Differential Diagnosisof CHD
Differential DiagnosisDifferential Diagnosisof CHDof CHD
In Slide Show mode, to advance slides, press spacebar
William Herring, M.D. © 2003
Nine Lesions Which Produce 75% of All Severe Congenital Heart Lesions In the Neonate
Decreased flow1. Tetralogy of Fallot2. Tricuspid Atresia3. Severe Pulmonic
Stenosis4. Ebstein’s
Increased Flow5. Transposition 6. VSD
Nine Lesions Which Produce 75% of All Severe Congenital Heart Lesions In the Neonate
Pulmonary venous hypertension7. Hypoplastic left heart8. Coarctation of the aorta9. TAPVR with infradiaphragmatic obstruction
What’s leftLeft-to-right shunts
ASDPDA
Truncus arteriosus
Cyanotic
Cyanosis With Decreased Vascularity
TetralogyTruncus-type IVTricuspid atresia*Transposition*Ebstein's
* Also appears on DDx of Cyanosis with ↑ Vascularity
Ebstein’s AnomalyEbstein’s Anomaly
CyanoticCyanotic
Cyanosis With Increased Vascularity
Truncus types I, II, IIITAPVRTricuspid atresia*Transposition*Single ventricle
* Also appears on DDx of Cyanosis with ↓ Vascularity
Totalanomalousvenousreturn(TAPVR)
Totalanomalousvenousreturn(TAPVR)
Acyanotic
Cardiomegaly with Normal Vasculature
Viral myocarditisEndocardial fibroelastosisAberrant left coronary arteryCystic medial necrosisDiabetic mother
Acyanotic
Endocardial Cushion DefectEndocardial Cushion Defect
CHF In NewbornImpede Return of Flow to Left Heart
Infantile coarctationCongenital aortic stenosisHypoplastic left heart syndromeCongenital mitral stenosisCor triatriatumObstruction to venous return from lungs
TAPVR from below diaphragm
CHF In Chronologic Sequence
CHF In Chronologic Sequence
CHF In NewbornImpede Return of Flow to Left Heart
Infantile coarctationCongenital aortic stenosisHypoplastic Left Heart SyndromeCongenital mitral stenosisCor triatriatumObstruction to venous return from lungs
TAPVR from below diaphragm
CHF In 2nd-3rd Week
Coarctation of the aortaInterruption of the aortic arch
CHF-later
Coarctation of the aorta –adult type
Unknowns
31
Increasedflow
1° Pulmonary Hypertension1° Pulmonary Hypertension
MitralStenosisMitralStenosis
26
PAH
Atrial Septal DefectAtrial Septal Defect
Pericardial EffusionPericardial Effusion
17
Normal
Aortic StenosisAortic Stenosis
MitralStenosisWith SeverePAH
MitralStenosisWith SeverePAH
MS
33
Cyanotic
Tetralogy of FallotTetralogy of Fallot
Tetralogy of FallotComponents of
Ventricular septal defectPulmonic stenosisOverriding aortaRight ventricular hypertrophy
ASDASD
Acyanotic
LA Ao
ASD
PDA
VSD
CHFCHF
Pulmonary Interstitial EdemaX-ray Findings
Thickening of the interlobular septaKerley B lines
Peribronchial cuffingWall is normally hairline thin
Thickening of the fissuresFluid in the subpleural space in continuity with interlobular septa
Pleural effusions
Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD)
35
AtrialSeptal Defect(ostium primum type)with PAH
AtrialSeptal Defect(ostium primum type)with PAH
MS with PAH
PulmonicStenosisPulmonicStenosis
Most Commons
Most common cause of CHF in newbornHypoplastic left heart syndrome
Most common cause of CHF > 2 weeksCoarctation of the aorta (infantile form)
Most common cyanotic heart diseaseTetralogy of Fallot
Most common dz associated c R archTetralogy of Fallot
Most Commons
Most common L R shuntVentricular Septal Defect
Most common L R shunt dx’d in adultAtrial Septal Defect
Dz most commonly associated c R archTruncus arteriosus
The End
Recommended
