardiac valves - tricuspid, pulmonary, mitral, and aortic valves. It describes the location and structure of each valve, including the number of cusps/leaflets and papillary muscles. It also reviews common disorders that can affect each valve such as stenosis, regurgitation, and atresia. The causes, symptoms, and management approaches for various valve disorders are summarized.
This document discusses diseases of the heart valves, focusing on rheumatic heart disease and mitral valve disease. It describes the causes, pathogenesis, clinical features, investigations, and management of acute rheumatic fever and chronic rheumatic heart disease, with a specific focus on mitral stenosis due to valve fibrosis and calcification from repeated rheumatic fever attacks. Key points include the immunological mechanism leading to valve damage, Jones criteria for diagnosing acute rheumatic fever, and the resulting mitral stenosis pathology of restricted blood flow from the left atrium to ventricle.
This document provides information on Ebstein's anomaly, a rare congenital heart defect involving abnormal development of the tricuspid valve. It discusses the embryology, anatomy, physiology, clinical presentation and natural history. Key points include:
- Ebstein's anomaly results from a failure of the tricuspid valve leaflets to properly separate from the myocardium during development. This causes downward displacement of the valve and dilation of the right ventricle.
- Clinical presentations vary from fetal cyanosis to incidental murmurs later in life. Arrhythmias are common. Survival depends on severity but most children and adolescents have little disability.
- Long term outcomes are limited but available data shows around 15
This document provides an overview of how different congenital heart diseases appear on chest x-rays. It describes the typical enlargements seen in different cardiac chambers and pulmonary vasculature for various conditions. For example, it notes that the right atrium is commonly enlarged in Ebstein's anomaly and atrial septal defects, while the left atrium may be enlarged in ventricular septal defects or patent ductus arteriosus. The document also discusses abnormalities in heart shape, such as a "boot"-shaped silhouette in tetralogy of Fallot. Overall, it serves as a guide for interpreting chest x-ray findings in the context of congenital heart disease.
This document summarizes diagnostic radiology techniques for imaging the cardiovascular system. It describes normal appearances and abnormalities seen on x-rays, CT, MRI, echocardiography and nuclear medicine imaging. Key sections outline normal cardiac anatomy and sizes seen on x-ray, as well as abnormalities such as heart enlargement, pulmonary blood flow changes, aortic abnormalities like aneurysms and dissections. Imaging methods for evaluating these conditions are also mentioned.
1. Aortic regurgitation occurs when blood leaks backwards from the aorta into the left ventricle during diastole due to failure of the aortic valve leaflets to coapt properly.
2. It can be acute, caused by things like infective endocarditis or aortic dissection, or chronic, caused by conditions like bicuspid aortic valve or hypertension.
3. Chronic AR is often well-tolerated for years as the left ventricle dilates and hypertrophies to accommodate the increased volume, but acute AR can rapidly lead to heart failure and shock if not emergently treated.
1. The document discusses what cardiovascular conditions can be seen on chest x-rays, including enlargement of the heart, changes to chamber size, valve calcification, and changes to pulmonary vessel size.
2. Enlargement of the heart can indicate dilatation of one or more chambers or pericardial effusion. Volume overload from conditions like mitral regurgitation can cause ventricular enlargement visible on x-ray.
3. Calcification of the valves, particularly the mitral and aortic valves, can be seen on x-ray and indicates rheumatic heart disease or congenital aortic stenosis.
This document discusses valvular heart disease, including the spectrum of disease for the aortic, mitral, and tricuspid valves. Key points include descriptions of chronic and acute aortic stenosis and regurgitation, mitral regurgitation and stenosis including etiologies and physical exam findings. Diagnosis is via ECG, echocardiogram, and cardiac catheterization. Treatment depends on severity and includes medical management as well as surgical interventions like valve replacement or repair.
A Road from Coronary to Pulmonary: A Rare Imaging Presentationpateldrona
This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT imaging revealed multiple sources of blood flow to the lungs including a dilated left main coronary artery to right pulmonary artery collateral, a patent ductus arteriosus to the left pulmonary artery, and multiple aortopulmonary collateral arteries. This represents an extremely rare occurrence of coronary-pulmonary connections providing a major source of pulmonary blood flow in addition to normally seen aortopulmonary collaterals. Detection of these varied collateral pathways has important implications for surgical planning in such complex congenital heart disease cases.
A Road from Coronary to Pulmonary: A Rare Imaging Presentationclinicsoncology
This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT imaging revealed multiple sources of blood flow to the lungs, including a dilated coronary artery-to-pulmonary artery collateral from the left main coronary artery to the right pulmonary artery, as well as a patent ductus arteriosus connecting the aorta to the left pulmonary artery. Additionally, there were several major aortopulmonary collateral arteries arising from the descending aorta. This represents an extremely rare finding, as coronary-to-pulmonary connections are unusual. Identifying all sources of pulmonary blood flow is important for surgical planning in patients with conditions like pentalogy of Fallot and
The document describes the anatomy and function of the heart. It discusses the four chambers of the heart, including the right and left atria separated by the interatrial septum and the right and left ventricles separated by the interventricular septum. It also describes the four heart valves - the mitral and tricuspid valves between the atria and ventricles, and the aortic and pulmonary valves at the exits of the ventricles.
Valvular heart disease can be caused by stenosis, which is a narrowing of the valve that prevents forward blood flow, or insufficiency/regurgitation, which is a failure of the valve to close completely allowing reverse blood flow. Common causes mentioned include rheumatic fever, which can cause thickening and fusion of valves, calcification due to aging, and myxomatous degeneration of the mitral valve. Infective endocarditis is an infection of the heart valves that can be acute and destructive or subacute with lower virulence, and is commonly caused by bacteria entering the bloodstream from procedures or infections elsewhere in the body.
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
This document discusses the management of end-stage mitral stenosis. It begins with the anatomy and pathology of mitral stenosis, then covers the clinical presentation, diagnosis, complications and treatment options. Surgical intervention is indicated for symptomatic patients who are not candidates for percutaneous mitral balloon valvuloplasty. The options for surgery include open commissurotomy or valve replacement, with the choice of prosthetic or bioprosthetic valve depending on the patient's characteristics and risk of anticoagulation. Intraoperative echocardiography helps guide surgical decisions. Postoperative management focuses on pulmonary hypertension, heart failure and arrhythmias.
The document discusses various heart conditions and their appearances on an x-ray. It describes findings for conditions such as heart failure, valvular heart diseases including mitral stenosis and regurgitation, aortic stenosis and regurgitation, congenital heart diseases like atrial septal defect and ventricular septal defect, pulmonary stenosis, coarctation of the aorta, and tetralogy of Fallot. For each condition, it lists abnormalities that may be seen on an x-ray such as enlarged heart chambers, valve calcification, pulmonary edema or hypertension, and post-stenotic dilatation of vessels.
