The description about common congenital Heart diseases are as follows:
Atrial Septa1 Defect
As mentioned above, ASD is best seen in subcostal views. These windows could become suboptimal with increasing age, in that case one may have to perfom transesopheeal echo. ASD should be defined under following heads:
Atrial Septa1 Defect
As mentioned above, ASD is best seen in subcostal views. These windows could become suboptimal with increasing age, in that case one may have to perfom transesopheeal echo. ASD should be defined under following heads:
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| Transducer position for suprasternal "long axis" view |
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| Fossa ovalis ASD (subcostal short axis view) |
ASD can be classified in four types:
i)Ostium primum ASDIpartial AVSD
ii) Ostium secbndum or fossa ovalis ASD
iii) Sinus venoSous ASD (SVCAVC type)
iv) Coronary shus defects.
In a patient of ASD one should look for associations like abnormally draining systemic and pulmonary veins, mitral valve disease. Sometimes ASDs are impdrtant and are necessary as they provide channel for decompression 4s in tricuspidlmitral atresia or site for mixing as in TGA.PA pressures can calculated from TR jet Gradient:
TR Max PG + RA mean pressure = PA systolic pressure
In presence of RV failure in a relatively young patient with ASD one must interrogate again for presence of PS, Pulmonary embolism, Pulmonary vein stenosis, left sided obstructive and regurgitant lesions as well as LV dysfunction.
Fossa Ovalis ASD
Commonest defect is fossa ovalis ASD. It can be closed by devices. ASD should be sized in various views and their rims should also be assessed if device closure is planned. Trans-esophageal echo is a must before and during the procedure.
Sinus Venosus Defect
Commonly found in relation to SVC or IVC. It is usually associated with PAPVC of right pulmonary veins. It is best seen in sub-costal short axis view.
Ostium Primum ASD
It is caused by deficient lower part of atrial septum and is part of endocardia1 cushion defect. This is commonly associated with common AV valve or cleft mitral valve. ASD can be evaluated in subcostal short and long axis views.Associated findings like dilated RA, RV, abnormal septa1 motion should be recorded. TR and TR velocity are helpful in measuring the PA systolic pressure.
Ventricular Septa1 Defect (VSD)
VSD can be found in various part of ventricular septum hence all possible views except suprasternal views are used to detect and define the VSD. VSDs are classified in two ways:
A) According to their location
B) According to change they bring in PA pressures
i)Ostium primum ASDIpartial AVSD
ii) Ostium secbndum or fossa ovalis ASD
iii) Sinus venoSous ASD (SVCAVC type)
iv) Coronary shus defects.
In a patient of ASD one should look for associations like abnormally draining systemic and pulmonary veins, mitral valve disease. Sometimes ASDs are impdrtant and are necessary as they provide channel for decompression 4s in tricuspidlmitral atresia or site for mixing as in TGA.PA pressures can calculated from TR jet Gradient:
TR Max PG + RA mean pressure = PA systolic pressure
In presence of RV failure in a relatively young patient with ASD one must interrogate again for presence of PS, Pulmonary embolism, Pulmonary vein stenosis, left sided obstructive and regurgitant lesions as well as LV dysfunction.
Fossa Ovalis ASD
Commonest defect is fossa ovalis ASD. It can be closed by devices. ASD should be sized in various views and their rims should also be assessed if device closure is planned. Trans-esophageal echo is a must before and during the procedure.
Sinus Venosus Defect
Commonly found in relation to SVC or IVC. It is usually associated with PAPVC of right pulmonary veins. It is best seen in sub-costal short axis view.
Ostium Primum ASD
It is caused by deficient lower part of atrial septum and is part of endocardia1 cushion defect. This is commonly associated with common AV valve or cleft mitral valve. ASD can be evaluated in subcostal short and long axis views.Associated findings like dilated RA, RV, abnormal septa1 motion should be recorded. TR and TR velocity are helpful in measuring the PA systolic pressure.
Ventricular Septa1 Defect (VSD)
VSD can be found in various part of ventricular septum hence all possible views except suprasternal views are used to detect and define the VSD. VSDs are classified in two ways:
A) According to their location
B) According to change they bring in PA pressures
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| Ostium primum ASD. subcostal 4 C view |
Classification According to Location
1) Perimembranous VSD
VSD is present in perimembranous area hence it causes TV-AV continuity.
2) Doubly Committed VSD
These are anterior dtfects roofed by both semilunar valves. Majority of cases in this variety develop aortic valve prolapse and subsequently AR.
1) Perimembranous VSD
VSD is present in perimembranous area hence it causes TV-AV continuity.
2) Doubly Committed VSD
These are anterior dtfects roofed by both semilunar valves. Majority of cases in this variety develop aortic valve prolapse and subsequently AR.
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| Subcostal short axis view: inlet VSD |
3) Inlet VSD
Found in between Wo AV valves. It is a posterior defect. AVSD (endocardia1 cushion defect) is usbally associated with VSD in this area when it is called as AV canal type VSD. It is usually associated with abnormal chordal attachment of TV, also known as straddling of TV.
4) Muscular VSD
Found in any part o septum isolated or in association with other VSDs. They have high rate of sponataneous closure
Perimembranous and muscular VSDs can be closed by device.
Classification Accoitding to Change They Bring in PA Pressures
1) Restrictive VSDi
VSD is restrictive when VSD pressure gradient is more than 60mmHg (systolic cuff pressure-VSD lpressure gradient = PA systolic pressure). PA systolic pressure can also be estimated Erom TR gradient. Tybulent jet is noticed in colour Doppler. VSOs are restrictive due to its smaller size or sometimes surrounding structur6s like tricuspid valve or aortic valve cover it partially.
