Скачать презентацию Congenital Heart Disease Adult CHD is not Скачать презентацию Congenital Heart Disease Adult CHD is not

8 Congenital heart disease.ppt

  • Количество слайдов: 68

Congenital Heart Disease Congenital Heart Disease

Adult CHD is not rare ! 7 1000 Adult Survival 85 % Adult CHD is not rare ! 7 1000 Adult Survival 85 %

Adult Congenital Heart Disease v Newly diagnosis v Previous diagnosed but not repaired l Adult Congenital Heart Disease v Newly diagnosis v Previous diagnosed but not repaired l Clinically insignificant lesion l Eisenmenger syndrome v Performed operation l Cure: l New VSD, PDA problems: TOF, Fontan….

Congenital Heart Disease (CHD) v Simple congenital HD l Atrial septal defect: ASD l Congenital Heart Disease (CHD) v Simple congenital HD l Atrial septal defect: ASD l Ventricular septal defect: VSD l Patent ductus arteriosus: PDA l Pulmonary stenosis: PS) l Ebstein’s anomaly l Aortic stenosis: AS v Complex congenital HD) l Tetralogy of Fallot: TOF l Transposition of great arteries: TGA

Clinical Problems in CHD v Heart failure v Infective endocarditis v Pulmonary hypertension (PHT) Clinical Problems in CHD v Heart failure v Infective endocarditis v Pulmonary hypertension (PHT)

Echo in congenital disease v Diagnosis v Severity l Prognosis l Decision of treatment Echo in congenital disease v Diagnosis v Severity l Prognosis l Decision of treatment - OP v Combined anomaly v Evaluaion of cardiac function

ASD 80 8 40/0 10 99 100/0 80 99 ASD 80 8 40/0 10 99 100/0 80 99

Diagnosis of ASD v Clinical features l Dyspnea, Cardiomegaly, Atrial fibrillation v Direct findings Diagnosis of ASD v Clinical features l Dyspnea, Cardiomegaly, Atrial fibrillation v Direct findings l Identification l Confirm of shunt: 2 D echo of shunt: Doppler v Indirect findings l Volume overloading of Rt heart - Enlargement of RV, RA, PV l Pulmonary hypertension

Echo in ASD v When we suspect ASD? v How we diagnose ASD? v Echo in ASD v When we suspect ASD? v How we diagnose ASD? v What is type of ASD? v How severe ASD? • Enlargement of RV, RA, PV • Pulmonary hypertension: TR jet velocity • Qp/Qs v Combined congenital anomaly v ASD size

ASD: Diagnosis 1. Identification of septal defect (cf. echo drop-out) 2. Confirm by Doppler ASD: Diagnosis 1. Identification of septal defect (cf. echo drop-out) 2. Confirm by Doppler (cf. venous flow)

ASD diagnosis: Echo drop-out Normal ASD If difficult : Using color Doppler, RV enlargement ASD diagnosis: Echo drop-out Normal ASD If difficult : Using color Doppler, RV enlargement

ASD: Type v Ostium secundum l Most V common v Ostium primum v Sinus ASD: Type v Ostium secundum l Most V common v Ostium primum v Sinus venosus type S V P

ASD: Secundum vs primum Secundum Primum ASD: Secundum vs primum Secundum Primum

ASD: Sinus Venosus Defect ASD: Sinus Venosus Defect

ASD: RV enlargement ASD Normal ASD: RV enlargement ASD Normal

ASD: RV enlargement ASD Normal ASD: RV enlargement ASD Normal

ASD: RV enlargement ASD Normal ASD: RV enlargement ASD Normal

ASD: Paradoxical Septal Motion Systole Diastole ASD: Paradoxical Septal Motion Systole Diastole

ASD: Pulmonary hypertension ASD: Pulmonary hypertension

ASD: Pulmonary hypertension Simplified Bernoulli equation P = 4 V 22 V 1 V ASD: Pulmonary hypertension Simplified Bernoulli equation P = 4 V 22 V 1 V 2

ASD: Pulmonary hypertension PAPsystolic = 4 VTR 2 + RAP ASD: Pulmonary hypertension PAPsystolic = 4 VTR 2 + RAP

ASD: Pulmonary hypertension ASD: Pulmonary hypertension

ASD: Qp/Qs ASD: Qp/Qs

ASD: Combined anomaly v. Secundum ASD l mitral valve prolapse v. Primum ASD l ASD: Combined anomaly v. Secundum ASD l mitral valve prolapse v. Primum ASD l cleft mitral valve v. Sinus venosus defect l anomalous return pulmonary venous

MV prolapse MV prolapse

Cleft mitral valve Cleft mitral valve

ASD: Treatment v Medical treatment l Endocarditis prophylaxis: not recommended v Surgical treatment l ASD: Treatment v Medical treatment l Endocarditis prophylaxis: not recommended v Surgical treatment l Indication: l Device Qp/Qs 2. 0 closure: secundum ASD l Contraindication Severe pulmonary hypertension

ASD: Device Closure Device Size ( 4 - 38 mm ) ASD: Device Closure Device Size ( 4 - 38 mm )

Case: 45/Male, Dyspnea Case: 45/Male, Dyspnea

RV enlargement: “ASD” RV enlargement: “ASD”