Eisenmenger syndrome is a condition where a congenital heart defect causes a long-standing left-to-right shunt, resulting in pulmonary hypertension and eventual reversal of blood flow into a right-to-left shunt. Over time, the increased blood pressure in the lungs causes damage that leads to pulmonary vascular disease and cyanosis. Patients experience clinical manifestations such as cyanosis, clubbed fingers, fainting, heart failure, abnormal heart rhythms, and bleeding disorders.
This document contains 7 figures and their captions that describe various types of cyanotic congenital heart disease characterized by increased pulmonary blood flow. The figures show imaging findings for conditions such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, endocardial cushion defect, aorticopulmonary window, ruptured sinus of Valsalva aneurysm, coronary artery fistula, and partial anomalous pulmonary venous return. The images demonstrate features such as cardiomegaly, increased pulmonary vascularity, and vascular shunts.
This document discusses valvular heart diseases, including causes, types, and pathology. It focuses on rheumatic fever as a common cause of acquired valvular diseases. Key points include:
- Valvular diseases include stenosis (impaired opening) and insufficiency (impaired closing), producing murmurs. Common sites are mitral and aortic valves.
- Rheumatic fever results from an autoimmune response to Group A streptococcal infection, causing inflammation in heart, joints, and other tissues through molecular mimicry.
- Rheumatic fever most commonly causes mitral stenosis through fibrosis and scarring. Acute rheumatic carditis is characterized by scattered inflammatory foci (
This document discusses diseases of the heart valves, including causes, pathophysiology, clinical features, investigations, and management. It focuses on rheumatic heart disease as a common cause of valve disease. Rheumatic fever results from an immune response to streptococcal infection and can cause inflammation of the heart valves and tissues. Over time, this leads to valve stenosis or regurgitation. The major valves affected are the mitral and aortic valves. Clinical exam findings and imaging tests like echocardiogram are used to diagnose valve disease and determine severity. Treatment involves medications for symptoms as well as surgical procedures like valve repair or replacement in severe cases.
This document discusses the development of the heart and fetal circulation. It then provides guidance on evaluating plain radiographs of congenital heart disease. Key findings include:
- Increased pulmonary vascularity can indicate increased venous or arterial flow, such as from left-to-right shunts in atrial septal defect (ASD) or ventricular septal defect (VSD).
- Decreased pulmonary vascularity suggests outflow tract issues as in Tetralogy of Fallot.
- Conditions like hypoplastic left heart present with pulmonary edema due to the left ventricle's inability to handle venous return.
- Fetal circulation has three shunts (ductus venosus, foramen
The anatomy of the cardiac valves and their abnormalitiesIbrahim Tawfeeq
The document discusses the anatomy of the four cardiac valves - tricuspid, pulmonary, mitral, and aortic valves. It describes the location and structure of each valve, including the number of cusps/leaflets and papillary muscles. It also reviews common disorders that can affect each valve such as stenosis, regurgitation, and atresia. The causes, symptoms, and management approaches for various valve disorders are summarized.
This document discusses diseases of the heart valves, focusing on rheumatic heart disease and mitral valve disease. It describes the causes, pathogenesis, clinical features, investigations, and management of acute rheumatic fever and chronic rheumatic heart disease, with a specific focus on mitral stenosis due to valve fibrosis and calcification from repeated rheumatic fever attacks. Key points include the immunological mechanism leading to valve damage, Jones criteria for diagnosing acute rheumatic fever, and the resulting mitral stenosis pathology of restricted blood flow from the left atrium to ventricle.
This document provides information on Ebstein's anomaly, a rare congenital heart defect involving abnormal development of the tricuspid valve. It discusses the embryology, anatomy, physiology, clinical presentation and natural history. Key points include:
- Ebstein's anomaly results from a failure of the tricuspid valve leaflets to properly separate from the myocardium during development. This causes downward displacement of the valve and dilation of the right ventricle.
- Clinical presentations vary from fetal cyanosis to incidental murmurs later in life. Arrhythmias are common. Survival depends on severity but most children and adolescents have little disability.
- Long term outcomes are limited but available data shows around 15
This document provides an overview of how different congenital heart diseases appear on chest x-rays. It describes the typical enlargements seen in different cardiac chambers and pulmonary vasculature for various conditions. For example, it notes that the right atrium is commonly enlarged in Ebstein's anomaly and atrial septal defects, while the left atrium may be enlarged in ventricular septal defects or patent ductus arteriosus. The document also discusses abnormalities in heart shape, such as a "boot"-shaped silhouette in tetralogy of Fallot. Overall, it serves as a guide for interpreting chest x-ray findings in the context of congenital heart disease.
This document summarizes diagnostic radiology techniques for imaging the cardiovascular system. It describes normal appearances and abnormalities seen on x-rays, CT, MRI, echocardiography and nuclear medicine imaging. Key sections outline normal cardiac anatomy and sizes seen on x-ray, as well as abnormalities such as heart enlargement, pulmonary blood flow changes, aortic abnormalities like aneurysms and dissections. Imaging methods for evaluating these conditions are also mentioned.
1. Aortic regurgitation occurs when blood leaks backwards from the aorta into the left ventricle during diastole due to failure of the aortic valve leaflets to coapt properly.
2. It can be acute, caused by things like infective endocarditis or aortic dissection, or chronic, caused by conditions like bicuspid aortic valve or hypertension.
3. Chronic AR is often well-tolerated for years as the left ventricle dilates and hypertrophies to accommodate the increased volume, but acute AR can rapidly lead to heart failure and shock if not emergently treated.
1. The document discusses what cardiovascular conditions can be seen on chest x-rays, including enlargement of the heart, changes to chamber size, valve calcification, and changes to pulmonary vessel size.
2. Enlargement of the heart can indicate dilatation of one or more chambers or pericardial effusion. Volume overload from conditions like mitral regurgitation can cause ventricular enlargement visible on x-ray.
3. Calcification of the valves, particularly the mitral and aortic valves, can be seen on x-ray and indicates rheumatic heart disease or congenital aortic stenosis.
This document discusses valvular heart disease, including the spectrum of disease for the aortic, mitral, and tricuspid valves. Key points include descriptions of chronic and acute aortic stenosis and regurgitation, mitral regurgitation and stenosis including etiologies and physical exam findings. Diagnosis is via ECG, echocardiogram, and cardiac catheterization. Treatment depends on severity and includes medical management as well as surgical interventions like valve replacement or repair.
