The Van Praagh classification system uses a "S, D, S" notation to systematically analyze congenital heart defects based on 1) visceroatrial situs, 2) ventricular loop orientation, and 3) position of the great arteries. This facilitates communication between physicians by providing a standardized approach to describing abnormalities in cardiac chamber position, connections, and vessel arrangements.

2.  Van Praagh classification system 1960s
 Facilitates communication between
physicians involved in diagnosing and
managing congenital cardiovascular
abnormalities.
 Three-part notation “{S, D, S}”

3.  Sequential segmental analysis (Europe)
 Emphasizes the junctional variations across
the atrioventricular (AV) and
ventriculoarterial connections

4.  Normal anatomy
 “{S, D, S}”
 situs solitus D loop situs solitus
 visceroatrial ventricular position & relat
situs loop -ion of great
vessels

5.  Determination of the AV and
ventriculoarterial relations concordant or
discordant.
 Any associated malformations of the
chambers, septa, outflow tracts, and great
vessels.

6. 1. Visceroatrial situs
2. Ventricular loop orientation
3. Position and relation of great vessels

7. 1. VISCERAL SITUS : location of spleen & liver
2. Identify right atrium
Right atrial appendage Left
Broad and blunt Narrower than rt.
Trapezoid shape Tubular finger like
broad connection with
atrium
Narrow connection with
rest of atrium
Pectinate ms. extend
beyond the appendage
Do not

8.  If right and left atrial appendages are not
clearly identifiable, the radiologist can turn to
other, extrinsic anatomic structures.
 Supra diaphragmatic IVC or coronary sinus
 Bronchial and pulmonary lobar anatomy

9. 3.Thoracoabdominal situs
 Situs solitus
 Inversus
 Ambiguus

10. 4. Compare the position of the right atrium
with that of the visceral organs and assign a
letter.
a) Situs solitus --- S
b) Situs inversus --- I
c) Situs ambiguous ---A

16. 1. D – loop (dextro)
2. L – loop (levo)
3. X – loop (unknown)

17. 1. Identify the morphologic right and left
ventricles on the basis of their intrinsic
characteristics.
Texture and distribution of internal trabeculae.

18. RIGHTVENTRICLE LEFTVENTRICLE
Moderator band Smooth septum
Coarse trabeculae Thin fine trabeculae
Papillary muscles attached to
both the free wall and the
interventricular septum
Papillary muscles attached to
the free wall only
Tricuspid AV valve Bicuspid AV valve
Septal and parietal bands Smooth superior septal
surface

19.  If answer to this question isYES ---- D loop
 Right ventricle to left of morphological left
ventricle --- L loop
 Complex cases --- hand/ loop rule

20.  Identify right ventricle
 Palm against the interventricular septum, the
thumb in the right ventricular inflow tract (AV
valve), and the fingers in the outflow tract.
 Normal ventricular configuration the right
hand will always fit into the right ventricle,
whereas the left hand will always fit into the
left ventricle.

22.  Right-sided aortic valve --- D loop
 Left sided aortic valve --- L loop

25.  Aorta
 Main pulmonary artery
 Classified according to their position and
relation at the level of the aortic and
pulmonary valves.
 In difficult cases, branching vessels can be
used as reference points.

26. 1. Situs solitus
2. Situs inversus
3. D- transposition
4. L- transposition
5. D- malposition
6. L- malposition

30.  DTRANSPOSITION : aorta anterior and right
of MPA.
 LTRANSPOSITION : aorta anterior and left of
MPA.
 Neither anterior nor posterior – malposition
(originate from the same ventricle or are
overriding, for example, in double-outlet left
or right ventricle)

32.  ATRIOVENTRICULAR:
1. Concordant (normal)
2. Discordant
3. Ambiguous
4. Double inlet
5. Absent right or left connection.

33.  VENTRICULOARTERIAL CONNECTION:
1. Permanent truncus arteriosus
2. Concordant
3. Discordant (TGV)
4. Double outlet right ventricle
5. Double outlet left ventricle (the great
vessels arise from the left ventricle).

34.  Atrial and ventricular septal defects
 Ventricular outflow tract stenosis
 Aortic coarctation and hypoplasia of the
aortic arch
 Patent ductus arteriosus.

35.  A systematic segmental approach to imaging
evaluation, which emphasizes the proximal-
to-distal positions and relationships of
cardiac chambers and great vessels, greatly
facilitates the detection and characterization
of congenital heart disease for accurate
diagnosis and successful management.