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Congenital Heart Diseases
Cyanotic
Normal Flow
RVHLVH
Non Cyanotic
Plethora
CoAMR
PSMS
CoA Bayi
LVH RVH
VSDPDA
ASDPAVSDPAPVD
Oligemia Plethora
TOFPS + ShuntObstruktif + L→RPAEbstein Anomaly
Common Mixing Atrial• TAPVD• UniatrialCommon mixing AV• CAVSDCommon Mixing Ventricle• Single ventricle• HLHS, TA, MA• DORV, DILV Truncus (A-P Window)TGA + VSD
Common Mixing
• Pressure & saturation of O2 in Aorta & pulmonal is the same
PDA
Adolescent/Adult
HF (+) PH (-)HF (-) PH (+)
Premature Mature
Medical th/+
IndomethacinControlled Failed
Elective After >12 weeks
L→R L↔R
•Clinical•EKG•CXR•Echo
Medical th/
Closedspontaneously Ligation or Amplatzer Ductal Occluder Conservative
LVOTO : left ventricular outflow tract obstruction
Cath
LV < 2/3
Cath
PARI< 8
PARI> 8
Can not be resected
BTS
SEQUENTIAL ANALYSIS
1. Established Atrial Situs
2. Ascertain Atrioventicular connexions
3. Decide Ventriculo-Arterial
4. Ascertain relationships– Right – Left & Anterior – Posterior
relationship
Morphology Right Atrium
• Atrial appendages “blunt ending”
• Receives Systemic Venous Return
• Coronary sinus enter to the smooth wall sinus venorum separated by from trabeculated right auricle by crista terminalis
Morphology Left Atrium
• Atrial Appendages “Finger Shaped”
• Receive blood from Pulmonary Vein
• Smooth walled is not separated from trabeculated wall by crista
Morphology Right Ventricle
• Coarse trabeculation of the wall• Shape “Rounded”• Contain infundibulum & tricuspid valve• Tricuspid valve separated from Pulmonary valve
by crista supraventricularis
trabecula septomarginalis• Insertion of papillary muscle of Tricuspid
– Single Anterior– Multiple Posterior– Medial
MORPHOLOGY LEFT VENTRICLE
• Fine Trabeculation
• Shape “ellipse”• Mitral valve & Ao Valve in fibrous continuity
• Bileaflet mitral valve• No medial papillary insertion, all to free wall
SITUSEstablished Atrial Situs• Situs Solitus
• Morphology right Atrium right side• Morphology left Atrium on the left side
• Situs Inversus• Morphology right Atrium left side• Morphology left Atrium on the right side
• Situs Ambigus• Not possible to separate right & left atria by
morphological
Situs Solitus
By Plain Ro• Right sided liverMeans / Inference Right Sided• Inferior vena cava & RA• Sinus Node• Tri-lobed, morphologically right Lung• Echo
– short axis Subxiphoid Thoracal XV A
Spine
Bronchial Branches
• Strong Xray
• Right side three lobed distance from bifurcatio shorter
• Left side two lobed distance from the bifurcatio shorter
• IVC always to RA
• In LA isomerism, there must be an interrupted IVC.
Azygos to SVC (Left)
Hemiazygos to SVC (right)
• SVC doesn’t always into RA, can be bilateral
SITUS AMBIGUS
By Plain Ro• Liver both side, stomach in the middleBilateral right lung type• RA isomerism• AspleniaBilateral left lung type• LA isomerism• Polysplenia
AV connection
• Discordant• Ambigus • Double inlet• Single inlet (univentricular)• Straddling,
– insertion of papillary muscle MV in RV or – insertion of papillary muscle TV in LV
• Overriding– Insertion papillary of overriding mitral in the LV
• Ventricle inversion can be determined by EKG– Normal V1 RSR, V6 qRS– Ventricle inversion V1 qRS, V6 RSR
VA c Ao onnection
• Physical examination– 2nd Heart sound single, not accentuated : PA– 2nd Heart sound single, loud : TGA
» Side by side» Anterior (Ao) posterior (P)
Normal
P
PP
Ao
AoAo
Hyperoxidation Test
• O2 100% 10-20 minutes
• Lung problem– Saturation O2 increased to 100%
• Cardiac problem – saturation O2 increased less than 30%
Posisi jantung dalam rongga toraks
5 Langkah Utama– Situs Atrial– Loop bulbo ventrikuler– Koneksi atrioventrikuler– Relasi kedua pembuluh darah utama– Koneksitas ventrikulo arterial
Anomali pada setiap segmen
SITUS ATRIALPANDANGAN SUBCOSTAL ( SAGITAL KORONAL )