SlideShare une entreprise Scribd logo
1  sur  65
Télécharger pour lire hors ligne
BASICS OF ADULT
CONGENITAL HEART DISEASE
     ASSESSMENT
           Christina Attenhofer Jost
     Cardiovascular Center Klinik Im Park
     C di         l C t Kli ik I P k
                      and
 Children‘s University Hospital Zurich (ACHD)


               EUROECHO CONGRESS - COPENHAGEN -
                     TEACHING COURSE 2010
BAD NEWS: EVERYONE GETS OLDER
                        OLDER……………..




            EUROECHO CONGRESS - COPENHAGEN -
                  TEACHING COURSE 2010
GOOD NEWS: EVERYONE GETS OLDER
     NEWS




    After Khairy et al. JACC 2010;56:1149


             EUROECHO CONGRESS - COPENHAGEN -
                   TEACHING COURSE 2010
A congenital echo cardiologist
• assumes that every vein, artery,
  chamber or valve is abnormal until it is
  shown to be normal
• will use an organized method when
  examining the CV system

                     P.O. Leary
                     P O Leary, Mayo Clinic

               EUROECHO CONGRESS - COPENHAGEN -
                     TEACHING COURSE 2010
Segments - Connection

 Great veins
                    Veno-atrial
                    V     ti l
    Atria
                 Atrio-ventricular
 Ventricles

                 Ventriculo-arterial
Great arteries
Atria
•   Atrial i
    A i l situs solitus: mRA anterior and right of mLA
                    li     RA      i     d i h f LA
•   Atrial situs inversus: mRA to the left of mLA
•   True atrial situs ambiguous = rare
•   Thicker limbus of the foramen ovale on the same side as
    morphologic RA (mRA), thinner valve of the foramen ovale on
    the same side as morphologic LA (mLA)
•   Connection CS and suprahepatic IVC to mRA
•   Morphology atrial appendages
    - mRA: course, muscular appearing walls
       RA                   l        i       ll
    with pectinate muscles and crista terminalis
    - mLA: smooth surface
Ventricular morphology:
                    Cardiac crux
   Normal
   N    l                   Ventricular
                            morphology
 RA               LA
                            – TV committed
                              to RV
                            – MV committed
                              to LV
                            Valve morphology
 RV               LV        – TV apically displaced
                            – MV superior insertion

W.D. Edwards, Mayo Clinic
Ventricular morphology:
                    Cardiac crux
   Normal
   N    l                    CCTGA    Ventricular
                                      morphology
 RA               LA        RA   LA
                                      – TV committed
                                        to RV
                                      – MV committed
                                        to LV
                                      Valve morphology
 RV               LV                  – TV apically displaced
                            LV   RV
                                      – MV superior insertion

W.D. Edwards, Mayo Clinic
Left Ventricle
                 • smooth endocardial
                   surface
                 • large discrete
                   large,
                   papillary muscles not
                   inserting into septum
                 • more round shaped
                 • mitral valve


W.D. Edwards
Right Ventricle
                • coarse
                  trabeculation
                • septoparietal
                      t     i t l
                  muscle bundle
                • multiple small
                  papillary muscles
                  with septal and
                  free wall
                  attachments
W.D. Edwards
What is that?




  EUROECHO CONGRESS - COPENHAGEN -
        TEACHING COURSE 2010
What is that?


                    1.   CC G
                         CCTGA
                    2.   HCM
                    3.   Noncompaction
                    4.
                    4    Endocardial fibroelastosis
                    5.   Double chambered LV




  EUROECHO CONGRESS - COPENHAGEN -
        TEACHING COURSE 2010
What is that?




                                W.D. Edwards
                                W D Ed    d




  EUROECHO CONGRESS - COPENHAGEN -
        TEACHING COURSE 2010
What is that?




Congenitally corrected transposition

            EUROECHO CONGRESS - COPENHAGEN -
                  TEACHING COURSE 2010
Overview of Adult CHD
• Outflow obstruction assessment
  Outflow tract, aortic valve, coarctation,
  pulmonary valve
• Abnormal intracardiac communications
  ASD, VSD, PDA, anomalous pulmonary
  veins, persistent left superior vena cava
• Complex malformations
  Ebstein s anomaly, TOF, CCTGA
  Ebstein’s anomaly TOF CCTGA, complete
  transposition, univentricular heart
Subaortic stenosis
• 8 30 % of LVOT obstruction
  8-30     f        b t    ti
• In 80 %, discrete obstruction by fibrous ring
• In 20 %, diffuse tunnel-like narrowing by a
  fibromuscular band
• In 60 % associated with multilevel LVOT
  obstruction, VSD, coarctation of the aorta,
  Shone syndrome, PDA, left superior vena
  Sh          d      PDA l ft        i
  cava, HCM, PS, bicuspid aortic valve etc.
    F. Walker. Diagnosis and management of adult CHD 2003
Discrete subaortic stenosis
• Aortic valve usually tricommissural
• Hypertrophy of muscular ventricular septum
    yp      p y                         p
  in up to 75 %
             Muscle
 membrane




                        P. O’Leary Mayo Clinic
Congenitally Abnormal Aortic Valve




         Leonardo Da Vinci
Bicuspid aortic valve
• Incidence 1%, familial in 25 %
• Males : females = 3:1 to 5:1
• Associated congenital cardiovascular lesions
  include coarctation, Turner syndrome, PDA,
  William’s syndrome, VSD, Shone’s complex,
  abnormal coronary arteries
Bicuspid aortic valve




    Schaefer et al.
Heart 2008 94: 1634-1638
Supravalvular aortic stenosis
• 6 % of congenital LVOT obstruction
• Most often due to elastin
  arteriopathy
• Association with coarctation, PDA,
  ASD, VSD, tetralogy of Fallot,
  coronary artery abnormalities,
  bicuspid aortic valve
15 year old with Williams Beuren
            syndrome
Coarctation
                          • Prevalence 0.4/1000 live
                            births
                          • 7 % of CHD
                                  f
                          • Severe heart failure,
                            hypertension etc
                                          etc.
                          • Up to 50 % associated
                            lesions (VSD, abnormal
                                    (VSD
                            AV valve, subvalvular
                            stenosis, AV septal
                                            p
Juxtaductal coarctation     defects, etc)
   by W.D. Edwards
Coarctation

                                              P.O.Leary




               Patel, Young from
     Echocardiographic in Ped and Adult CHD


•   BP MEASUREMENT ARMS AND LEGS
•   Systolic pressure gradient with Bernouilli equation (4(V22-v12)
•   Doppler assessment of abdominal aortic flow
•   Imaging aorta by MRI/CT compulsory
Pulmonary stenosis




      W.D. Edwards
      W D Ed    d
       Mayo Clinic
Pulmonary stenosis
• 7 to 10 % of CHD
• 90 % valvular (often isolated),
  10 % supravalvular or subvalvular
• S
  Supravalvular PS: often in Williams
           l l PS ft i Willi
  syndrome
• Noonan syndrome: 2/3 have PS due to
  valve dysplasia
25 year old woman with PS only?