A Road from Coronary to Pulmonary: A Rare Imaging Presentationpateldrona
This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT imaging revealed multiple sources of blood flow to the lungs including a dilated left main coronary artery to right pulmonary artery collateral, a patent ductus arteriosus to the left pulmonary artery, and multiple aortopulmonary collateral arteries. This represents an extremely rare occurrence of coronary-pulmonary connections providing a major source of pulmonary blood flow in addition to normally seen aortopulmonary collaterals. Detection of these varied collateral pathways has important implications for surgical planning in such complex congenital heart disease cases.
A Road from Coronary to Pulmonary: A Rare Imaging Presentationclinicsoncology
This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT imaging revealed multiple sources of blood flow to the lungs, including a dilated coronary artery-to-pulmonary artery collateral from the left main coronary artery to the right pulmonary artery, as well as a patent ductus arteriosus connecting the aorta to the left pulmonary artery. Additionally, there were several major aortopulmonary collateral arteries arising from the descending aorta. This represents an extremely rare finding, as coronary-to-pulmonary connections are unusual. Identifying all sources of pulmonary blood flow is important for surgical planning in patients with conditions like pentalogy of Fallot and
A Road from Coronary to Pulmonary: A Rare Imaging Presentationgeorgemarini
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Its association with Pulmonary Atresia is considered to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases, systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation. Such patients commonly undergo a Cardiac CT as an imperative pre-operative investigation for detailed information of these collaterals which helps plan further management. Here, we present a Case Report of an adult female patient with Pentalogy of Fallot wherein, a Cardiac CT showed the presence of dilated coronary-to-pulmonary collateral circulation. i.e. CAPA apart from the normally visualized MAPCA’s, an extremely rare occurrence.
A Road From Coronary To Pulmonary: A Rare Imaging Presentationkomalicarol
This case report describes a rare presentation in a 21-year-old female patient with pentalogy of Fallot. Cardiac CT revealed multiple sources of blood flow to the lungs including a dilated left main coronary artery to right pulmonary artery collateral, a patent ductus arteriosus to the left pulmonary artery, and multiple major aortopulmonary collateral arteries. This represents an extremely rare occurrence of coronary-pulmonary connections providing a major source of pulmonary blood flow in addition to normally seen major aortopulmonary collaterals. Detection of these various collateral pathways is important for surgical planning in such patients.
The document describes a case of a 3-week-old infant referred for tachypnea. Chest x-ray showed cardiomegaly and normal pulmonary vascularity. Aortogram showed normal aorta but retrograde filling of the left coronary artery from collaterals, with the proximal left coronary draining into the pulmonary artery rather than the aorta. The most likely diagnosis is Bland-White-Garland Syndrome, a rare condition where one coronary artery, usually the left, originates from the pulmonary artery rather than the aorta.
CT Chest Fundamentals provides an overview of CT imaging of the chest. There are several types of CT scans discussed including standard, high-resolution, low-dose, CT angiography, and paired inspiratory-expiratory scans. CT allows visualization of chest anatomy including the lungs, mediastinum, bronchi, vessels, and lymph nodes. Common chest abnormalities that can be identified on CT include tracheal and bronchial abnormalities, masses or nodules in the lungs or hilum, lymph node enlargement, and vascular abnormalities. CT is useful for evaluating many lung diseases and conditions.
1) The document describes various types of congenital heart diseases including acyanotic and cyanotic defects with left-to-right or right-to-left shunts.
2) Tetralogy of Fallot and transposition of the great arteries are discussed in detail as common cyanotic congenital heart diseases with decreased or increased pulmonary blood flow respectively.
3) Other cyanotic defects described include pulmonary atresia, Ebstein's anomaly, tricuspid atresia, and truncus arteriosus.
This case series presents 7 cases of congenital aortic diseases assessed using cardiac computed tomography angiography (CCTA). CCTA provided detailed visualization of vascular structures and spatial relationships that were important for diagnosis and surgical planning. The cases included vascular rings, interrupted arches, coarctation and hypoplasia. CCTA allowed early diagnosis and treatment. Multi-imaging is important for assessing these complex anomalies and guiding management, like surgical or endovascular interventions. Three-dimensional CCTA images provided valuable information for optimal diagnosis and surgical planning.
Presentation1, radiological imaging of scimitar syndromeAbdellah Nazeer
Scimitar syndrome is characterized by a hypoplastic right lung drained by an anomalous vein into the inferior vena cava, known as a scimitar vein. It presents with a partial anomalous pulmonary venous return most commonly on the right side. Associated findings include congenital heart defects, diaphragmatic anomalies, and vertebral anomalies. Radiological imaging plays an important role in diagnosis, with chest x-rays sometimes showing the scimitar vein and reduced lung volume. CT and MRI are useful to precisely map the anomalous pulmonary vein and associated abnormalities.
Thoracic outlet syndrome is caused by compression of the neurovascular structures passing through the thoracic outlet. It has three subtypes depending on whether the brachial plexus, subclavian vein, or subclavian artery is compressed. Diagnosis involves clinical maneuvers to reproduce symptoms and imaging like ultrasound, MRI, CT or angiography. Ultrasound is useful for assessing blood flow changes during maneuvers but other modalities show the full thoracic outlet anatomy. Treatment depends on subtype but may include surgery or endovascular procedures, with follow-up ultrasound to monitor outcomes.
Presentation1, radiological imaging of thoracic aortic aneurysm.Abdellah Nazeer
- The document discusses thoracic aortic aneurysms, including their causes, imaging appearance, and classifications. CT angiography and MRI are described as the preferred imaging modalities. True aneurysms are distinguished from false aneurysms caused by trauma or surgery. The Stanford and DeBakey classification systems are outlined. Examples of imaging findings are provided for various thoracic aortic pathologies.
Fetal MRI can provide additional useful information when evaluating congenital heart disease (CHD) prenatally. It may help characterize complex CHD and detect associated extracardiac abnormalities when ultrasound is inconclusive. Fetal MRI is particularly helpful in the late second and third trimesters as ultrasound can be limited by decreasing amniotic fluid and ossifying ribs. It allows assessment of organs like the lungs, thymus and brain that may be involved with certain CHD or genetic syndromes.
