Embed Size (px)
Citation preview
13/06/2018
1
©2018 MFMER | slide-1
A WHole New World
Heidi M. Connolly
©2018 MFMER | slide-2
35-Year Old Female with MurmurAsymptomatic – 18 Weeks Pregnant
©2018 MFMER | slide-3
What is the the most likely diagnosis?
1. Atrial septal defect
2. Ventricular septal defect
3. Patent ductus arteriosus
4. Pulmonary hypertension
©2018 MFMER | slide-4
35-Year Old Female with MurmurAsymptomatic – 18 Weeks Pregnant
©2018 MFMER | slide-5 ©2018 MFMER | slide-6
35-Year Old Female with MurmurAsymptomatic – 18 Weeks Pregnant
TR = 2.6 m/sec
13/06/2018
2
©2018 MFMER | slide-7 ©2018 MFMER | slide-8
What’s the diagnosis?
©2018 MFMER | slide-9
Secundum ASD
©2018 MFMER | slide-10
What next?
1. Transoesophageal echo
2. Cardiac catheterization
3. Device closure
4. Surgical closure
5. Other
©2018 MFMER | slide-11
• Unrepaired ASD
SGA births, neonatal risk and fetal mortality
pre-eclampsia risk
• L to R shunt may with CO change during pregnancy
Counterbalanced by PVR
• Paradoxical embolism risk
• Familial types – consider screening
ASD and Pregnancy
ACHD ACC/AHA Guidelines: JACC 2008©2018 MFMER | slide-12
Robot-assisted ASD Closure
Whole New World
Courtesy of Dr. Joseph Dearani
13/06/2018
3
©2018 MFMER | slide-13
Right Heart Enlargement – Differential Diagnosis
•Atrial septal or pulmonary vein level shunt
•VSD and PDA – Left heart enlargement
•PH and PE – RV hypertrophy
•TR and PR
•Right ventricular myopathy
•Systemic right ventricle
©2018 MFMER | slide-14
Atrial Septal DefectsOften Diagnosed in Adulthood
SVC
IVC
RV
3
2
4
1
1) Primum 15% 2) Secundum 80%
3) Sinus venosus 5-10% 4) Coronary sinus <1%
ESC GUCH Guidelines: 2010
©2018 MFMER | slide-15
Indications for intervention in ASD
©2018 MFMER | slide-16
Other Examples
©2018 MFMER | slide-17 ©2018 MFMER | slide-18
Secundum ASD
13/06/2018
4
Secundum Atrial Septal Defect
Specimen (Four-Chamber View)
RA LA
LVRV
Courtesy of Dr. WD Edwards
3-D Transoesophageal Echocardiogram
©2018 MFMER | slide-21
Primum ASD
©2018 MFMER | slide-22
Primum ASD
What else should we look for?
©2018 MFMER | slide-23
What else should we look for?
1. Mitral valve regurgitation
2. RVOT obstruction
3. Patent ductus arteriosus
4. Anomalous coronary artery
©2018 MFMER | slide-24
Atrioventricular Septal DefectPrimum ASD
•Deficient AV septum
•MV and TV abnormal
•Primum ASD, cleft MV
RA
LA
Courtesy of Dr. WD Edwards
13/06/2018
5
Primum ASD – Partial AV Defect
ECG - left axis deviation, first degree AV block
Associations - MV and TV cleft, VSD, LVOT obstruction©2018 MFMER | slide-26
Something Else
©2018 MFMER | slide-27
21-Year Old Female with DyspneaAgitated Saline Injection
©2018 MFMER | slide-28
What’s the diagnosis?
1. Anomalous pulmonary vein
2. Secundum ASD
3. Patent foramen ovale
4. Intrapulmonary shunt
5. Sinus venosus ASD
©2018 MFMER | slide-29
Sinus Venosus
ASD
©2018 MFMER | slide-30
13/06/2018
6
©2018 MFMER | slide-31 ©2018 MFMER | slide-32
Another Example SVASD
©2018 MFMER | slide-33
18-Year-Old Male – Asymptomatic
©2018 MFMER | slide-34
18-Year-Old Male – Asymptomatic
©2018 MFMER | slide-35
18-Year-Old Male – Asymptomatic
©2018 MFMER | slide-36
Atrial Septal DefectSinus Venosus Type (Superior)
Diagram (Four-Chamber View)
RA
LV
LA
RV
R Pulm Vein
Courtesy of Dr. WD Edwards
*
13/06/2018
7
©2018 MFMER | slide-37
Sinus Venosus ASD
Anomalous PV connection
©2018 MFMER | slide-38
TOE - Sinus Venosus ASD with APV
©2018 MFMER | slide-39
TOE - Sinus Venosus ASD with APV
©2018 MFMER | slide-40
Sinus Venosus ASD
©2018 MFMER | slide-41
Something Else
©2018 MFMER | slide-42
13/06/2018
8
©2018 MFMER | slide-43 ©2018 MFMER | slide-44
What’s the diagnosis?
1. Secundum ASD
2. Patent foramen ovale
3. Cortriatriatum
4. Coronary sinus ASD
©2018 MFMER | slide-45
Coronary Sinus
ASD
©2018 MFMER | slide-46
Coronary Sinus ASD
©2018 MFMER | slide-47
Coronary Sinus ASD
Often difficult to diagnose
May be an isolated abnormality
May be associated with LSVC or complex CHD
©2018 MFMER | slide-48
Take Home Points
• Right heart enlargement (RHE)
• Think ASD
• RHE out of proportion to ASD size
• Think multiple defects or APVC
• RHE and early positive agitated saline in LA
• Think SVASD
• SVASD – APVC (not seen by TTE)
• Primum ASD – cleft MV, VSD, LVOT obstruction
13/06/2018
9
©2018 MFMER | slide-49
Questions & Discussion
©2018 MFMER | 3683658-49
