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” سبحانك لا علم لنا إلا ما علمتنا إنك أنت العليم الحكيم“

” سبحانك لا علم لنا إلا ما علمتنا إنك أنت العليم الحكيم“. Echo – Club. TEE Case Presentation. By Dr Osama Abd El Raouf Cardiologist-PSCCH. Atrial Septal Defect. ASD is the most common congenital heart disease encountered in adult. ASD occurs in one child per 1,500 live births.

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” سبحانك لا علم لنا إلا ما علمتنا إنك أنت العليم الحكيم“

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  1. ”سبحانك لا علم لنا إلا ما علمتنا إنكأنت العليم الحكيم“

  2. Echo – Club TEE Case Presentation By Dr Osama Abd El Raouf Cardiologist-PSCCH

  3. Atrial Septal Defect • ASD is the most common congenital heart disease encountered in adult. • ASD occurs in one child per 1,500 live births. • ASD is more common in female with ratio of 4:1 .

  4. Types of ASDs • There are 4 types of ASD • Ostium Secundum. • Ostium Primum. • Sinus Venosus. • Coronary sinus defects.

  5. Secundum defects Secundum defects are the most common, accounting for 6-10% of all congenital lesions.

  6. Atrial Septal Defect (Primum) • Ostium primum is the next most common type and is located in the lower portion of the atrial septum. • This type of ASD often will have a mitral valve defect associated with it called a mitral valve cleft .

  7. Sinus Venosus ASD Partial anomalous pulmonary venous connection (right pulmonary veins to junction of superior vena cava and right atrium.

  8. Sinus Venosus ASD Sinus venosus ASD associated with PAPVR.

  9. Sinus Venosus ASD Routine chest X-ray of this 14 year old girl suggests prominent right heart borders on the two views. There is also prominence of the pulmonary artery segment due to pulmonary overcirculation from partial anomalous right pulmonary veins draining into the SVC and an associated atrial sinus venosus defect.

  10. CHEST X RAY IN ASD The chest x-ray demonstrates prominent pulmonary vessels and a proximal pulmonary artery segment.

  11. CHEST X RAY IN ASD Chest x-ray of untreated ASD demonstrates prominent pulmonary vessels and a proximal pulmonary artery segment.

  12. Role Of Echocardiography

  13. ME 4 Chamber View • A snapshot of the heart is obtained that includes all 4 chambers (LA, RA, LV, RV), 2 valves (MV, TV), • The septums (IAS, IVS) and the inferoseptal and anterolateral LV walls. • Segments of the anterior (A2) and posterior (P2) mitral valve leaflets are typically imaged in this view.

  14. ME 4 Chamber View Identify the Following Structures:- • Left Atrium (LA) • Right Atrium (RA) • Left Ventricle (LV): inferoseptal (IS) + anterolateral (AL) walls • Right Ventricle (RV) • Mitral Valve: anterior(AMVL) + posterior (PMVL) leaflets • Tricuspid Valve: septal (STVL) + anterior (ATVL) leaflets

  15. Transesophageal Echo and ASD Diagnosis TEE Diagram showing the entrance of SVC into the right atrium,, notice atrial septum separating both atria.

  16. TEE Bicaval View TEE diagram showing the entrance of SVC into the right atrium Notice intact atrial septum separating both atria.

  17. TEE Bicaval View TEE bicaval view showing the entrance of SVC into the right atrium. Notice intact atrial septum separating both atria.

  18. Transesophageal Echo and ASD Diagnosis

  19. Transesophageal Echo and ASD Diagnosis

  20. Transesophageal Echo and ASD Diagnosis • Prominent Eustachian valve. • Crista terminals. • Pectinate muscle. Always look else where

  21. Structures belong to right atrium Crista Terminalis Crista Terminalis

  22. Structures belong to right atrium Crista Terminalis Crista Terminalis

  23. Structures That Belong There

  24. Transesophageal Echo ,Bicaval View Do you notice something else?

  25. Amplatzer ASD closure device. Percutaneous Closure of an ASD The State of Art

  26. Amplatzer ASD closure device.

  27. Indications for percutaneous closure of an ASD The basic requirements for percutaneous closure of an ASD include: • Secundum defect. • Adequate inferior and superior rim around the defect. Therefore, device closure will not impinge upon the superior vena cava , inferior vena cava or AV valves. • No significant right to left shunting—closure would reduce cardiac output. • No other findings that require open heart surgery. This would lead to surgical closure of the ASD.

  28. Case Study Experience of PSCCH 20 years old Saudi female was diagnosed to have ostium secundum. ASD and was referred from our OPD for closure of the defect.

  29. Case Study Experience of PSCCH Large ostium secundom ASD

  30. Ostium Secundum ASD ME 4 chamber view showing big ostium secundom ASD with large left to right shunt.

  31. Inflation of the Balloon

  32. Inflation of the Balloon

  33. Deployment of a ASD Device

  34. Deployment of a ASD Device

  35. Deployment of a ASD Device

  36. Device is in position

  37. Device is in position

  38. Device is in position

  39. Device is in position

  40. Device is in position

  41. TEE View Device is in position Cath View

  42. Device is in position Successful closure of the defect with no significant residual shunt.

  43. Device is in position No interference with aortic and mitral valve function.

  44. Percutaneous Closure of an ASD The State of Art Comparison of the result before and after the procedure.

  45. Team Work What would the interventional wants to know Case- 2

  46. 1- Clear Diagnosis - Clear Indication.

  47. 2- Are All Pulmonary Veins Normal ?

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