Presentation1, radiological imaging of karrtegner,s syndrome.Abdellah Nazeer
Kartagener syndrome is a type of primary ciliary dyskinesia characterized by a clinical triad of sinusitis, situs inversus, and bronchiectasis. Radiological findings can demonstrate the mirror-image reversal of organ positioning (situs inversus) as well as signs of chronic sinusitis and bronchiectasis including mucus plugging. Computed tomography is particularly useful for evaluating the bronchiectasis morphology and associated findings like mosaic perfusion patterns or tree-in-bud signs of infection. Differential diagnosis includes other causes of impaired mucociliary clearance and immunodeficiencies.
This document discusses pulmonary hypertension and outlines various modalities used to diagnose it, including x-ray, CT, and echocardiography. By the time a diagnosis is made, 90% of patients will have an abnormal chest x-ray showing signs like an enlarged right ventricle, right atrium, and pulmonary vessels. CTPA provides detail of pulmonary vessels and can detect emboli, while HRCT is useful for underlying lung conditions. Echocardiography estimates pulmonary pressures, assesses right ventricular size and function, and can detect valve issues or shunts that may be causing pulmonary hypertension.
Fetal magnetic resonance imaging (MRI) can provide additional information to ultrasound for the evaluation of congenital heart disease (CHD). MRI uses sequences like HASTE, True-FISP, and cine MRI to visualize cardiac anatomy and function in multiple planes. It allows assessment of cardiac situs, chambers, vessels, and septa. Associated extracardiac anomalies can also be detected. While MRI adds clinical information, ultrasound remains the standard first-line imaging technique due to wider availability and lack of ionizing radiation with MRI. Fetal MRI may be considered when ultrasound is inconclusive or limited by advanced gestational age.
This document discusses the use of echocardiography in evaluating congenital heart diseases in adults. It outlines the indications for echocardiography and describes how to perform the examination and interpret findings. Key abnormalities that can be identified include atrial septal defects, ventricular septal defects, atrioventricular septal defects, anomalies of venous inflow, and abnormalities of ventricular morphology. Echocardiography is well-suited for diagnosing and monitoring these congenital heart conditions in adulthood.
Presentation1.pptx, radiological imaging of pulmonary embolism.Abdellah Nazeer
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New microsoft office power point presentationRiyadhWaheed
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
1. Imaging of Congenital Heart Diseases
DR.RIYADH W AL ESAWI
Assist.prof.diagnostic radiology
Faculty of medicine/ Kufa University
DMRD, MSc, PhD
2. CONGENITAL HEART DISEASE
• Definition:
• Congenital heart diseases are structural or functional circulation
system anomalies which provide clinical symptoms at birth or
in other life periods
3. Cyanotic HD
with increased pulmonary flow
• Transposition of great arteries (TGA), Truncus arteriosus, common ventricle (CV),
anomalous pulmonary venous conection (PAPVC, TAPVC) .
with decreased pulmonary flow
• Tetralogy of Fallot (ToF), pulmonary atresia with/without ventricular septum defect (PA
+ VSD), tricuspid atresia (TA), Ebstein anomaly.
with pulmonary stasis
• TAPVC with pulmonary veins stenosis, cor triatriatum
5. Cyanotic heart diseases
Increased Pulmonary Vascularity Decreased Pulmonary Vascularity
Total anomalous pulmonary venous connection
(TAPVC)
Tetralogy of Fallot
Truncus arteriosus Tricuspid atresia
Transposition of great arteries Pulmonary atresia
Single ventricle Pulmonary stenosis and atrial septic defect
Double outlet right ventricle Ebstein's anomaly
6. 1-TGA
Transposition of great artery is the most common cyanotic heart
disease in the neonatal group. Depending on chamber-vessel
connection there are two entities; D-TGA In approximately 60% of
the patients, the aorta is anterior and to the right of the
pulmonary artery (dextro-transposition of the great arteries [d-
TGA]). ,and L-TGA, the aorta is anterior and to the left of the
pulmonary artery (levo-transposition of the great arteries [l-
TGA]). Coronary arteries arise from aorta, from posterior cusps. Due
to atrio-ventricular concordance and ventriculo-arterial discordance,
systemic venous blood passes through the right heart to the aorta and
pulmonary venous blood passes through the left heart to the lungs.
7. From a practical standpoint, the presence or absence of associated
cardiac anomalies defines the clinical presentation and surgical
management of a patient with transposition of the great arteries. The
primary anatomic subtypes are
1- TGA with intact ventricular septum.
2- TGA with VSD.
3- TGA with VSD and left ventricular outflow tract obstruction.
4- TGA with VSD and pulmonary vascular obstructive disease.
8. • In one third of patients with TGA, the coronary artery anatomy is
abnormal, with a left circumflex coronary arising from the right
coronary artery (22%), a single right coronary artery (9.5%), a single
left coronary artery (3%), or inverted origin of the coronary arteries
(3%) representing the most common variants.
• Survival is dependent on the existence of a communication between
pulmonary and systemic circulations, PDA, VSD, ASD.
9. • Total repair of D-TGA involves performing the rerouting the
systemic return to left atrium through a channel (Senning procedure)
and directing pulmonary return to the right atrium. In Rastelli
procedure transventricular rerouting of the left ventricular outflow is
performed. Pulmonary trunk is divided and a conduit is placed within
right ventricle and the pulmonary trunk.
• Jantane procedure is a 3-stage arterial switch procedure.
• Imaging by MDCT and /or MRI is helpful in demonstrating a post-
procedural complications like stenosis at various sites of anastomosis
.
• In L-TGA there is a discordant atrio-ventricular and ventricular
arterial connection. Some patients may be asymptomatic or present
late. Treatment involves the double switch procedure (Senning of
mustard) or Rastelli’s repair.
10. Chest X-Ray- Egg on String
Chest radiograph obtained in a neonate
shows narrowing of the superior
mediastinum, enlargement of the
cardiac silhouette with abnormal
convexity of the right atrial border,
and increased vascular flow—typical
features of transposition of the
great arteries.
14. TGA. A two-month-old male cyanotic child,
suspected on echocardiography to have TGA,
large VSD, PS, diagnosed with transposition of
great arteries, VSD and PS: (a) diagrammatic
illustration of TGA with narrowing of the
pulmonary outflow; (b) Plain radiography
demonstrate mild biventricular cardiac
enlargement. Lung fields are unremarkable; (c)
Axial MIP image showing anteriorly located
large aorta (arrow) and posteriorly located
pulmonary artery ( open arrows); (d) CT axial
image demonstrates biventricular enlargement
with large ventricular septal defect (circle).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
15. (e) Lateral MIP CT image
demonstrates anterior location of
aorta (arrow). There is a narrowing
of the pulmonary arterial origin
(open arrow) (f). Modified oblique
view shows large ventricular septal
defect, anteriorly located aorta
(arrow) and posterior pulmonary
artery with narrowing at the origin.