Whenever VSD is getting smaller due to aortic valve prolapse, aortic valve should be evaluated for incompetence and surgery should be advised at the right time so that valve cduld be preserved.
Found in between Wo AV valves. It is a posterior defect. AVSD (endocardia1 cushion defect) is usbally associated with VSD in this area when it is called as AV canal type VSD. It is usually associated with abnormal chordal attachment of TV, also known as straddling of TV.
4) Muscular VSD
Found in any part o septum isolated or in association with other VSDs. They have high rate of sponataneous closure
Perimembranous and muscular VSDs can be closed by device.
Classification Accoitding to Change They Bring in PA Pressures
1) Restrictive VSDi
VSD is restrictive when VSD pressure gradient is more than 60mmHg (systolic cuff pressure-VSD lpressure gradient = PA systolic pressure). PA systolic pressure can also be estimated Erom TR gradient. Tybulent jet is noticed in colour Doppler. VSOs are restrictive due to its smaller size or sometimes surrounding structur6s like tricuspid valve or aortic valve cover it partially.
Whenever VSD is getting smaller due to aortic valve prolapse, aortic valve should be evaluated for incompetence and surgery should be advised at the right time so that valve cduld be preserved.
2) Non-restrictive VSD
In non-restrictive VSD PA pressures are elevated hence VSD gradient is low.Non-restrictive VSD is larger in size and has laminar flow in colour Doppler study. Serial echocardiographic studies are done in infants with VSD to assess the VSD size, VSD jet velocity, LV dimension (indirect assessment of level of shunt) and surrounding structures to decide the exact time of intervention. Smaller VSDs are hemodynamically insignificant but they are more prone for bacterial endocarditis due to turbulence created by VSD jet. Associated conditions in a case of VSD makes the major shift in clinical course and management like association of severe RVOT obstruction (TOF). RVOT obstruction changes the direction of flow across the VSD and patient needs early intervention. VSD may be only outlet for LV when both great vessels align with RV. In that case finding of restrictive VSD is an ominous sign and requires urgent intervention. VSD in inlet area may be associated with abnormal attachment of tricuspid valve i.e. chordae to opposite side of septum. Shunt calculation across the VSD can be done utilizing the RVOT and LVOT dimensions and RVOT VTI but such a calculation are not very correct and they are not done routinely. Best echocardiographic parameter of increased shunt is LVIDd (LV end diastolic dimension) Z-Score.
Patient Ductus Arteriosus
Best view to visualize a patient ductus arteriosus is high parasternal or ductal view. A patient ductus arteriosus in this view is seen as a 3rd channel beside RPA and LPA producing a dinner fork appearance. Descending aorta can also be imagined in this view when it curves down to meet ductus in its anterior aspect and left subclavian artery; Opening of PDA in pulmonary artery is clearly
seen and can be measured. A PDA size beyond 4-5 mm can be send for surgical ligation. A smaller sized PDA can be closed by interventional procedure like coiling or device closure. In a patient with PDA one should further interrogate for VSD, bicuspid aortic valve and coarctation of aorta. Some times PDA can be sole source of pulmonary blood flow (like in pulmonary atresia) or systemic
blood flow (aortic &-esia/HLHS). CW Doppler velocity of PDA can be used to assess PA pressure. PDA flow signals are continuous, maximal in late systole and are above the baseline. Like the VSD, end diastolic LV dimension is an important echocarddographic indicator of the level of shunt.
In non-restrictive VSD PA pressures are elevated hence VSD gradient is low.Non-restrictive VSD is larger in size and has laminar flow in colour Doppler study. Serial echocardiographic studies are done in infants with VSD to assess the VSD size, VSD jet velocity, LV dimension (indirect assessment of level of shunt) and surrounding structures to decide the exact time of intervention. Smaller VSDs are hemodynamically insignificant but they are more prone for bacterial endocarditis due to turbulence created by VSD jet. Associated conditions in a case of VSD makes the major shift in clinical course and management like association of severe RVOT obstruction (TOF). RVOT obstruction changes the direction of flow across the VSD and patient needs early intervention. VSD may be only outlet for LV when both great vessels align with RV. In that case finding of restrictive VSD is an ominous sign and requires urgent intervention. VSD in inlet area may be associated with abnormal attachment of tricuspid valve i.e. chordae to opposite side of septum. Shunt calculation across the VSD can be done utilizing the RVOT and LVOT dimensions and RVOT VTI but such a calculation are not very correct and they are not done routinely. Best echocardiographic parameter of increased shunt is LVIDd (LV end diastolic dimension) Z-Score.
Patient Ductus Arteriosus
Best view to visualize a patient ductus arteriosus is high parasternal or ductal view. A patient ductus arteriosus in this view is seen as a 3rd channel beside RPA and LPA producing a dinner fork appearance. Descending aorta can also be imagined in this view when it curves down to meet ductus in its anterior aspect and left subclavian artery; Opening of PDA in pulmonary artery is clearly
seen and can be measured. A PDA size beyond 4-5 mm can be send for surgical ligation. A smaller sized PDA can be closed by interventional procedure like coiling or device closure. In a patient with PDA one should further interrogate for VSD, bicuspid aortic valve and coarctation of aorta. Some times PDA can be sole source of pulmonary blood flow (like in pulmonary atresia) or systemic
blood flow (aortic &-esia/HLHS). CW Doppler velocity of PDA can be used to assess PA pressure. PDA flow signals are continuous, maximal in late systole and are above the baseline. Like the VSD, end diastolic LV dimension is an important echocarddographic indicator of the level of shunt.
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| Apical 5 chamber view |
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