Non cyanotic Congenital heart diseases
C Bussadori (Milano,IT)
Department of Pediatric Cardiology and Adult with Congenital Heart Diseasep gy gIRCCS- Policlinico San Donato
San Donato Milanese – Milano Italy
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
ASD Ostium secundum The Most Common atrial septal defect
– Various size – Parasternal Short axisParasternal Short axis– Subcostal view
• Suboptimal in adults
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
ASD Ostium secundum The Most Common atrial septal defect
– Modified apical 4 ch– Various size – CFD
• Beware to high RA pressure
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
ASD Ostium secundum The Most Common atrial septal defect
It seem circular but often it isn’tIt seem circular but often it isn’t– Measure from different views and consider
the largest– 3D it helps– TEE 2D or 3D offer ultimate sizing for ASD
and rim diameters
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
ASD Ostium secundum The Most Common atrial septal defect
It seem circular but often it isn’t– TEE 2D or 3D offer ultimate
information on ASD and rims information on ASD and rims shape and dimension
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ASD Differential Diagnosis: OS 1Partial AV septal defectAV valve at the same level: MR, goose neck deformity of LVOTPost S gical Complication SAS Complete AV blockPost Surgical Complication: SAS, Complete AV block
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ASD Differential Diagnosis:Sinus Venous Defects• Difficult to diagnose by TTE• Modified parasternal• Subcostal• Subcostal• Often associate to
Anomalous pulmonary venous drainage
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Ventricular septal defect
• Perimembranous– Various estension
• MuscularI l O l i l – Inlet, Outlet, apical trabecular
– Doubly committed Subarterial
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Perimembranous VSD
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Perimembranous VSD Perimembranous VSD TTE TEETTE TEE
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Perimembranous VSD 2D TEE 3D TEE
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Perimembranous VSD Perimembranous VSD
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Perimembranous VSD Perimembranous VSD
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Perimembranous VSD
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Muscular VSD•Apical TrabecularApical Trabecular
•4 chamber
•Muscular Inlet•Muscular Inlet
•Short Axis
M lti l VSD•Multiple VSD
•3D
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Doubly committed SubarterialFibrous continuty
between aortic and between aortic and pulmonary valves
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PDA• Most of adult cases of
PDA are small and silent
• Parasternal short axis view
• CFM Demonstrate L to R Sh t f PDA t R Shunt from PDA to MPA
• CW Doppler reflects • CW Doppler reflects PA pressure
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010
Aortic coarctation • Between left subclavian and arterial
duct • Frequently associated toeque t y assoc ated to• PDA, VSD, Ao.Bic.• Modified Bernoulli formula
(ΔP 4( 2 2))• (ΔP=4(v22 – v12))• CW peack gradient. Mean Gradient
• PW abdominal aorta
V1
V2
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Aortic bicuspidiap
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Aortic bicuspidia
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Aortic regurgitation
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Sinus of Valsalva Perforation
Pulmonic StenosisVarious Morphology
*Milo S Heart 1988;60:128-133
80% are dome shapedp
Pulmonic stenosis
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Pulmonic stenosis
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PS “hour-glass”
Take home a messageg
• Non cyanotic CHD could be an unexpected y p
diagnosis in an adult cardiac patient
• Recognize the anatomical features and
th h i l i l h t t pathophysiological changes to suggest
appropriate treatment and Follow UPappropriate treatment and Follow UP
EUROECHO CONGRESS - COPENHAGEN -TEACHING COURSE 2010