(triangle).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
17. 2-TRUNCUS ARTERIOSUS
TA; Incidence 1 in 11000 live births
Truncus arteriosus is an uncommon cono-truncal anomaly characterized
by a single arterial vessel that originates from the heart, overrides the
ventricular septum, and supplies the all the three, systemic, pulmonary,
and coronary circulation.
Associated with DiGeorge syndrome and chromosome 22q11 deletion .
Echocardiography is adequate for diagnosis and surgical planning in
most of patients. MRI or MDCT may be needed for delineation of
branching pattern of pulmonary arteries, demonstration of
aortopulmonary collateral vessels, pulmonary venous abnormalities and
configuration of aortic arch.
18. Type I = pulmonary trunk arises from proximal truncus
Type II and III= no pulmonary trunk; branch PA arise from
posterior and lateral mid-segments of truncus.
Type IV=pulmonary circulation dependent on MAPCAs.
TA associated with right aortic arch, interrupted aortic arch, COA, PDA, Coronary
artery anomalies, Unilateral absence of pulmonary artery.
Collet and Edwards classification
19. Truncus arteriosus. (a) Diagrammatic
representation of vascular anatomy in truncus
arteriosus; (b) Plain radiograph shows moderate
cardiac enlargement with increased pulmonary
arterial markings, especially on right side(open
arrow); (c) echocardiography shows a single
trunk(open arrow) providing origin to
pulmonary artery and aorta; (d-f) Reconstructed
outflow CT images shows a single large
ascending aorta overriding large septal
defect(circle); (e) Reconstructed axial oblique
CT view shows pulmonary arteries arising from
posterior aspect of aorta (triangle).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
20. A three -month-old male with breathing
difficulty, recurrent chest infection,
diagnosed with truncus arteriosus; (a)
Axial CT view shows configuration of
aortic arch (arrow) and origin of
pulmonary artery(arrow); (b) 3 D
reconstruction showing larger aorta
(arrow) and RPA and LPA arising
posteriorly (open arrows). Also, there is
an aberrant left subclavian artery
(triangle).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
21. 3-Total anomalous pulmonary venous
connection -TAPVC
• Supracardiac
• Intracardiac
• infracardaic
• These anomalies involve drainage of the pulmonary veins to
the systemic circulation. Intracardiac TAPVC is associated
with atrial isomerism (polysplenia or asplenia).
• Anomalous pulmonary venous drainage can be associated
with obstruction, especially infracardiac variety.
22. • Plain radiography characteristically shows signs of severe pulmonary
oedema or congestion with normal cardiac size in obstructed TAPVC .
• In supracardiac TAPVC shows cardiomegaly with wide mediastinum
and plethoric lungs. (Snow man or Figure of ‘8’ heart).
• CT or MRI plays a greater role in imaging these anomalies .
23. SNOW MAN
Snowman heart (supracardiac
type only) due to prominent
veins (SVC, innominate) : most
common Increased pulmonary
vascularity.
24. Supracardiac TAPVC. A three-month-old female
presenting with cyanosis while feeding, abnormal vessel
on echography, diagnosed with TAPVC: (a) diagrammatic
representation of confluence of pulmonary veins into a
vertical vein, draining subsequently in to left innominate
vein; (b) Plain radiography demonstrating biventricular
cardiomegaly and plethoric lung fields. Widening of the
mediastinum is noted on left side (arrow); (c,d) Grey
scale and colour Doppler echocardiography demonstrate
ascending vertical vein (triangle and arrows) Both atria
are enlarged; (e) MIP image in coronal plane of contrast-
enhanced CT demonstrates confluence of all pulmonary
veins into vertical vein and innominate vein. (Triangles);
(f) Coronal CT MIP image demonstrates pulmonary
plethora, dilated MPA and vena-cavae (triangles).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
25. Supracardiac TAPVC. A three-month-old
female presenting with cyanosis while
feeding, abnormal vessel on echography,
diagnosed with TAPVC (g, h) 3-D CT
reconstructed images viewed from
posterior aspect demonstrates anomalous
drainage of all the pulmonary veins into
vertical vein (arrow).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
26. Intra-cardiac TAPVC. A two-month-old female
presenting with cyanosis while crying, shown to
have a septal defect on echocardiography
diagnosed with intra-cardiac total anomalous
pulmonary venous drainage: (a) Diagrammatic
illustration showing a confluence of pulmonary
veins draining into the enlarged coronary sinus;
(b) Echocardiography shows dilated coronary
sinus draining in to enlarged right atrium
(arrow); (c) Colour Doppler exam shows
enhanced flow in to right atrium via coronary
sinus; (d) Axial CT MIP image shows
confluence of pulmonary veins and dilated
coronary sinus, draining into right atrium (open
arrows).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
27. A two-month-old female presenting with
cyanosis while crying, shown to have a septal
defect on echocardiography diagnosed with
intra-cardiac total anomalous pulmonary venous
drainage: (a) axial CT images the level of
pulmonary artery revealed grossly dilated MPA
(open arrow); (b) axial CT image demonstrates
grossly enlarged right atrium with a large
secundum septal defect (open arrow). There is
enlargement of the both ventricular cavities; (c)
Coronal CT MIP image shows confluence of
pulmonary veins (arrows); and (d) increased
pulmonary arterial vascularity.
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
28. Infra-cardiac TAPVC. 3-day-old female neonate
presenting with respiratory distress, diagnosed
with infra-diaphragmatic TAPVC to portal vein
on MDCT. (a) Diagrammatic representation of
vascular anatomy in infra-cardiac TAPVC.
Anomalous common pulmonary vein (CPV) is
shown draining to portal vein (colored red); (b)
Plain radiograph shows obscured cardiac
shadow with evidence of pulmonary oedema;
(c)Coronal MIP CT reconstruction show
anomalous CPV traversing the diaphragm and
joining portal vein (arrow). Minimal narrowing
noted at diaphragmatic level (triangle); (d,e)
Axial CT images shows confluence of
pulmonary veins (star) and site of union with
portal vein (open arrow).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
29. A three-day-old female neonate
presenting with respiratory distress,
diagnosed with infra-diaphragmatic
TAPVC to portal vein on MDCT: (a) 3 D
rendered CT image viewed from
posterior aspect shows the course of
common pulmonary vein (arrows); (b)
Sagittal MIP CT reconstruction show
anomalous common pulmonary vein
traversing the diaphragm with minimal
narrowing at diaphragmatic level
(triangle).Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
31. The chest X-ray shows an enlarged heart, long ventricular and long middle left arch, and
increased pulmonary vascular bed. The middle arch suggests the aorta emerging from the
right ventricle to the left. Four-chamber apical echocardiography highlights in A the double
inlet tract of single left ventricle with two atrioventricular valves, and in B, in the same
projection, moderate insufficiency of the right atrioventricular valve (mosaic of regurgitation).