   V max 4.8m/sec
25 year old woman with PS only?
25 year old woman with PS
25 year old woman with PS only?




       PS, PR,
       PS PR mean gradient 56mmHg
                       di t 56    H
       AS, AR, mean gradient 52mmHg
                   PDA
          Noncompaction of the LV
                  PSLVC
A congenital echo cardiologist
• Is only amazed when a heart is
  completely normal.
       p    y




               EUROECHO CONGRESS - COPENHAGEN -
                     TEACHING COURSE 2010
Overview of Adult CHD
• Outflow obstruction assessment
  Outflow tract, aortic valve, coarctation,
  pulmonary valve
• Abnormal intracardiac communications
  ASD, VSD, PDA, anomalous pulmonary
  veins, persistent left superior vena cava
• Complex malformations
  Ebstein s
  Ebstein’s anomaly, TOF, CCTGA, complete
  transposition, univentricular heart
Atrial septal defects: 10% of CHD

                   Ostium primum ASD =
                     partial AVSD 15%


   Sinus venosus
      ASD 5%


    Secundum
     ASD 80%




   InferiorSinus
      venosus
      ASD<1%         Coronary sinus
                        ASD<1% After Perloff JK. Clinical Recognition of
                                         Congenital Heart Disease 2003
Simple secundum ASD?
•   Dyspnea on exertion NYHA II
•   Dizziness, occasional fainting
•   First degree AV block (PR interval 396 ms)
•   Holter intermittent 2nd and 3rd degree
    AV block
        b oc
HOLT ORAM SYNDROME =
HEART HAND SYNDROME
Female with 5 children working 100%
              children,
Female with 5 children working 100%
              children,




               IVC
                 C
                     RA



                     SVC
Female with 5 children working 100%
              children,




               IVC
                 C
                     RA



                     SVC
Female with 5 children working 100%
              children,
Female with 5 children working 100%
              children,
A congenital echo cardiologist
• Knows that women don‘t tire easily…
  there is always an explanation
               y       p




              EUROECHO CONGRESS - COPENHAGEN -
                    TEACHING COURSE 2010
Sinus venosus atrial septal defect

• Description in 1858
• 5% of ASDs
• Common association with
  PAPVC i 97 % -
         in
  TAPVC rare
Ventricular septal defects




1 = membranous (70-80%); 2 = double committed/subarterial
  or supracristal (5-7%), 3 = muscular (5-20%); 4 = inlet (8%)
               Ammash, Warnes. Ann Int Med 2001;135:812
              after C
               f    Capelli and colleagues: A J C di l 1983
                        lli d ll            Am Cardiol
Ventricular septal defect
VSD in adults
• VSD operated in childhood with or without
        p
  residual VSD
• Small VSD with insignificant L-R shunt
                               LR
• VSD with significant L-R shunt, pulmonary
  hypertension,
  hypertension and various degrees of LV
  volume overload
• Eisenmenger syndrome: large VSD with large
  L-R shunt
VSD and aortic regurgitation




Early systole, blood through    Right coronary cusp and aortic Unsupported right or NC cusp
               VSD                 sinus driven into RV (Venturi   pushed down away from
                                              effect)                  other cusp: AR
                            Ammash, Warnes. Ann Int Med 2001;135:812
                      after Tatsuno and colleagues. Circulation 1973;48:1028
VSD: 45 year old man, no symptoms
                 man
VSD: 45 year old man, no symptoms
                 man
A congenital echo cardiologist
• Knows that good advice may go down
                       y
  the drain occasionally




             EUROECHO CONGRESS - COPENHAGEN -
                   TEACHING COURSE 2010
Normal pulmonary venous connections




        Ammash et al. JACC 1997;1351-8
Normal pulmonary venous connections

  Right PV                                    Left PV




             Ammash et al. JACC 1997;1351-8
Scimitar syndrome – what the hell is that??
Scimitar syndrome
 •   PAPVC of th right pulmonary
               f the i ht l
     vein or veins to the IVC
 •   Anomalous systemic arterial
     supply to the right lung
           l t th i ht l
 •   Varying degrees of hypoplasia of
     the right lung with or without
     pulmonary sequestration

 •   25 % associated CHD: VSD, ASD,
     PDA, coarctation, TOF


M. Vogel in Adult Congenital Heart Disease 2003


                                                  From the website: Children’s H
                                                  F    th    b it Child     ’ Hospital B t
                                                                                  it l Boston
Scimitar syndrome: 1st Description

                  .. If you think it is sufficiently interesting
                  for insertion in your valuable journal
                                                   journal,
                  it is much at your service. – I have
                  the honour to remain, Sir,

                  Your very obedient servant

                  GEORGE COOPER

                  Breatford, 27th June, 1836
Overview of Adult CHD
• Outflow obstruction assessment
  Outflow tract, aortic valve, coarctation,
  pulmonary valve
• Abnormal intracardiac communications
  ASD, VSD, PDA, anomalous pulmonary
  veins, persistent left superior vena cava
• Complex malformations
  Ebstein s anomaly, TOF, CCTGA
  Ebstein’s anomaly TOF CCTGA, complete
  transposition, univentricular heart
Ebstein s
                          Ebstein‘s anomaly
•    1:200 000
     1:200’000 live births
•    <1 % of CHD
•    80-90 % interatrial communication
•    Bicuspid or atretic aortic valve
•    PA or hypoplastic PA
•    Coarctation
•    MVP,
     MVP accessory mitral valve tissue
•    left ventricular dysplasia
     resembling noncompaction          W.D. Edwards, Mayo Clinic
    Attenhofer Jost, Connolly et al. Circulation 2007;115:277




                                                                W.D. Edwards, Mayo Clinic
15 year with heart failure due to
 associated LV noncompaction



                    RV


                                LV




         Attenhofer Jost, Connolly et al. J
              ASE: 2004:17: 677-680
Ebstein‘s anomaly
 mild and severe
64 year old female with brain
    abscess age 10 years
3D echo
in Ebstein’s anomaly




