Congenital heart defects anatomic consideration
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Congenital heart defects Anatomic consideration. Dr. Yasser Salem. Defects from abnormal cardiac development. Defects of cardiac positioning Defects of atrial septation Defects of ventricular septation Defects of A.V. canal and A.V. valves

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Congenital heart defects anatomic consideration

Congenital heart defectsAnatomic consideration

Dr. Yasser Salem


Defects from abnormal cardiac development
Defects from abnormal cardiac development

  • Defects of cardiac positioning

  • Defects of atrial septation

  • Defects of ventricular septation

  • Defects of A.V. canal and A.V. valves

  • Defects of cono-truncal development and semi-lunar valves

  • Defects in aortic arch

  • Defects in venous system (systemic or pulmonary)


Variants of situs sidedness
Variants of Situs (sidedness)

  • Solitus

  • Inversus

  • Ambiguous

    • Left isomerism

    • Right isomerism


Situs solitus
Situs solitus

Left

Right


Situs inversus
Situs inversus

Right

Left


Situs ambiguous left isomerism
Situs ambiguousLeft isomerism

Left

Left


Situs ambiguous right isomerism
Situs ambiguousRight isomerism

Right

Right



Situs1
Situs ????

RA

LA



Defects of cardiac positioning
Defects of cardiac positioning

  • Levocardia (normal orientation)


Defects of cardiac positioning1
Defects of cardiac positioning

  • Mesocardia

    • Centrally located heart or

    • Inferior base apex axis



Defects of cardiac positioning3
Defects of cardiac positioning

  • Dextrocardia

    • Isolated dextrocardia (with situs solitus) accompanied by severe cardiac anomalies e.g. A.V. or V.A. discordance single ventricle or heterotaxy syndrome

    • Dextrocardia with situs inversus less likely to be accompanied with other anomalies


Defects of cardiac positioning4
Defects of cardiac positioning

  • Levocardia (normal orientation)




Atrio ventriculo arterial sequence2
Atrio-ventriculo-arterial sequence

  • Concordance

    Normal sequence AV & VA

  • Discordance

    Reversed sequence AV & VA

Corrected TGA = AV discordance + VA discordance


Atrio ventriculo arterial sequence3
Atrio-ventriculo-arterial sequence

Corrected TGA = AV discordance + VA discordance




Defects from abnormal cardiac development1
Defects from abnormal cardiac development

  • Defects of cardiac positioning

  • Defects of atrial septation

  • Defects of ventricular septation

  • Defects of A.V. canal and A.V. valves

  • Defects of cono-truncal development and semi-lunar valves

  • Defects in aortic arch

  • Defects in venous system (systemic or pulmonary)







Defects of atrial septation4
Defects of atrial septation

  • P.F.O.

  • Ostium secundum defect

  • Ostium primum defect

  • Sinus venosus A.S.D.

  • Single atrium

  • Septal aneurysm


Defects in ventricular septation
Defects in ventricular septation

  • Outlet conal defect, conal septal hypoplasia, sub-pulmonary defect, infundibular defect, supracristal defect, doubly committed juxta-arterial defect

  • Membranous peri-membranous defect, para-membranous defect, conoventricular defect

  • Inlet peri-inlet defect, AV canal type defect, AV septal defect, endocardial cushion defect.

  • Muscular

1

2



Defects of a v canal a v valves
Defects of A.V. canal & A.V. valves

  • A.V. canal defect

  • Tricuspid and mitral valve defects

  • Ebstien anomaly


Defects of a v canal a v valves1
Defects of A.V. canal & A.V. valves

  • A.V. canal defect

    • Atrial communication

    • Ventricular communication

    • Abnormal A.V. valve development


Defects of a v canal a v valves2
Defects of A.V. canal & A.V. valves

  • A.V. canal defect

    • Complete

      • Rastelli A

      • Rastelli B

      • Rastelli C


Defects of a v canal a v valves3
Defects of A.V. canal & A.V. valves

  • A.V. canal defect

    • Complete

    • Transitional

    • Partial


Defects of a v canal a v valves4
Defects of A.V. canal & A.V. valves

  • A.V. canal defect

    • Complete

      • Balanced ventricles

      • Unbalanced ventricles


Defects from abnormal cardiac development2
Defects from abnormal cardiac development

  • Defects of cardiac positioning

  • Defects of atrial septation

  • Defects of ventricular septation

  • Defects of A.V. canal and A.V. valves

  • Defects of cono-truncal development and semi-lunar valves

  • Defects in aortic arch

  • Defects in venous system (systemic or pulmonary)



Defects of conotruncal development semilunar valves1
Defects of conotruncal development & semilunar valves

  • Tetralogy of fallot

  • DORV

  • Transposition of great arteries T.G.A.

  • Truncus arteriosus

  • Pulmonary stenosis and atresia

  • Aortic stenosis and subaortic membrane





Tetralogy of fallot3
Tetralogy of fallot

McGoon ratio

  • Definition

    • Diameter of left plus right pulmonary arteries at the pre-branching point divided by diameter of descending aorta at the level of diaphragm

  • Normal 2.1

  • More than 1.2 adequate for V.S.D. closure

  • Less than 0.8 inadequate


Tetralogy of fallot4
Tetralogy of fallot

  • Nakata index

  • TNPAI total neo-pulmonary artery index


DORV

DORV

TGA

F4


DORV

DORV

TGA

F4


DORV

  • Types in relation to great arteries

    • Sub-aortic

    • Sub-pulmonic

    • Doubly committed

    • Non committed




T ransposition of g reat a rteries d type
Transposition of Great ArteriesD-type

  • PFO

  • VA discordance

  • Connecting vessel (PDA)


Transposition of great arteries l type
Transposition of Great ArteriesL-type

  • AV discordance

  • VA discordance


Transposition of great arteries l type1
Transposition of Great ArteriesL-type

Corrected TGA = AV discordance + VA discordance



Defects in aortic arch1
Defects in aortic arch

  • Right side aortic arch


Defects in aortic arch2
Defects in aortic arch

  • Coarctation of Aorta


Defects of pulmonary venous drainage
Defects of pulmonary venous drainage

  • Total anomalous pulmonary venous drainage

  • Partial Anomalous pulmonary venous drainage


Defects of systemic venous drainage
Defects of systemic venous drainage

  • Persistent left SVC

  • Interrupted IVC


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