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Congenital heart defects Anatomic consideration

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

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  1. Congenital heart defectsAnatomic consideration Dr. Yasser Salem

  2. 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)

  3. Variants of Situs (sidedness) • Solitus • Inversus • Ambiguous • Left isomerism • Right isomerism

  4. Situs solitus Left Right

  5. Situs inversus Right Left

  6. Situs ambiguousLeft isomerism Left Left

  7. Situs ambiguousRight isomerism Right Right

  8. Situs

  9. Situs ???? RA LA

  10. Cardiac position

  11. Defects of cardiac positioning • Levocardia (normal orientation)

  12. Defects of cardiac positioning • Mesocardia • Centrally located heart or • Inferior base apex axis

  13. Defects of cardiac positioning • Dextrocardia

  14. 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

  15. Defects of cardiac positioning • Levocardia (normal orientation)

  16. Atrio-ventriculo-arterial sequence

  17. Atrio-ventriculo-arterial sequence

  18. Atrio-ventriculo-arterial sequence • Concordance Normal sequence AV & VA • Discordance Reversed sequence AV & VA Corrected TGA = AV discordance + VA discordance

  19. Atrio-ventriculo-arterial sequence Corrected TGA = AV discordance + VA discordance

  20. Concordant flow with spatial discordance

  21. Discordant flow with spatial concordance

  22. 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)

  23. Defects of atrial septation

  24. Embryologic cardiac tube

  25. Defects of atrial septation

  26. Defects of atrial septation

  27. Defects of atrial septation

  28. Defects of atrial septation • P.F.O. • Ostium secundum defect • Ostium primum defect • Sinus venosus A.S.D. • Single atrium • Septal aneurysm

  29. 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

  30. Gerbode defect

  31. Defects of A.V. canal & A.V. valves • A.V. canal defect • Tricuspid and mitral valve defects • Ebstien anomaly

  32. Defects of A.V. canal & A.V. valves • A.V. canal defect • Atrial communication • Ventricular communication • Abnormal A.V. valve development

  33. Defects of A.V. canal & A.V. valves • A.V. canal defect • Complete • Rastelli A • Rastelli B • Rastelli C

  34. Defects of A.V. canal & A.V. valves • A.V. canal defect • Complete • Transitional • Partial

  35. Defects of A.V. canal & A.V. valves • A.V. canal defect • Complete • Balanced ventricles • Unbalanced ventricles

  36. 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)

  37. Defects of conotruncal development & semilunar valves

  38. 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

  39. Tetralogy of fallot

  40. Tetralogy of fallot

  41. Tetralogy of fallot

  42. 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

  43. Tetralogy of fallot • Nakata index • TNPAI total neo-pulmonary artery index

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