Differential Diagnosisof CHD

Differential DiagnosisDifferential Diagnosisof CHDof CHD

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William Herring, M.D. © 2003

Nine Lesions Which Produce 75% of All Severe Congenital Heart Lesions In the Neonate

Decreased flow1. Tetralogy of Fallot2. Tricuspid Atresia3. Severe Pulmonic

Stenosis4. Ebstein’s

Increased Flow5. Transposition 6. VSD

Nine Lesions Which Produce 75% of All Severe Congenital Heart Lesions In the Neonate

Pulmonary venous hypertension7. Hypoplastic left heart8. Coarctation of the aorta9. TAPVR with infradiaphragmatic obstruction

What’s leftLeft-to-right shunts

ASDPDA

Truncus arteriosus

Cyanotic

Cyanosis With Decreased Vascularity

TetralogyTruncus-type IVTricuspid atresia*Transposition*Ebstein's

* Also appears on DDx of Cyanosis with ↑ Vascularity

Ebstein’s AnomalyEbstein’s Anomaly

CyanoticCyanotic

Cyanosis With Increased Vascularity

Truncus types I, II, IIITAPVRTricuspid atresia*Transposition*Single ventricle

* Also appears on DDx of Cyanosis with ↓ Vascularity

Totalanomalousvenousreturn(TAPVR)

Totalanomalousvenousreturn(TAPVR)

Acyanotic

Cardiomegaly with Normal Vasculature

Viral myocarditisEndocardial fibroelastosisAberrant left coronary arteryCystic medial necrosisDiabetic mother

Acyanotic

Endocardial Cushion DefectEndocardial Cushion Defect

CHF In NewbornImpede Return of Flow to Left Heart

Infantile coarctationCongenital aortic stenosisHypoplastic left heart syndromeCongenital mitral stenosisCor triatriatumObstruction to venous return from lungs

TAPVR from below diaphragm

CHF In Chronologic Sequence

CHF In Chronologic Sequence

CHF In NewbornImpede Return of Flow to Left Heart

Infantile coarctationCongenital aortic stenosisHypoplastic Left Heart SyndromeCongenital mitral stenosisCor triatriatumObstruction to venous return from lungs

TAPVR from below diaphragm

CHF In 2nd-3rd Week

Coarctation of the aortaInterruption of the aortic arch

CHF-later

Coarctation of the aorta –adult type

Unknowns

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Increasedflow

1° Pulmonary Hypertension1° Pulmonary Hypertension

MitralStenosisMitralStenosis

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PAH

Atrial Septal DefectAtrial Septal Defect

Pericardial EffusionPericardial Effusion

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Normal

Aortic StenosisAortic Stenosis

MitralStenosisWith SeverePAH

MitralStenosisWith SeverePAH

MS

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Cyanotic

Tetralogy of FallotTetralogy of Fallot

Tetralogy of FallotComponents of

Ventricular septal defectPulmonic stenosisOverriding aortaRight ventricular hypertrophy

ASDASD

Acyanotic

LA Ao

ASD

PDA

VSD

CHFCHF

Pulmonary Interstitial EdemaX-ray Findings

Thickening of the interlobular septaKerley B lines

Peribronchial cuffingWall is normally hairline thin

Thickening of the fissuresFluid in the subpleural space in continuity with interlobular septa

Pleural effusions

Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD)

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AtrialSeptal Defect(ostium primum type)with PAH

AtrialSeptal Defect(ostium primum type)with PAH

MS with PAH

PulmonicStenosisPulmonicStenosis

Most Commons

Most common cause of CHF in newbornHypoplastic left heart syndrome

Most common cause of CHF > 2 weeksCoarctation of the aorta (infantile form)

Most common cyanotic heart diseaseTetralogy of Fallot

Most common dz associated c R archTetralogy of Fallot

Most Commons

Most common L R shuntVentricular Septal Defect

Most common L R shunt dx’d in adultAtrial Septal Defect

Dz most commonly associated c R archTruncus arteriosus

The End