   35 year old patient with
            ld ti t ith
   Ebstein‘s anomaly and
         severe TR
Tetralogy of Fallot
             • Most common cyanotic
               CHD
             • 4 10 % of all CHD
               4-10     f ll
             • 15 % deletion
               chromosome 22q11
               (CATCH 22 syndrome)
             • Unoperated patients
               rarely present the 1st
               time as adults

P.O. Leary
Surgical repair of TOF
• VSD closure
• Resection of infundibular muscle
• P l
  Pulmonary valvotomy +/- monocusp (G
              l t      /           (Goretex)
                                        t )
• RVOT patch
• Transannular patch if needed or
      RV to PA conduit (anomalous CA), rarely
      Pulmonary valve replacement not for infants
      Pulmonary valve homograft
      Pulmonary arterioplasty


• Correction of other lesions
A congenital echo cardiologist
• Never starts with the echo before
  reading the operative notes and last
        g      p
  exams




               EUROECHO CONGRESS - COPENHAGEN -
                     TEACHING COURSE 2010
Tetralogy of Fallot: echo after repair

•   Residual l
    R id l pulmonary regurgitation
                                it ti
•   Residual RVOT obstruction
•   RV dysfunction
•   Residual shunting
•   AR with or without aortic root dilatation
•   LV dysfunction
Conclusion
• E h
  Echocardiography in adult CHD
            di     h i d lt
  encompasses a huge variety of
  possible problems and unique
  situations
• It is hard to adequately diagnose and
  t eat e e C
  treat even CHD of simple or moderate
                   o s peo       ode ate
  severity
• Complex CHD belongs to a tertiary
  referral center
End – thank you

Contenu connexe

Tendances

Congenital heart disease for undergraduates student uod 2015
Congenital heart disease for undergraduates student uod 2015Congenital heart disease for undergraduates student uod 2015
Congenital heart disease for undergraduates student uod 2015Azad Haleem
 
Anesthesia And Congenital Heart Disease
Anesthesia And Congenital Heart DiseaseAnesthesia And Congenital Heart Disease
Anesthesia And Congenital Heart DiseaseAhmed Shalabi
 
4 Congenital Heart Disease
4 Congenital Heart Disease4 Congenital Heart Disease
4 Congenital Heart Diseaseghalan
 
Left-Right Shunt Natural history & Principles of Management
Left-Right ShuntNatural history & Principles of ManagementLeft-Right ShuntNatural history & Principles of Management
Left-Right Shunt Natural history & Principles of Managementdrranjithmp
 
Acyanotic Congenital Heart Disease - VSD - Dr. Gunasekaran
Acyanotic Congenital Heart Disease - VSD - Dr. GunasekaranAcyanotic Congenital Heart Disease - VSD - Dr. Gunasekaran
Acyanotic Congenital Heart Disease - VSD - Dr. Gunasekaranpediatricsmgmcri
 
Acyanoticcongenitalheartdisease 150417031927-conversion-gate01
Acyanoticcongenitalheartdisease 150417031927-conversion-gate01Acyanoticcongenitalheartdisease 150417031927-conversion-gate01
Acyanoticcongenitalheartdisease 150417031927-conversion-gate01Manju Mulamootll Abraham
 
Critical congenital heart diseases
Critical congenital heart diseases  Critical congenital heart diseases
Critical congenital heart diseases Vaishnavi S Nair
 
Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)
Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)
Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)DR NIKUNJ SHEKHADA
 
Evaluation of congenital heart disease
Evaluation of congenital heart diseaseEvaluation of congenital heart disease
Evaluation of congenital heart diseaseSandip Gediya
 
Congenital heart disease for post graduates toufiqur rahman NICVD
Congenital heart disease for post graduates toufiqur rahman NICVDCongenital heart disease for post graduates toufiqur rahman NICVD
Congenital heart disease for post graduates toufiqur rahman NICVDPROFESSOR DR. MD. TOUFIQUR RAHMAN
 
CONGENITAL HEART DISEASE: APPROACH TO DIAGNOSIS
CONGENITAL HEART DISEASE: APPROACH TO DIAGNOSISCONGENITAL HEART DISEASE: APPROACH TO DIAGNOSIS
CONGENITAL HEART DISEASE: APPROACH TO DIAGNOSISNizam Uddin
 
Management of congenital heart disease in infants
Management of congenital heart disease in infantsManagement of congenital heart disease in infants
Management of congenital heart disease in infantsSMSRAZA
 

Tendances (20)

Congenital heart disease for undergraduates student uod 2015
Congenital heart disease for undergraduates student uod 2015Congenital heart disease for undergraduates student uod 2015
Congenital heart disease for undergraduates student uod 2015
 
Anesthesia And Congenital Heart Disease
Anesthesia And Congenital Heart DiseaseAnesthesia And Congenital Heart Disease
Anesthesia And Congenital Heart Disease
 
4 Congenital Heart Disease
4 Congenital Heart Disease4 Congenital Heart Disease
4 Congenital Heart Disease
 
Left-Right Shunt Natural history & Principles of Management
Left-Right ShuntNatural history & Principles of ManagementLeft-Right ShuntNatural history & Principles of Management
Left-Right Shunt Natural history & Principles of Management
 
Asd ppt
Asd pptAsd ppt
Asd ppt
 
Avsd picu
Avsd   picuAvsd   picu
Avsd picu
 
Asd and vsd
Asd and vsdAsd and vsd
Asd and vsd
 
Atrial septal defect
Atrial septal defectAtrial septal defect
Atrial septal defect
 
Acyanotic Congenital Heart Disease - VSD - Dr. Gunasekaran
Acyanotic Congenital Heart Disease - VSD - Dr. GunasekaranAcyanotic Congenital Heart Disease - VSD - Dr. Gunasekaran
Acyanotic Congenital Heart Disease - VSD - Dr. Gunasekaran
 
Acyanoticcongenitalheartdisease 150417031927-conversion-gate01
Acyanoticcongenitalheartdisease 150417031927-conversion-gate01Acyanoticcongenitalheartdisease 150417031927-conversion-gate01
Acyanoticcongenitalheartdisease 150417031927-conversion-gate01
 
Critical congenital heart diseases
Critical congenital heart diseases  Critical congenital heart diseases
Critical congenital heart diseases
 
Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)
Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)
Asd managment DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SR)
 
Acyanotic heart diseases
Acyanotic heart diseasesAcyanotic heart diseases
Acyanotic heart diseases
 
Evaluation of congenital heart disease
Evaluation of congenital heart diseaseEvaluation of congenital heart disease
Evaluation of congenital heart disease
 