Edmar et al,Arq Bras Cardiol. 2014 Jan; 102(1)
32. 5-Double Outlet Right Ventricle (DORV)
• DORV is a cono-truncal defect characterized by origin of both great arteries
predominantly from RV.
• A ventricular septal defect is invariably present; its location in relation to the
semilunar valves may be subaortic (50%), subpulmonary (30%), uncommitted,
or remote . A large majority (66%) of patients with DORV have some degree of
pulmonary stenosis or atresia. DORV has a complex spectrum of physiology
based on the location of VSD and flow of blood from ventricle to great arteries.
Surgical planning depends upon complexity of physiology, associated anomalies
and whether or not there is pulmonary arterial hypertension. CT imaging with
3D reconstruction of the septum and ventricular outflow provides accurate
characterization of types of VSD with good correlation with surgical
observation and autopsy.
34. DORV
(DORV) with aberrant right subclavian artery.
One-year-old male referred to exclude CHD,
diagnosed with a DORV in association with ARSA; (a)
Diagrammatic representation of vascular anatomy in
DORV, both great arteries arising from RV; (b) Plain
radiograph reveal cardiomegaly with oligemic lungs;
(c) Sagittal oblique MIP views shows dilated aortic
arch with normal branching. There is a small
PDA(triangle); (d)Axial MIP images shows
infundibular and valvular stenosis(arrows); (e)
Outflow view shows both aorta and PA arising from
RV, LV communicating with a large VSD(star); (f) CT
Coronal MIP view shows ARSA (open arrow) and
narrowing of origin of LPA (arrow).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
35. DORV, anomalous conus branch.
One-year-old male presented with the cyanosis on
feeding and feeding difficulty, suspected as TOF on
echocardiography , diagnosed with DORV: (a)
Diagrammatic representation patient of vascular
anatomy in DORV; (b) Plain radiograph shows right
ventricular cardiac configuration, oligemic lungs and
right aortic arch (arrow); (c) Outflow view shows
both aorta and PA arising from RV, LV
communicating with a large VSD(arrow); (d) Axial
CTA reveals normal size pulmonary arteries and right
aortic arch (arrow) (e) Axial CT at aortic root show
conus branch crossing RTOT(open arrow); (f)
Coronal CT reconstruction shows tight infundibular
stenosis (open arrow).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
37. 1-TOF• - Most common of cyanotic HD, 6-10%
• Predominant pathology of TOF is the
outflow narrowing of the right ventricle
and varying degree of the narrowing of
pulmonary artery and branches. Other
components include ventricular septal
defect and overriding of aorta.
• CLINICAL:
cyanosis by 3-4 months
• squanting when fatiqued
• episodes of loss of conscious
• Associated with;
• Pulmonary infundibular or valvular stenosis.
• Right aortic arch anomalies, vascular rings or
slings 25%
38. • Hemodynamics:
RV outflow obstructionRV hypertrophy
• Radiographic features:
• Boot-shaped heart (RV enlargement)
• Right AA
• Small PA
• Treatment:
– Total corrective repair
– Blalock-Taussig shunt or
modified one
TOF
39. Plain radiography typically shows
-upturned cardiac apex due to right
ventricular hypertrophy.
-Lungs oligemia
-Prominent right aortic arch is
noted in up to 25% of patients.
TOF
40. Variants of TOF
Pentalogy of Fallot; tetralogy +ASD
Pink tetralogy; VSD with mild pulmonary
stenosis
Trilogy of Fallot; PA stenosis, RVH, patent
foramen ovale
Courtesy CristopherMeyer, MD
41. Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
A three-month-old female presented with
cyanosis on feeding, ;
(a) Diagrammatic representation of cardiac
anatomy in TOF;
(b) Plain radiograph shows moderate cardiac
enlargement with upturned apex (RV
configuration) (triangle) and decreased
pulmonary arterial markings;
(c) Echocardiography long axis view
demonstrates a large malaligned
perimembraneous VSD (arrow);
(d) Colour Doppler examination of RV outflow
demonstrates narrowing of pulmonary artery
with turbulent flow.
42. A three-month-old female presented with
cyanosis on feeding, diagnosed as Tetralogy on
echocardiography
(e) axial CT images shows a large subaortic
ventricular septal defect (arrow) and RVH;
(f) Sagittal CT demonstrates large
aorta(triangle) with normal branching pattern;
(g) axial CT image at a slightly higher level
shows severe narrowing of pulmonary
infundibulum and proximal pulmonary artery
(arrow). Right and left pulmonary arteries are
relatively small. Also, there are enlarged
collateral arteries in chest wall (open arrow)
h) 3D reconstruction of aorta shows enlarged
major aorto-pulmonary collateral arteries
(MAPCA) (arrows).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
43. A 21-year-old female presented with
palpitations, right ventricular outflow
obstruction on echocardiography diagnosed
with PS; (a) Diagrammatic representation of
cardiac anatomy in TOF (b) CXR shows
normal cardiac size and configuration.
Pulmonary arterial markings are decreased; (c)
RVOT reconstructed CT; and (d) axial CT
image at a slightly higher level shows severe
narrowing of pulmonary infundibulum,
pulmonary valve and proximal PA (arrows).
RPA and LPA are relatively small; (e)
Reconstructed CT view shows a large sub-
aortic VSD (arrow) and large overriding aorta.
There is biventricular enlargement and
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
44. Pulmonary Atresia.
An eight-month-old male with cyanosis at birth, feeding
difficulty; failure to demonstrate pulmonary artery on
echocardiography diagnosed with pulmonary atresia: (a)
Diagrammatic representation of cardio-vascular anatomy
in pulmonary atresia; (b) Plain radiograph shows mild
cardiac enlargement with upturned apex (RV
configuration) and decreased pulmonary arterial
markings. Collateral vessel around right hilar region are
prominent (open arrow); (c) axial CT images shows a
large sub-aortic ventricular septal defect (arrow) and
RVH; (d) Reconstructed outflow CT view shows
overriding of aorta and large sub-aortic VSD (arrow).
45. An eight-month-old male with
cyanosis at birth, Diagnosed with
pulmonary atresia: (e) Axial CT
slightly at a lower level shows blind
ending pulmonary infundibulum
(angled arrow). Main pulmonary artery
is absent. Right and left pulmonary
arteries reconstituted by collaterals
(triangles); (f) 3D reconstruction of
aorta shows enlarged collateral arteries
(arrow) (MAPCA).
