By Sara Thorne, Paul Clift
To the grownup heart specialist, the language of congenital center sickness may be complicated and the spectrum of illness bewildering. Many locate the possibility of assembly an grownup with complicated congenital center sickness within the emergency division irritating, and rightly so. This e-book goals to dispel confusion and equip cardiology trainees, common cardiologists, and acute medication physicians with a legitimate realizing of the foundations of the body structure and administration of grownup congenital center sickness, for you to deal with emergencies and realize the necessity for referral to a expert unit.
With easy-to-understand diagrams and key scientific issues, this instruction manual presents either speedy reference to be used whilst the scientific desire arises and likewise an perception into the fundamental ideas of congenital middle sickness, giving the reader an exceptional grounding within the care of the grownup with congenital center sickness.
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Additional info for Adult Congenital Heart Disease
Provides diagnostic information on patients with limited TTE views following previous surgery or chest deformities. Excellent visualization of complications of Fontan procedure (Fig. g. obstruction or thrombosis. Visualization of atrial bafﬂes to detect stenoses or leaks. Provides evaluation of AV valves and site of chordal insertion. Characterizes outﬂow tract obstructions, abnormalities of the aorta, such as CoA and PDA. TRANSOESOPHAGEAL ECHO (TOE) Fig. 10 Fontan (tricuspid atresia, TGA) with spontaneous echo contrast in the Fontan pathway (RA).
Requires specialist training. Potentially lengthy scans and breath-holds. g. valves and atrial septum. • Some patients (2%) are claustrophobic. • Susceptibility artefacts from stents, sternal wires, and rods from spinal deformities. • Pacemakers, ICDs, aneurysm clips, or metallic implants are contraindicated. • • • • Gadolinium contrast • IV gadolinium contrast can be used to provide 3D contrast angiography, assess myocardial viability or the presence of scar tissue. g. 13). • Assessment of valvar regurgitant volume and fraction.
1 Physiological Classiﬁcation of Congenital Heart Disease Acyanotic Cyanotic—Obligatory right to left shunt No shunt Left to right shunt Eisenmenger syndrome High pulmonary blood ﬂow Normal or low pulmonary blood ﬂow Level of shunt Example of speciﬁc lesion Large ASD Atrial, with obstruction to pulmonary blood ﬂow Severe PS with ASD, Left SVC to LA connection Ventricular Ventricular, with obstruction to pulmonary blood ﬂow Fallot, Pulmonary atresia VSD, Univentricular heart with PS PDA Arterial Extra cardiac Pulmonary AVM AVSD Multiple Example of speciﬁc lesion Level of shunt Example of speciﬁc lesion Level of Example Level of shunt of speciﬁc shunt lesion RV inﬂow Ebstein’s anomaly Atrium PAPVD ASD AVSD Atrium ASD AVSD Atrial LV inﬂow Congenital MS, Cor triatatrium Ventricle VSD Ventricle VSD RV outﬂow Infundibular stenosis, PS Artery PDA AP window Artery LV outﬂow Subaortic stenosis, Bicuspid AoV Multiple AVSD Multiple Arterial Supravalvar stenosis, CoA AP aortopulmonary, ASD atrial septal defect, AoV aortic valve, AVSD atrioventricular septal defect, CoA coarctation of aorta, LA left atrium, LV left ventricle, MS mitral stenosis, PAPVD partial anomalous pulmonary venous drainage, PDA patent ductus arteriosus, PS pulmonary stenosis, RV right ventricle, SVC superior vena cava, VSD ventricular septal defect PHYSIOLOGICAL CLASSIFICATION Example of speciﬁc lesion Level of lesion 5 6 CHAPTER 1 Morphology and classiﬁcation Sequential segmental analysis Any heart can be described using this approach.
Adult Congenital Heart Disease by Sara Thorne, Paul Clift