Congenital heart disease for post graduates toufiqur rahman NICVD
Congenital heart disease for post graduates toufiqur rahman NICVDCongenital heart disease for post graduates toufiqur rahman NICVD
Congenital heart disease for post graduates toufiqur rahman NICVD
 
CONGENITAL HEART DISEASE: APPROACH TO DIAGNOSIS
CONGENITAL HEART DISEASE: APPROACH TO DIAGNOSISCONGENITAL HEART DISEASE: APPROACH TO DIAGNOSIS
CONGENITAL HEART DISEASE: APPROACH TO DIAGNOSIS
 
Atrial septal defects
Atrial septal defectsAtrial septal defects
Atrial septal defects
 
Acyanotic and cyanotic shunt lesions 03 2019
Acyanotic and cyanotic shunt lesions 03 2019Acyanotic and cyanotic shunt lesions 03 2019
Acyanotic and cyanotic shunt lesions 03 2019
 
Congenital heart disease toufiqur rahman NICVD
Congenital heart disease toufiqur rahman NICVDCongenital heart disease toufiqur rahman NICVD
Congenital heart disease toufiqur rahman NICVD
 
Management of congenital heart disease in infants
Management of congenital heart disease in infantsManagement of congenital heart disease in infants
Management of congenital heart disease in infants
 

En vedette

The adult with congenital heart disease
The adult with congenital heart diseaseThe adult with congenital heart disease
The adult with congenital heart diseaseasadsoomro1960
 
A good ppt on Clinical congenital heart disease for Post Graduate
A good ppt on Clinical congenital heart disease for Post GraduateA good ppt on Clinical congenital heart disease for Post Graduate
A good ppt on Clinical congenital heart disease for Post GraduateKurian Joseph
 
ACHD_Slide_Set.PPT
ACHD_Slide_Set.PPTACHD_Slide_Set.PPT
ACHD_Slide_Set.PPTHospital
 
Valve replacement:choosing the right valve in ACHD
Valve replacement:choosing the right valve in ACHDValve replacement:choosing the right valve in ACHD
Valve replacement:choosing the right valve in ACHDCHESSA GUCH
 
Segmental approach in congenital heart disease [autosaved].pptx 2.pptx final
Segmental approach in congenital heart disease [autosaved].pptx 2.pptx     finalSegmental approach in congenital heart disease [autosaved].pptx 2.pptx     final
Segmental approach in congenital heart disease [autosaved].pptx 2.pptx finalShabnam Mohammadzadeh
 
Anesthesia for children with Congenital Heart Disease
Anesthesia for children with Congenital Heart DiseaseAnesthesia for children with Congenital Heart Disease
Anesthesia for children with Congenital Heart Diseasecairo1957
 
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...cyanotic and acyanotic Congenital heart disease for undergraduated student uo...
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...Azad Haleem
 
Classification of Congential Heart Diseases and cyanotic heart disease
Classification of Congential Heart Diseases and cyanotic heart diseaseClassification of Congential Heart Diseases and cyanotic heart disease
Classification of Congential Heart Diseases and cyanotic heart diseaseChristian Medical College & Hospital
 
Adult congenital heart disease and the surgical patient
Adult congenital heart disease and the surgical patientAdult congenital heart disease and the surgical patient
Adult congenital heart disease and the surgical patientsxbenavides
 
Echo assesmentof rv function
Echo assesmentof rv functionEcho assesmentof rv function
Echo assesmentof rv functionDeepak Agrawal
 
Electrocardiography in Adult Congenital Heart Diseases
Electrocardiography in Adult Congenital Heart DiseasesElectrocardiography in Adult Congenital Heart Diseases
Electrocardiography in Adult Congenital Heart DiseasesSaleh AL-Hatem
 
Congenital heart disease
Congenital heart diseaseCongenital heart disease
Congenital heart diseasePuneet Shukla
 
Ischemic heart disease
Ischemic heart diseaseIschemic heart disease
Ischemic heart diseasehodmedicine
 
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASE
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASE
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
 
Images In Clinical Medicine23 4 2009
Images In Clinical Medicine23 4 2009Images In Clinical Medicine23 4 2009
Images In Clinical Medicine23 4 2009hospital
 
Fun In Cardiology
Fun In CardiologyFun In Cardiology
Fun In Cardiologyhospital
 
Fun In Cardiology Pscc
Fun In Cardiology PsccFun In Cardiology Pscc
Fun In Cardiology Pscchospital
 

En vedette (20)

The adult with congenital heart disease
The adult with congenital heart diseaseThe adult with congenital heart disease
The adult with congenital heart disease
 
A good ppt on Clinical congenital heart disease for Post Graduate
A good ppt on Clinical congenital heart disease for Post GraduateA good ppt on Clinical congenital heart disease for Post Graduate
A good ppt on Clinical congenital heart disease for Post Graduate
 
ACHD_Slide_Set.PPT
ACHD_Slide_Set.PPTACHD_Slide_Set.PPT
ACHD_Slide_Set.PPT
 
Valve replacement:choosing the right valve in ACHD
Valve replacement:choosing the right valve in ACHDValve replacement:choosing the right valve in ACHD
Valve replacement:choosing the right valve in ACHD
 
Segmental approach in congenital heart disease [autosaved].pptx 2.pptx final
Segmental approach in congenital heart disease [autosaved].pptx 2.pptx     finalSegmental approach in congenital heart disease [autosaved].pptx 2.pptx     final
Segmental approach in congenital heart disease [autosaved].pptx 2.pptx final
 
Anesthesia for children with Congenital Heart Disease
Anesthesia for children with Congenital Heart DiseaseAnesthesia for children with Congenital Heart Disease
Anesthesia for children with Congenital Heart Disease
 
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...cyanotic and acyanotic Congenital heart disease for undergraduated student uo...
cyanotic and acyanotic Congenital heart disease for undergraduated student uo...
 
