saq discussion

8/17/2019 Saq Discussion

1/19

Saq discussion


2/19

Qs

• Outline anatomical defects andimaging ndings in – ASD

– PDA

– Coarctation of aorta

– Mitral regurgitation


3/19

ASD

• Commonest cong heart dx inadults (80!0"#

• a%normal o&ening in the atrialse&tum allo'ing communication%et'een the ) and *) atria

• *t to t shunt – +f longstanding, -isenmenger

&h.siolog. * shunt

• /x more in

• ).&es – Ostium secundum1 80", interatrial

connection at fossa o2alis

ostium &rimum (assoc 'ith A3SD#

Sinus 2enosus defect ( assoc PAP3D#

4nrooofed coronar. sinus


4/19

• +maging

• C5 – -nlarged rt atrium

• ( ris6 throm%oem%oli,

tach.ar.thmias#

– -nlarged rt 2entricle• *aterallling

retrosternal airs&ace

–

shunt 2ascularit.• Mar6ed central &ulm A

dilatation, ma. %ecomeaneur.smal and calcif.


5/19


6/19

3SD

• defects inthe inter2entricular se&tumthat allo' a haemod.namiccommunication %et'eenthe ) and *) 2entricles

• Commonest cong heart dxin childhood, onl. 70" inadults

• ).&es – Mem%ranous&erimem%ranous1

80" – Muscular

• +nlet

• Outletsu%arterial

• midmuscular


7/19

• indings – Shunt 2ascularit.

– -nlargement of 3, *A and *3

– left 2entricular a&ex &ro9ectsto the left, inferiorl. and&osteriorl.:

– *A enlargement ;dou%ledensit. sign %ehind the rightatrium, and straightening orfocal con2exit. of the leftmediastinal %order is seen%elo' the &ulmonar. arter.

shado': –


8/19

• cardiovascularassociationstetralog. of allot

•

truncus arteriosus• dou%le outlet right

2entricle

• aortic coarctation

• tricus&id atresia

• aortic regurgitation

• &ulmonar. stenosis

http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/coarctation-of-the-aortahttp://radiopaedia.org/articles/tricuspid-atresiahttp://radiopaedia.org/articles/missing?article%5Btitle%5D=aortic-regurgitationhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=aortic-regurgitationhttp://radiopaedia.org/articles/tricuspid-atresiahttp://radiopaedia.org/articles/tricuspid-atresiahttp://radiopaedia.org/articles/coarctation-of-the-aortahttp://radiopaedia.org/articles/coarctation-of-the-aortahttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/double-outlet-right-ventriclehttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1


9/19

PDA

• &ersistent &atenc. of

the ductus arteriosus anormal connection ofthe fetal circulation

%et'een the aorta and the

&ulmonar. arterial s.stemthat de2elo&s from the>th aortic arch:

• Associations – Premature neonates

– tetralog. of allot – -isenmenger s.ndrome

– h.&o&lastic left heart

– &ulmonar. atresia

– Do'ns s.ndro

http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/eisenmenger-syndromehttp://radiopaedia.org/articles/hypoplastic-left-heart-syndromehttp://radiopaedia.org/articles/hypoplastic-left-heart-syndromehttp://radiopaedia.org/articles/hypoplastic-left-heart-syndromehttp://radiopaedia.org/articles/eisenmenger-syndromehttp://radiopaedia.org/articles/eisenmenger-syndromehttp://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1http://radiopaedia.org/articles/tetralogy-of-fallot-tof-1


10/19

• indings – Same as 3SD

exce&t ma. ha2e

enlarged ascendingand arch of aorta

– Ductus ma. clacif.in adults


11/19

• Krichenko classifcation

based on CT angiography• t.&e A? 8@" conical

ductus,&rominent aorticam&ulla 'ith narro'ing at&ulmonar. arter. end

• t.&e ? 'indo', short and 'ide

ductus 'ith %lending of&ulmonar. arter.

• t.&e C? long tu%ular ductus'ith no constrictions

• t.&e D? multi&le constrictions

'ith com&lex ductus• t.&e -? elongated ductus 'ith

remote constriction


12/19


13/19

Coarctation• Coarctation of the aorta is

a luminal narro'ing of a

short section of the aortacommonl. at site ofinsertion of the ductusarteriosus

• thought to de2elo& due to

&resence of excessi2el.integrated ductal tissuearound the aortic isthmus,'hich contracts along 'iththe ductus arteriosus at

the time of %irth:

• +f se2ere, s.stemic&erfusion is com&romised'ith ductal closure

• +f less se2ere,the %od.maintains &erfusion %.renal mechanisms,resulting in s.stemich.&ertension &roximal tothe coarctation: Collateralarterial 2essels de2elo&o2ertime to maintain lo'er%od. &erfusion as the

&atientgro's


14/19

• the collateral

&ath'a.s (internalmammar. and

• &osteriormediastinalarteries


15/19

• associations – %icus&id aortic

2al2e? B@80"

–

2entricular se&tal defect (3SD#

– truncus arteriosus

– trans&osition of the

great arteries ()A#,#

– mitral 2al2e defects

– )urners s.ndrome7@0"

http://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/transposition-of-the-great-arterieshttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/truncus-arteriosushttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/ventricular-septal-defect-vsdhttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valvehttp://radiopaedia.org/articles/bicuspid-aortic-valve


16/19

• CM or C) ma. %erequired &osto&erati2el. toesta%lish if there is recoarctation aneur.smaldilatation, or *3h.&ertro&h. secondar. toh.&ertension


17/19

Mitral regurgitation• due to functional or

anatomical d.sfunctionof the mitral 2al2e

• acute causes – m.ocardial infarction

'ith &a&illar. muscle

ru&ture

– chordal ru&ture (seen inm.xomatousdegeneration

– infecti2e endocarditis

– &rosthetic mitral 2al2ed.sfunction

• Chronic causes – annular calcication

– m.xomatousdegeneration

– &re2ious

infecti2einEammator. illness

– rheumatic heartdisease

– infecti2eendocarditis


18/19

indings

• Marked Lt atriumenlargement – Con2exit.straightenin

g lt heart order

– Doule densit. sign

– S&la.ing carina

– Mild Lt ventricleenlargement

–Moderate enlargedRV and pulm trunk

– Upper zone venousenlargement


19/19

saq discussion

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