Echo in ASD v Unknown origin RV & RA enlargement v TEE in sinus Echo in ASD v Unknown origin RV & RA enlargement v TEE in sinus venosus defect

VSD 62 8 40/0 10 99 100/0 80 99 VSD 62 8 40/0 10 99 100/0 80 99

Echo diagnosis of VSD v Clinical features l Pansystolic murmur v Direct findings l Echo diagnosis of VSD v Clinical features l Pansystolic murmur v Direct findings l Identify septal defect l Confirm Lt to Rt shunt v Indirect findings l Rt heart volume overloadng - Enlargement of RV l Pulmonary hypertension

VSD: Pansystolic Murmur VSD: Pansystolic Murmur

Echo in VSD v When we suspect VSD? v Diagnosis of VSD? v What Echo in VSD v When we suspect VSD? v Diagnosis of VSD? v What type of VSD? v How severe VSD? l RV size & function l Pulmonary hypertension: TR jet vs VSD jet l Qp/Qs v Combined anomaly: AV prolapse, AR

VSD: Type v Perimembranous v Subarterial (infundibular) v Muscular VSD: Type v Perimembranous v Subarterial (infundibular) v Muscular

VSD RV side LV side VSD RV side LV side

VSD: Type VSD: Type

VSD: Perimembranous VSD: Perimembranous

VSD: Subarterial VSD: Subarterial

VSD: Type perimembranous subarterial VSD: Type perimembranous subarterial

VSD: Muscular VSD: Muscular

VSD with Septal Aneurysm VSD with Septal Aneurysm

VSD with Spontaneous Closure VSD with Spontaneous Closure

VSD: AR d/t AV prolapse VSD: AR d/t AV prolapse

VSD with pulmonary HTN VSD with pulmonary HTN

VSD with pulmonary HTN TR jet VSD jet DP : 27 mm. Hg DP VSD with pulmonary HTN TR jet VSD jet DP : 27 mm. Hg DP : 103 mm. Hg (BP: 140/90) PASP: 37 mm. Hg

VSD: Treatment v Medical treatment l Endocarditis prophylaxis: not recommended v Surgical treatment l VSD: Treatment v Medical treatment l Endocarditis prophylaxis: not recommended v Surgical treatment l Indication: l Device Qp/Qs 1. 5 ~ 2. 0 closure l Contraindication Severe pulmonary hypertension

Patent Ductus Arterosus(PDA) Patent Ductus Arterosus(PDA)

PDA PDA

PDA: Physical Findings v Continuous M v Wide pulse pressure v Differential cyanosis l PDA: Physical Findings v Continuous M v Wide pulse pressure v Differential cyanosis l Rt to Lt shunt

Ebstein anomaly Ebstein anomaly

Ebstein Anomaly Apical displacement of septal, posterior leaflet of TV: 8 mm/m 2 Ebstein Anomaly Apical displacement of septal, posterior leaflet of TV: 8 mm/m 2

Ebstein Anomaly Apical displacement of septal, posterior leaflet of TV: 8 mm/m 2 Ebstein Anomaly Apical displacement of septal, posterior leaflet of TV: 8 mm/m 2

Tetralogy of Fallot (TOF) Tetralogy of Fallot (TOF)

TOF v Ventricular septal defect v Pulmonic stenosis v Rt ventricular hypertrophy v Overriding TOF v Ventricular septal defect v Pulmonic stenosis v Rt ventricular hypertrophy v Overriding of aorta

TOF TOF

TOF TOF

TOF: Surgery TOF: Surgery

Clinical Problems in CHD v. Heart failure v. Infective endocarditis v. Pulmonary hypertension (PHT) Clinical Problems in CHD v. Heart failure v. Infective endocarditis v. Pulmonary hypertension (PHT) l Eisenmenger syndrome

Eisenmenger Syndrome v 1897: Vicktor Eisenmenger l 32 yo woman with dyspnea, cyanosis l Eisenmenger Syndrome v 1897: Vicktor Eisenmenger l 32 yo woman with dyspnea, cyanosis l Hemoptysis l Autopsy: Large VSD v 1958: Paul Wood l “Eisenmenger Syndrome”

Eisenmenger Syndrome v Elevated pulmonary artery resistance and severe pulmonary HT secondary to large Eisenmenger Syndrome v Elevated pulmonary artery resistance and severe pulmonary HT secondary to large L R shunt v Reversal of shunt

Eisenmenger Synd: Survival Mean age of death: 45 yr Eisenmenger Synd: Survival Mean age of death: 45 yr

Pulmonary HT: Reversibility PA Pressure Pulmonary Blood Flow L to R shunt X Pulmonary Pulmonary HT: Reversibility PA Pressure Pulmonary Blood Flow L to R shunt X Pulmonary Vascular Resistance

Reversibility of Pulmonary HT 27 yo lady with dyspnea TR jet: 85 mm. Hg Reversibility of Pulmonary HT 27 yo lady with dyspnea TR jet: 85 mm. Hg

Reversibility of Pulmonary HT Post. Op 1 yr f/u Reversibility of Pulmonary HT Post. Op 1 yr f/u

2004. 12 60 mm. Hg 2005. 2 40 mm. Hg 2006. 4 25 mm. 2004. 12 60 mm. Hg 2005. 2 40 mm. Hg 2006. 4 25 mm. Hg