46. • Pulmonary atresia with bronchial
compression by collateral artery.
• A three-year-old female presenting with
exertional dyspnoea, diagnosed with a
pulmonary atresia on echocardiography:
(a) Diagrammatic representation of
vascular anatomy in Pulmonary atresia;
(b) Plain radiograph shows mild cardiac
enlargement with upturned apex(arrow)
(RV configuration) and decreased
pulmonary arterial markings.
47. TOF absent Pulmonary valve: A One-day-old female
child presenting with respiratory distress, cyanosis,
diagnosed with TOF with absent pulmonary valve on
echo and CT: (a) Diagrammatic representation of vascular
anatomy in TOF with absent pulmonary valve: (b) Plain
radiograph shows hyperinflated left lung (arrow) due to
partial left bronchial compression; (c) Coronal 3-D
airway reconstruction demonstrates left bronchial
compression(triangle); (d) Axial MIP CT image shows
gross dilatation of pulmonary arteries with relative
narrowing at valve level (arrow); (e) CT coronal MIP
view shows severe dilatation of RPA and LPA (triangles);
(f) Axial CT images reveals subaortic VSD (circle).
48. Pseudotruncus:
Pseudotruncus refers to severe form of TOF in which pulmonary
artery and their proximal branches are completely atretic,
disconnecting right ventricles from pulmonary artery . Large
collateral arteries from the aorta provide blood-flow to pulmonary
circulation by reconstituting the more distal pulmonary branches.
49. • Pseudotruncus. A 10-year-male patient
presenting with exertional dyspnoea, investigated
for cardiac disease diagnosed with severe
pulmonary atresia: (a) Diagrammatic
representation of vascular anatomy in severe
pulmonary atresia (pseudo-truncus); (b) axial CT
images shows a large ascending aorta (arrow)
and absent pulmonary artery. Large collateral
artery is seen arising from descending aorta
(open arrow); (c) Reconstructed coronal CT view
shows collateral arteries reconstituting
pulmonary arteries.(triangles); (d) 3D
reconstruction of aorta shows enlarged collateral
arteries (open arrow) (MAPCA).
Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
50. 2-Ebstein’s Anomaly
Distal displacement of TV, atrialization of RV, enlarged R atrium
Incidence < 1% of all CHDs
Associated with maternal lithium intake especially in first 8 weeks of
gestation.
80% with ASD with right to left shunt.
Imaging features; oligemic lungs.
Box shape heart due dilated rt.atrium
Normal size left atrium
Small aorta, bulge of MPA.
51. On plain radiography Ebstein’s anomaly has the classic appearance of
‘box shaped heart’. Large heart size is common in Ebstein’s anomaly
due to massively enlarged right atrium, which can also cause a anterior
bulge in lateral chest radiograph. Adequate evaluation can be
performed by echocardiography and MR imaging. Typically there is
caudal displacement, dysplasia of septal and posterior leaflets of
tricuspid valve, dilatation of the right atrium and atrialized portion of
the RV, which may pulsate paradoxically in ventricular systole.
Associated cardiac anomalies and conduction defects can be observed.
Ebstein’s Anomaly
52. MR imaging is superior in demonstrating morphological features,
chamber contractility and measuring regurgitant tricuspid flow, which
has prognostic value.
Management of Ebstein’s anomaly depends upon the age of patient,
severity of the malformation, degree of right ventricular outflow tract
obstruction and dynamic status of pulmonary vascular resistance. The
surgical approach depending on the exact context involve ligation of a
patent ductus arteriosus, placement of a systemic to pulmonary shunt,
tricuspid valve repair or reducing flow across tricuspid valve .
53. Ebstein anomaly, first
described by German
physician Wilhelm Ebstein
in 1866, accounts for 0.5%–
0.7% of cases of congenital
heart disease
55. Ebsteins Anomaly. A 17-year-old male
presenting with cyanosis and diagnosed
with Ebsteins anomaly on Echo and MR:
(a) Diagrammatic representation of cardiac
anatomy in Ebsteins anomaly; (b) Plain
radiograph shows enlarged cardiac shadow,
RA enlargement (arrow) and pulmonary
oligmia; (c) Echocardiography
demonstrating enlarged RA with apical
displacement of septal tricuspid leaflet
(arrow); (d) Axial bright blood MRI
examination shows dilated RA displaced
dysplastic tricuspid valves (open arrow);
(e) Sagittal images shows large RA cavity
and RV outflow tract(circle); (f) Coronal
images illustrates displaced tricuspid valve
(arrow).Venkatraman Bhat et al, J Clin Diagn Res. 2016 Jul; 10(7):
56. Complete agenesis of tricuspid valve
Associations:
ASD (100%), D-TGA (35%), VSD
Hemodynamics:
RAASDLALV
RA, LA and LV are enlarged
RV and PA are small
If TGA is present increased PA
Treatment:
PG to maintain PDA
Fontan procedure (RA PA)
3-Tricuspid atresia
57. Tricuspid Atresia
• Tricuspid atresia is the third most common congenital cyanotic heart
disease, accounting for 2 % of all congenital cardiac disorders .
• This is caused by embryological fusion of the dorsal and ventral
endocardial cushions too far to the right lateral position. There is
resultant obstruction to outflow from the RA to the RV; hence, both
atrial septal defect (ASD) and ventricular septal defect (VSD) or a
patent ductus arteriosus (PDA) are necessary for survival. There are
three subtypes: I, normal great arterial arrangement (70 %; II, D-
transposition of the great arteries; III L-TGA.
58. X-rays from a female with tricuspid atresia, normally related great arteries, a nonrestrictive ventricular septal
defect, and a large ostium secundum atrial septal defect. A, At age 11 years, pulmonary vascular resistance was
below systemic, pulmonary vascularity was increased, the left ventricle (LV) was enlarged, and the pulmonary
trunk (PT) and right atrium (RA) were dilated. B, At age 19 years, the pulmonary vascular resistance was supra
systemic, pulmonary vascularity was normal, and the pulmonary trunk and right atrium remained dilated, but the
left ventricle was no longer enlarged. Overlying breast tissue accounts for prominent lower lung field radio
densities.