Classification of Congential Heart Diseases and cyanotic heart disease
Classification of Congential Heart Diseases and cyanotic heart diseaseClassification of Congential Heart Diseases and cyanotic heart disease
Classification of Congential Heart Diseases and cyanotic heart disease
 
Adult congenital heart disease and the surgical patient
Adult congenital heart disease and the surgical patientAdult congenital heart disease and the surgical patient
Adult congenital heart disease and the surgical patient
 
Echo assesmentof rv function
Echo assesmentof rv functionEcho assesmentof rv function
Echo assesmentof rv function
 
Right Ventricle Echocardiography
Right Ventricle EchocardiographyRight Ventricle Echocardiography
Right Ventricle Echocardiography
 
Electrocardiography in Adult Congenital Heart Diseases
Electrocardiography in Adult Congenital Heart DiseasesElectrocardiography in Adult Congenital Heart Diseases
Electrocardiography in Adult Congenital Heart Diseases
 
Tetralogy of fallot
Tetralogy of fallotTetralogy of fallot
Tetralogy of fallot
 
Congenital heart disease
Congenital heart diseaseCongenital heart disease
Congenital heart disease
 
Ischemic heart disease
Ischemic heart diseaseIschemic heart disease
Ischemic heart disease
 
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASE
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASE
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASE
 
Images In Clinical Medicine23 4 2009
Images In Clinical Medicine23 4 2009Images In Clinical Medicine23 4 2009
Images In Clinical Medicine23 4 2009
 
Fun In Cardiology
Fun In CardiologyFun In Cardiology
Fun In Cardiology
 
Fun In Cardiology Pscc
Fun In Cardiology PsccFun In Cardiology Pscc
Fun In Cardiology Pscc
 
Complications ami
Complications amiComplications ami
Complications ami
 

Similaire à Basics of adult congenital heart disease assessment

Atrioventricular canal defect
Atrioventricular canal defectAtrioventricular canal defect
Atrioventricular canal defectDrvasanthi
 
Atrioventricular septal defects
Atrioventricular septal defectsAtrioventricular septal defects
Atrioventricular septal defectsIndia CTVS
 
PA/IVS - Dr. Julius King Kwedhi
PA/IVS - Dr. Julius King KwedhiPA/IVS - Dr. Julius King Kwedhi
PA/IVS - Dr. Julius King KwedhiDr. Julius Kwedhi
 
Double outlet right ventricle
Double outlet right ventricleDouble outlet right ventricle
Double outlet right ventricleRamachandra Barik
 
Double outlet right ventricle
Double outlet right ventricleDouble outlet right ventricle
Double outlet right ventricleHimanshu Rana
 
congenital heart disease_january2011_final
congenital heart disease_january2011_finalcongenital heart disease_january2011_final
congenital heart disease_january2011_finalEngidaw Ambelu
 
Atrial septal defects 16 3-15
Atrial septal defects 16 3-15Atrial septal defects 16 3-15
Atrial septal defects 16 3-15Dr. Harshil Joshi
 
Congenital heart disease
Congenital heart diseaseCongenital heart disease
Congenital heart diseaseDevendra Patel
 
EBSTEINS ANOMALY.pptx
EBSTEINS ANOMALY.pptxEBSTEINS ANOMALY.pptx
EBSTEINS ANOMALY.pptxAadhi55
 
Endocardial Cushion Defect / AVSD
Endocardial Cushion Defect / AVSDEndocardial Cushion Defect / AVSD
Endocardial Cushion Defect / AVSDHarshitha
 
Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...
Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...
Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...FIRAS ALJANADI
 

Similaire à Basics of adult congenital heart disease assessment (20)

Atrioventricular canal defect
Atrioventricular canal defectAtrioventricular canal defect
Atrioventricular canal defect
 
Atrioventricular septal defects
Atrioventricular septal defectsAtrioventricular septal defects
Atrioventricular septal defects
 
PA/IVS - Dr. Julius King Kwedhi
PA/IVS - Dr. Julius King KwedhiPA/IVS - Dr. Julius King Kwedhi
PA/IVS - Dr. Julius King Kwedhi
 
Cc tga
Cc tgaCc tga
Cc tga
 
Double outlet right ventricle
Double outlet right ventricleDouble outlet right ventricle
Double outlet right ventricle
 
Congenital heart disease
Congenital heart diseaseCongenital heart disease
Congenital heart disease
 
congenital heart disease
congenital heart diseasecongenital heart disease
congenital heart disease
 
Double outlet right ventricle
Double outlet right ventricleDouble outlet right ventricle
Double outlet right ventricle
 
cTGA PPT.pptx
cTGA PPT.pptxcTGA PPT.pptx
cTGA PPT.pptx
 
Asd new
Asd newAsd new
Asd new
 
12 heart
12 heart12 heart
12 heart
 
congenital heart disease_january2011_final
congenital heart disease_january2011_finalcongenital heart disease_january2011_final
congenital heart disease_january2011_final
 
Atrial septal defects 16 3-15
Atrial septal defects 16 3-15Atrial septal defects 16 3-15
Atrial septal defects 16 3-15
 
V s d may 2021
V s d  may 2021V s d  may 2021
V s d may 2021
 
Congenital heart disease
Congenital heart diseaseCongenital heart disease
Congenital heart disease
 
EBSTEINS ANOMALY.pptx
EBSTEINS ANOMALY.pptxEBSTEINS ANOMALY.pptx
EBSTEINS ANOMALY.pptx
 
Endocardial Cushion Defect / AVSD
Endocardial Cushion Defect / AVSDEndocardial Cushion Defect / AVSD
Endocardial Cushion Defect / AVSD
 
Cogenital heart ds.
Cogenital heart ds.Cogenital heart ds.
Cogenital heart ds.
 
Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...
Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...
Atrial Septal Defects, Ventricular septal defects Assessment,Investigations a...
 
TaPVD.pptx
TaPVD.pptxTaPVD.pptx
TaPVD.pptx
 

Plus de oussama El-h

La durée de la double antiagrégation plaquettaire
La durée de la double antiagrégation plaquettaireLa durée de la double antiagrégation plaquettaire
La durée de la double antiagrégation plaquettaireoussama El-h
 
Insuffisance mitrale et fonction ventriculaire gauche
Insuffisance mitrale et fonction ventriculaire gaucheInsuffisance mitrale et fonction ventriculaire gauche
Insuffisance mitrale et fonction ventriculaire gaucheoussama El-h
 
Médicaments qui peuvent causer ou exacerber une insuffisance cardiaque
Médicaments qui peuvent causer ou exacerber une insuffisance cardiaqueMédicaments qui peuvent causer ou exacerber une insuffisance cardiaque
Médicaments qui peuvent causer ou exacerber une insuffisance cardiaqueoussama El-h
 
Hypertension artérielle pulmonaire idiopathique et états apparentés
Hypertension artérielle pulmonaire idiopathique et états apparentésHypertension artérielle pulmonaire idiopathique et états apparentés
Hypertension artérielle pulmonaire idiopathique et états apparentésoussama El-h
 
