Euroecho2010 non-cyanotic-disease

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



– Modified apical 4 ch– Various size – CFD

• Beware to high RA pressure



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



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


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


ASD Differential Diagnosis:Sinus Venous Defects• Difficult to diagnose by TTE• Modified parasternal• Subcostal• Subcostal• Often associate to

Anomalous pulmonary venous drainage


Ventricular septal defect

• Perimembranous– Various estension

• MuscularI l O l i l – Inlet, Outlet, apical trabecular

– Doubly committed Subarterial


Perimembranous VSD


Perimembranous VSD Perimembranous VSD TTE TEETTE TEE


Perimembranous VSD 2D TEE 3D TEE


Perimembranous VSD Perimembranous VSD


Perimembranous VSD Perimembranous VSD


Perimembranous VSD


Muscular VSD•Apical TrabecularApical Trabecular

•4 chamber

•Muscular Inlet•Muscular Inlet

•Short Axis

M lti l VSD•Multiple VSD

•3D


Doubly committed SubarterialFibrous continuty

between aortic and between aortic and pulmonary valves


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


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


Aortic bicuspidiap


Aortic bicuspidia


Aortic regurgitation


Sinus of Valsalva Perforation

Pulmonic StenosisVarious Morphology

*Milo S Heart 1988;60:128-133

80% are dome shapedp

Pulmonic stenosis


Pulmonic stenosis


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


Education

Euroecho2010 non-cyanotic-disease