59. X-rays from an 18-year-old man with tricuspid atresia, complete transposition of the great arteries, a nonrestrictive
ventricular septal defect, and supra systemic pulmonary vascular resistance. A, Pulmonary vascularity is
diminished, and the dilated hypertensive posterior pulmonary trunk is border-forming (PT). The right cardiac
silhouette is hump-shaped because a prominent superior border is caused by an enlarged right atrium (RA) and a
receding inferior border, which is caused by a hypoplastic right ventricle. B, Left anterior oblique projection
highlights the hump-shaped right superior border
60. Tricuspid atresia. (a) Four-chamber steady-state
free precession (SSFP) image shows absent
tricuspid valve, which has been replaced by a
fatty wedge of tissue in the right AV groove
(arrow), a hypoplastic RV and dilated right
atrium (RA). (b) Tricuspid atresia in a patient
with dextro-transposition of the great arteries.
The RV is hypoplastic. Note that this has been
treated with a Fontan shunt (arrow)
Soham et al, Insights Imaging 2016 Oct; 7(5): 649–667
61. 4-PULMONARY ARTERY ATRESIA
• Pulmonary artery atresia (or sometimes known as pulmonary
atresia) there is complete disruption between the right ventricular
outflow tract (RVOT) and the pulmonary trunk.
Incidence is 1 in 10,000 births.
• Dr Vincent Tatco and Dr Yuranga Weerakkody, et al.
62. Pulmonary atresia can be classified into three types .
1- pulmonary atresia with intact interventricular septum (PA-IVS)
2- pulmonary atresia with VSD (PA-VSD)
3- complex pulmonary atresia (pulmonary atresia with complex cardiac
malformation)
Variants
• unilateral pulmonary artery atresia (UPAA)
• isolated unilateral pulmonary artery atresia
63. Radiographic features
Plain radiograph
PA-VSD
normal or mildly enlarged heart with poor or diminished pulmonary arterial
vascular markings.
asymmetrical vascular suggest stenosis within pulmonary arterial tree
there can be plethora due to horizontal arteries forming aortopulmonary
collaterals .
mottled appearance as the lung periphery may suggest pleuro-pulmonary
collateral formation .
PA-IVS
severe cardiomegaly from massive right atrial dilatation
Echocardiography
Echocardiography can characterize intracardiac anatomy. Has a limited role in
assessing pulmonary artery anatomy.
64. • MDCT
MDCT is better than echocardiography for pulmonary artery anatomy. It allows
evaluation of the following .
length of pulmonary atresia
presence of pulmonary artery confluence
• seagull appearance of the confluent pulmonary arteries and abbreviated pulmonary trunk
size of main, right, and left pulmonary arteries at the origin and at the hilum
presence of branch pulmonary artery stenosis
sources of pulmonary blood flow to each lung, including the number of
bronchopulmonary segments supplied by native pulmonary arteries and the
distribution of major aortopulmonary collateral arteries (MAPCAs)
Cardiac MRI
Allows direct visualization of the anomaly. Cine sequences may show a dilated
non contracting right ventricle 5. MR angiography allows detection of
aortopulmonary collaterals and patent ductus arteriosus if present.
65. Associations
tetralogy of Fallot: PA-VSD is considered by some authors
as a severe form of tetralogy of Fallot
truncus arteriosus (Collett and Edwards type IV) or
pseudotruncu : recognized to be a form of PA-VSD rather
than truncus arteriosus .
heterotaxy syndrome: pulmonary atresia is present in two-
fifths of right isomerism cases.
66. Pulmonary stenosis in heart
failure
•J Somerville and V Grech Images Paediatr Cardiol .12(1); Jan-Mar 2010
67. Pulmonary atresia with VSD
•J Somerville and V Grech Images Paediatr Cardiol .12(1); Jan-Mar 2010
69. Situs inversus
Arch on right
Apex on right
Stomach on right
Bibasilar reticulation
Situs inversus, bronchiectasis,
sinusitis==Kartagenars syndrome
70. Situs ambigus
Arch on right
Apex on left
Stomach on right
associations
1-Interruption of IVC
2-Azygous continuation
3-ASD
4-Abdominal heterotaxy
1
2
78. • Complete encirclement of the trachea & esophagus by the AA & its branches or
PA
• Symptoms are related to tracheal compression, less commonly esophageal
compression
• Types:
• Double AA
• Rt arch + Aberrant LSA
• Lt arch + Aberrant RSA
• Pulmonary sling: Aberrant left PA
passing between trachea & esophagus
Vascular Rings & Slings
88. • Incidence 0.1% of CHD
• Incomplete insertion of pulmonary veins into LAobstructionPVH
• Appears like a septum within normal sized LA
• classic cor triatriatum (cor triatriatum sinistrum / sinister): left atrium commoner
• cor triatriatum dextrum/dexter, right atrium.
Cor triatrium
89. • Hypoplastic LA, LV, Mitral valve, Aortic valve & Aorta
• Associated with ASD & PDA, infants die within 1st week as PDA closes
• CHF, severe pulmonary edema
Hypoplastic left heart ; Shones syndrome
94. Anomalous origin of the non-dominant LCX from the proximal most
segment of the RCA. Its proximal segment runs a retro-aortic course.
Mustafa et al,The Egyptian Journal of Hospital Medicine (July 2018) Vol.
72 (4), Page 4270-4277
95. Congenital and atherosclerotic coronary artery disease;
Anomalous origin of the dominant LCx from the right coronary sinus by a common ostium
with the RCA. Its proximal segment runs a retro-aortic course.
Mustafa et al,The Egyptian Journal of Hospital Medicine (July 2018) Vol.
72 (4), Page 4270-4277
96. Anomalous origin of the LMT from the right coronary sinus by a separate ostium
from the RC sinus, running an inter-arterial course and showing an average
caliber.
Mustafa et al,The Egyptian Journal of Hospital Medicine (July 2018) Vol.
72 (4), Page 4270-4277
97. Congenital and atherosclerotic coronary artery disease;
Anomalous origin of the RCA from the left coronary sinus by a separate ostium from the LMT. Its proximal
segment runs a short inter-arterial course without significant caliber attenuation.
Possible myocardial bridges at the mid and distal LAD segments.
Mustafa et al,The Egyptian Journal of Hospital
Medicine (July 2018) Vol. 72 (4), Page 4270-4277
98. Congenital coronary fistula; LCX to the right atrium.
Mustafa et al,The Egyptian Journal of
Hospital Medicine (July 2018) Vol. 72
(4), Page 4270-4277
The aorta (1) arises from the right ventricle (2), and the pulmonary artery (3) arises from the left ventricle (4). Communication between the systemic and the pulmonary circulation—an interatrial septal defect (5), an interventricular septal defect (6), or both—sustains
life by allowing oxygenated blood from the left atrium (7) to mix with deoxygenated blood from the right atrium (8) before it flows via the right ventricle to the aorta and via the left ventricle to the pulmonary artery.