Hypertrophie ventriculaire gauche au cours de l'hypertension artérielle
Hypertrophie ventriculaire gauche au cours de l'hypertension artérielleHypertrophie ventriculaire gauche au cours de l'hypertension artérielle
Hypertrophie ventriculaire gauche au cours de l'hypertension artérielleoussama El-h
 
Flutter atrial et tachycardies atriales non fluttériennes
Flutter atrial et tachycardies atriales non fluttériennesFlutter atrial et tachycardies atriales non fluttériennes
Flutter atrial et tachycardies atriales non fluttériennesoussama El-h
 
Introduction à l’électrophysiologie cellulaire cardiaque
Introduction à l’électrophysiologie cellulaire cardiaqueIntroduction à l’électrophysiologie cellulaire cardiaque
Introduction à l’électrophysiologie cellulaire cardiaqueoussama El-h
 
Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...
Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...
Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...oussama El-h
 
Le traitement anticoagulant de l’embolie pulmonaire
Le traitement anticoagulant de l’embolie pulmonaireLe traitement anticoagulant de l’embolie pulmonaire
Le traitement anticoagulant de l’embolie pulmonaireoussama El-h
 
Modalités d’arrêt du traitement antiagrégant plaquettaire
Modalités d’arrêt du traitement antiagrégant plaquettaireModalités d’arrêt du traitement antiagrégant plaquettaire
Modalités d’arrêt du traitement antiagrégant plaquettaireoussama El-h
 
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaireNouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaireoussama El-h
 
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaireNouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaireoussama El-h
 
Hypertension artérielle en 2011  de nouveaux choix
Hypertension artérielle en 2011  de nouveaux choixHypertension artérielle en 2011  de nouveaux choix
Hypertension artérielle en 2011  de nouveaux choixoussama El-h
 
Prise en charge des dyslipidémies
Prise en charge des dyslipidémiesPrise en charge des dyslipidémies
Prise en charge des dyslipidémiesoussama El-h
 
Prise en charge des dyslipidémies
Prise en charge des dyslipidémiesPrise en charge des dyslipidémies
Prise en charge des dyslipidémiesoussama El-h
 
Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...
Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...
Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...oussama El-h
 
Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...
Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...
Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...oussama El-h
 
Automesure ou mapa  que proposer à nos hypertendus
Automesure ou mapa  que proposer à nos hypertendusAutomesure ou mapa  que proposer à nos hypertendus
Automesure ou mapa  que proposer à nos hypertendusoussama El-h
 
Doit on interdire la conduite automobile aux coronariens âgés
Doit on interdire la conduite automobile aux coronariens âgésDoit on interdire la conduite automobile aux coronariens âgés
Doit on interdire la conduite automobile aux coronariens âgésoussama El-h
 
Revu rythmologie 2011 n 1
Revu rythmologie 2011 n 1Revu rythmologie 2011 n 1
Revu rythmologie 2011 n 1oussama El-h
 

Plus de oussama El-h (20)

La durée de la double antiagrégation plaquettaire
La durée de la double antiagrégation plaquettaireLa durée de la double antiagrégation plaquettaire
La durée de la double antiagrégation plaquettaire
 
Insuffisance mitrale et fonction ventriculaire gauche
Insuffisance mitrale et fonction ventriculaire gaucheInsuffisance mitrale et fonction ventriculaire gauche
Insuffisance mitrale et fonction ventriculaire gauche
 
Médicaments qui peuvent causer ou exacerber une insuffisance cardiaque
Médicaments qui peuvent causer ou exacerber une insuffisance cardiaqueMédicaments qui peuvent causer ou exacerber une insuffisance cardiaque
Médicaments qui peuvent causer ou exacerber une insuffisance cardiaque
 
Hypertension artérielle pulmonaire idiopathique et états apparentés
Hypertension artérielle pulmonaire idiopathique et états apparentésHypertension artérielle pulmonaire idiopathique et états apparentés
Hypertension artérielle pulmonaire idiopathique et états apparentés
 
Hypertrophie ventriculaire gauche au cours de l'hypertension artérielle
Hypertrophie ventriculaire gauche au cours de l'hypertension artérielleHypertrophie ventriculaire gauche au cours de l'hypertension artérielle
Hypertrophie ventriculaire gauche au cours de l'hypertension artérielle
 
Flutter atrial et tachycardies atriales non fluttériennes
Flutter atrial et tachycardies atriales non fluttériennesFlutter atrial et tachycardies atriales non fluttériennes
Flutter atrial et tachycardies atriales non fluttériennes
 
Introduction à l’électrophysiologie cellulaire cardiaque
Introduction à l’électrophysiologie cellulaire cardiaqueIntroduction à l’électrophysiologie cellulaire cardiaque
Introduction à l’électrophysiologie cellulaire cardiaque
 
Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...
Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...
Quelles indications pour le prasugrel et le ticagrelor dans les syndromes cor...
 
Le traitement anticoagulant de l’embolie pulmonaire
Le traitement anticoagulant de l’embolie pulmonaireLe traitement anticoagulant de l’embolie pulmonaire
Le traitement anticoagulant de l’embolie pulmonaire
 
Modalités d’arrêt du traitement antiagrégant plaquettaire
Modalités d’arrêt du traitement antiagrégant plaquettaireModalités d’arrêt du traitement antiagrégant plaquettaire
Modalités d’arrêt du traitement antiagrégant plaquettaire
 
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaireNouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaire
 
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaireNouveaux biomarqueurs d'évaluation du risque cardiovasculaire
Nouveaux biomarqueurs d'évaluation du risque cardiovasculaire
 
Hypertension artérielle en 2011  de nouveaux choix
Hypertension artérielle en 2011  de nouveaux choixHypertension artérielle en 2011  de nouveaux choix
Hypertension artérielle en 2011  de nouveaux choix
 
Prise en charge des dyslipidémies
Prise en charge des dyslipidémiesPrise en charge des dyslipidémies
Prise en charge des dyslipidémies
 
Prise en charge des dyslipidémies
Prise en charge des dyslipidémiesPrise en charge des dyslipidémies
Prise en charge des dyslipidémies
 
Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...
Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...
Comment et quand réaliser le bilan d’atteinte des organes cibles chez l’hyper...
 
Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...
Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...
Evolution de la prise en charge de la fibrillation atriale et nouvelles persp...
 
Automesure ou mapa  que proposer à nos hypertendus
Automesure ou mapa  que proposer à nos hypertendusAutomesure ou mapa  que proposer à nos hypertendus
Automesure ou mapa  que proposer à nos hypertendus
 
Doit on interdire la conduite automobile aux coronariens âgés
Doit on interdire la conduite automobile aux coronariens âgésDoit on interdire la conduite automobile aux coronariens âgés
Doit on interdire la conduite automobile aux coronariens âgés
 
Revu rythmologie 2011 n 1
Revu rythmologie 2011 n 1Revu rythmologie 2011 n 1
Revu rythmologie 2011 n 1
 

Dernier

AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxiammrhaywood
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptxraviapr7
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptxSandy Millin
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice documentXsasf Sfdfasd
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxDr. Santhosh Kumar. N
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxEduSkills OECD
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.raviapr7
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfYu Kanazawa / Osaka University
 
5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...CaraSkikne1
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 
In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxAditiChauhan701637
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxheathfieldcps1
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...Nguyen Thanh Tu Collection
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsEugene Lysak
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesCeline George
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxKatherine Villaluna
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17Celine George
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 

Dernier (20)

Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice document
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptx
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
 
5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 
In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptx
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George Wells
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 Sales
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 

Basics of adult congenital heart disease assessment

  • 1. BASICS OF ADULT CONGENITAL HEART DISEASE ASSESSMENT Christina Attenhofer Jost Cardiovascular Center Klinik Im Park C di l C t Kli ik I P k and Children‘s University Hospital Zurich (ACHD) EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 2. BAD NEWS: EVERYONE GETS OLDER OLDER…………….. EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 3. GOOD NEWS: EVERYONE GETS OLDER NEWS After Khairy et al. JACC 2010;56:1149 EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 4. A congenital echo cardiologist • assumes that every vein, artery, chamber or valve is abnormal until it is shown to be normal • will use an organized method when examining the CV system P.O. Leary P O Leary, Mayo Clinic EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 5. Segments - Connection Great veins Veno-atrial V ti l Atria Atrio-ventricular Ventricles Ventriculo-arterial Great arteries
  • 6. Atria • Atrial i A i l situs solitus: mRA anterior and right of mLA li RA i d i h f LA • Atrial situs inversus: mRA to the left of mLA • True atrial situs ambiguous = rare • Thicker limbus of the foramen ovale on the same side as morphologic RA (mRA), thinner valve of the foramen ovale on the same side as morphologic LA (mLA) • Connection CS and suprahepatic IVC to mRA • Morphology atrial appendages - mRA: course, muscular appearing walls RA l i ll with pectinate muscles and crista terminalis - mLA: smooth surface
  • 7. Ventricular morphology: Cardiac crux Normal N l Ventricular morphology RA LA – TV committed to RV – MV committed to LV Valve morphology RV LV – TV apically displaced – MV superior insertion W.D. Edwards, Mayo Clinic
  • 8. Ventricular morphology: Cardiac crux Normal N l CCTGA Ventricular morphology RA LA RA LA – TV committed to RV – MV committed to LV Valve morphology RV LV – TV apically displaced LV RV – MV superior insertion W.D. Edwards, Mayo Clinic
  • 9. Left Ventricle • smooth endocardial surface • large discrete large, papillary muscles not inserting into septum • more round shaped • mitral valve W.D. Edwards
  • 10. Right Ventricle • coarse trabeculation • septoparietal t i t l muscle bundle • multiple small papillary muscles with septal and free wall attachments W.D. Edwards
  • 11. What is that? EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 12. What is that? 1. CC G CCTGA 2. HCM 3. Noncompaction 4. 4 Endocardial fibroelastosis 5. Double chambered LV EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 13. What is that? W.D. Edwards W D Ed d EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 14. What is that? Congenitally corrected transposition EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 15. Overview of Adult CHD • Outflow obstruction assessment Outflow tract, aortic valve, coarctation, pulmonary valve • Abnormal intracardiac communications ASD, VSD, PDA, anomalous pulmonary veins, persistent left superior vena cava • Complex malformations Ebstein s anomaly, TOF, CCTGA Ebstein’s anomaly TOF CCTGA, complete transposition, univentricular heart
  • 16. Subaortic stenosis • 8 30 % of LVOT obstruction 8-30 f b t ti • In 80 %, discrete obstruction by fibrous ring • In 20 %, diffuse tunnel-like narrowing by a fibromuscular band • In 60 % associated with multilevel LVOT obstruction, VSD, coarctation of the aorta, Shone syndrome, PDA, left superior vena Sh d PDA l ft i cava, HCM, PS, bicuspid aortic valve etc. F. Walker. Diagnosis and management of adult CHD 2003
  • 17. Discrete subaortic stenosis • Aortic valve usually tricommissural • Hypertrophy of muscular ventricular septum yp p y p in up to 75 % Muscle membrane P. O’Leary Mayo Clinic
  • 18. Congenitally Abnormal Aortic Valve Leonardo Da Vinci
  • 19. Bicuspid aortic valve • Incidence 1%, familial in 25 % • Males : females = 3:1 to 5:1 • Associated congenital cardiovascular lesions include coarctation, Turner syndrome, PDA, William’s syndrome, VSD, Shone’s complex, abnormal coronary arteries
  • 20. Bicuspid aortic valve Schaefer et al. Heart 2008 94: 1634-1638
  • 21. Supravalvular aortic stenosis • 6 % of congenital LVOT obstruction • Most often due to elastin arteriopathy • Association with coarctation, PDA, ASD, VSD, tetralogy of Fallot, coronary artery abnormalities, bicuspid aortic valve
  • 22. 15 year old with Williams Beuren syndrome
  • 23. Coarctation • Prevalence 0.4/1000 live births • 7 % of CHD f • Severe heart failure, hypertension etc etc. • Up to 50 % associated lesions (VSD, abnormal (VSD AV valve, subvalvular stenosis, AV septal p Juxtaductal coarctation defects, etc) by W.D. Edwards
  • 24. Coarctation P.O.Leary Patel, Young from Echocardiographic in Ped and Adult CHD • BP MEASUREMENT ARMS AND LEGS • Systolic pressure gradient with Bernouilli equation (4(V22-v12) • Doppler assessment of abdominal aortic flow • Imaging aorta by MRI/CT compulsory
  • 25. Pulmonary stenosis W.D. Edwards W D Ed d Mayo Clinic
  • 26. Pulmonary stenosis • 7 to 10 % of CHD • 90 % valvular (often isolated), 10 % supravalvular or subvalvular • S Supravalvular PS: often in Williams l l PS ft i Willi syndrome • Noonan syndrome: 2/3 have PS due to valve dysplasia
  • 27. 25 year old woman with PS only? V max 4.8m/sec
  • 28. 25 year old woman with PS only?
  • 29. 25 year old woman with PS
  • 30. 25 year old woman with PS only? PS, PR, PS PR mean gradient 56mmHg di t 56 H AS, AR, mean gradient 52mmHg PDA Noncompaction of the LV PSLVC
  • 31. A congenital echo cardiologist • Is only amazed when a heart is completely normal. p y EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 32. Overview of Adult CHD • Outflow obstruction assessment Outflow tract, aortic valve, coarctation, pulmonary valve • Abnormal intracardiac communications ASD, VSD, PDA, anomalous pulmonary veins, persistent left superior vena cava • Complex malformations Ebstein s Ebstein’s anomaly, TOF, CCTGA, complete transposition, univentricular heart
  • 33. Atrial septal defects: 10% of CHD Ostium primum ASD = partial AVSD 15% Sinus venosus ASD 5% Secundum ASD 80% InferiorSinus venosus ASD<1% Coronary sinus ASD<1% After Perloff JK. Clinical Recognition of Congenital Heart Disease 2003
  • 34. Simple secundum ASD? • Dyspnea on exertion NYHA II • Dizziness, occasional fainting • First degree AV block (PR interval 396 ms) • Holter intermittent 2nd and 3rd degree AV block b oc
  • 35. HOLT ORAM SYNDROME = HEART HAND SYNDROME
  • 36. Female with 5 children working 100% children,
  • 37. Female with 5 children working 100% children, IVC C RA SVC
  • 38. Female with 5 children working 100% children, IVC C RA SVC
  • 39. Female with 5 children working 100% children,
  • 40. Female with 5 children working 100% children,
  • 41. A congenital echo cardiologist • Knows that women don‘t tire easily… there is always an explanation y p EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 42. Sinus venosus atrial septal defect • Description in 1858 • 5% of ASDs • Common association with PAPVC i 97 % - in TAPVC rare
  • 43. Ventricular septal defects 1 = membranous (70-80%); 2 = double committed/subarterial or supracristal (5-7%), 3 = muscular (5-20%); 4 = inlet (8%) Ammash, Warnes. Ann Int Med 2001;135:812 after C f Capelli and colleagues: A J C di l 1983 lli d ll Am Cardiol
  • 44. Ventricular septal defect VSD in adults • VSD operated in childhood with or without p residual VSD • Small VSD with insignificant L-R shunt LR • VSD with significant L-R shunt, pulmonary hypertension, hypertension and various degrees of LV volume overload • Eisenmenger syndrome: large VSD with large L-R shunt
  • 45. VSD and aortic regurgitation Early systole, blood through Right coronary cusp and aortic Unsupported right or NC cusp VSD sinus driven into RV (Venturi pushed down away from effect) other cusp: AR Ammash, Warnes. Ann Int Med 2001;135:812 after Tatsuno and colleagues. Circulation 1973;48:1028
  • 46. VSD: 45 year old man, no symptoms man
  • 47. VSD: 45 year old man, no symptoms man
  • 48. A congenital echo cardiologist • Knows that good advice may go down y the drain occasionally EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 49. Normal pulmonary venous connections Ammash et al. JACC 1997;1351-8
  • 50. Normal pulmonary venous connections Right PV Left PV Ammash et al. JACC 1997;1351-8
  • 51. Scimitar syndrome – what the hell is that??
  • 52. Scimitar syndrome • PAPVC of th right pulmonary f the i ht l vein or veins to the IVC • Anomalous systemic arterial supply to the right lung l t th i ht l • Varying degrees of hypoplasia of the right lung with or without pulmonary sequestration • 25 % associated CHD: VSD, ASD, PDA, coarctation, TOF M. Vogel in Adult Congenital Heart Disease 2003 From the website: Children’s H F th b it Child ’ Hospital B t it l Boston
  • 53. Scimitar syndrome: 1st Description .. If you think it is sufficiently interesting for insertion in your valuable journal journal, it is much at your service. – I have the honour to remain, Sir, Your very obedient servant GEORGE COOPER Breatford, 27th June, 1836
  • 54. Overview of Adult CHD • Outflow obstruction assessment Outflow tract, aortic valve, coarctation, pulmonary valve • Abnormal intracardiac communications ASD, VSD, PDA, anomalous pulmonary veins, persistent left superior vena cava • Complex malformations Ebstein s anomaly, TOF, CCTGA Ebstein’s anomaly TOF CCTGA, complete transposition, univentricular heart
  • 55. Ebstein s Ebstein‘s anomaly • 1:200 000 1:200’000 live births • <1 % of CHD • 80-90 % interatrial communication • Bicuspid or atretic aortic valve • PA or hypoplastic PA • Coarctation • MVP, MVP accessory mitral valve tissue • left ventricular dysplasia resembling noncompaction W.D. Edwards, Mayo Clinic Attenhofer Jost, Connolly et al. Circulation 2007;115:277 W.D. Edwards, Mayo Clinic
  • 56. 15 year with heart failure due to associated LV noncompaction RV LV Attenhofer Jost, Connolly et al. J ASE: 2004:17: 677-680
  • 58. 64 year old female with brain abscess age 10 years
  • 59. 3D echo in Ebstein’s anomaly 35 year old patient with ld ti t ith Ebstein‘s anomaly and severe TR
  • 60. Tetralogy of Fallot • Most common cyanotic CHD • 4 10 % of all CHD 4-10 f ll • 15 % deletion chromosome 22q11 (CATCH 22 syndrome) • Unoperated patients rarely present the 1st time as adults P.O. Leary
  • 61. Surgical repair of TOF • VSD closure • Resection of infundibular muscle • P l Pulmonary valvotomy +/- monocusp (G l t / (Goretex) t ) • RVOT patch • Transannular patch if needed or RV to PA conduit (anomalous CA), rarely Pulmonary valve replacement not for infants Pulmonary valve homograft Pulmonary arterioplasty • Correction of other lesions
  • 62. A congenital echo cardiologist • Never starts with the echo before reading the operative notes and last g p exams EUROECHO CONGRESS - COPENHAGEN - TEACHING COURSE 2010
  • 63. Tetralogy of Fallot: echo after repair • Residual l R id l pulmonary regurgitation it ti • Residual RVOT obstruction • RV dysfunction • Residual shunting • AR with or without aortic root dilatation • LV dysfunction
  • 64. Conclusion • E h Echocardiography in adult CHD di h i d lt encompasses a huge variety of possible problems and unique situations • It is hard to adequately diagnose and t eat e e C treat even CHD of simple or moderate o s peo ode ate severity • Complex CHD belongs to a tertiary referral center