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Cardiac Imaging for Beginners

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Ammar Sarwar

on 19 October 2010

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Transcript of Cardiac Imaging for Beginners

Coronaries Left Circumflex Left Anterior Descending Right Coronary Artery MULTIPLANAR REFORMATS LAD RCA LCX CORONARY PLAQUE Normal Atherosclerosis CORONARY ANOMALIES Normal Cardiac Catheterizations Left Circulation Left Circulation Right Circulation 3D Reconstruction Right Atrium Right Ventricle Pyramidal Shape.

The papillary muscles of the right ventricle
- septal and from the free wall surfaces


The leaflets of the pulmonary valve and the leaflets of the tricuspid valve are widely separated by the infundibular musculature.

The muscular trabeculations are relatively coarse, few, and straight, tending to parallel the right ventricular inflow and outflow tracts.

The inlet component extends from the atrioventricular junction to the distal attachments of the chordae tendineae of the tricuspid valve.

The apical trabecular component extends from the two parts associated with the valves and out to the apex. The moderator band is a prominent muscle bundle which crosses from the septomarginal trabeculation to the anterior papillary muscle and then to the parietal wall.

The normal right ventricle has a large muscular infundibular component making up its outflow tract. Right Ventricle Left Ventricle When is the right ventricle the right ventricle? Moderator band along septal wall
Muscular connection between arterial and AV valve
Coarse few trabeculae Ebstein's Anomaly Apical displacement of tricuspid leaflets
“Box-shaped” heart
Maternal lithium intake
Decreased to normal pulmonary vascularity Ventriculoarterial and atrioventricular discordance (RA to LV to PA, LA to RV to Ao)
0.4%–0.6% of all cases of congenital heart disease, high association with other cardiac lesions (VSD, PS, tricuspid abnormalities)
How do you define the atria and ventricles?
Valves go with what? L TGA Ventriculoarterial discordance (aorta off RV, PA off LV) with Atrioventricular concordance
315 / million live births, 2nd most common cyanotic congenital heart disease in first year of life1
40% have VSD
Surgical options D TGA Tetralogy of Fallot Pulmonic stenosis
Over-riding aorta
Right ventricular hypertrophy
VSD Congenital Heart Disease Coarctation of Aorta Patent Ductus Arteriosus Classically, five days of fever plus four of five diagnostic criteria must be met in order to establish the diagnosis. The criteria are:
erythema of the lips or oral cavity or cracking of the lips;
rash on the trunk;
swelling or erythema of the hands or feet;
red eyes (conjunctival injection)
swollen lymph node in the neck of at least 15 millimeters Kawasaki's Disease Right aortic Arch with Aberrant Left Subclavian Double Aortic Arch Most common vascular ring
Rarely associated with congenital heart disease
Vascular ring produces tracheal and/or esophageal compression

Symptoms may begin at birth and include
Tracheal compression, or
Difficulty swallowing

Anatomy
Right arch supplies RSCA and RCC
Left arch supplies LCC and LSCA Right Aortic Arch
At least five different types
Only two of importance
Mirror Image Type — Type I
Aberrant left subclavian — Type II

Mirror-image type almost always has associated CHD
Usually Tetralogy of Fallot
Aberrant Left Subclavian type rarely has associated CHD

Most common variety of right arch
Type ll—Aberrant Left Subclavian

Associated with cardiac defects 5-10% of the time
Tetralogy of Fallot most often (71%)
ASD or VSD next most often  (21%)
Coarctation of aorta rarely (7%) AORTA About 10% of all congenital heart lesions
•Most common cause of cyanotic heart
disease beyond neonatal period Squatting
•Dyspnea
•Failure to thrive
•Cyanosis-usually
•Severe cases « at birth « severe PS
•Mild cases « much later « mild PS
•“Pink tets” (acyanotic) and “Blue
tets” (cyanotic) Clinical Findings Second most common cause of
cyanosis in infancy
•Pulmonary and systemic
circulations form two separate
circuits
•Must be mixing between two
circuits for life Clinical Findings Ammar Sarwar Cardiac Imaging Classically, five days of fever plus four of five diagnostic criteria must be met in order to establish the diagnosis. The criteria are:
erythema of the lips or oral cavity or cracking of the lips;
rash on the trunk;
swelling or erythema of the hands or feet;
red eyes (conjunctival injection)
swollen lymph node in the neck of at least 15 millimeters. Cone shaped.

Fine trabeculations: numerous, fine muscular projections.
2 papillary muscles: the anterior lateral and the posterior medial
-The papillary muscles do not attach to the septum.

Inlet: From mitral valve (left ventricular valve) and extends from the atrioventricular junction to the attachments of the prominent papillary muscles.

Apical trabecular portion: is the most characteristic feature of the morphological left ventricle which contains the fine characteristic trabeculations.
- The smooth septal surface also helps in identification, since the morphologically left ventricle never possesses a septomarginal trabeculation or a moderator band.

Outlet portion of the morphologically left ventricle is distinguished by its abbreviated nature. here is no muscular segment of the ventriculoinfundibular fold in the left ventricle such as separates the arterial and the right ventricular valves. Left atrium Left Ventricle 2 chamber 4 chamber Short axis Left ventricular views 3 chamber What makes the left ventricle the left ventricle Smooth septal wall
Fibrous connection between arterial and AV valve
Numerous fine muscular trabeculations What makes the right ventricle the right ventricle? Moderator band along septal wall
Muscular connection between arterial and AV valve
Few coarse trabeculae Arrhythmogenic right ventricular cardiomyopathy Hypertrophic Cardiomyopathy Sudden onset of transient akinesia or dyskinesia of apical (or less frequently
mid portions) left ventricle without significant coronary artery stenosis
Generally occurs following periods of severe emotional or physical stress

AKA
transient apical ballooning syndrome
apical ballooning cardiomyopathy
stress-induced cardiomyopathy Taka-tsubo's Cardiomyopathy Left Ventricle Classically, five days of fever plus four of five diagnostic criteria must be met in order to establish the diagnosis. The criteria are:
erythema of the lips or oral cavity or cracking of the lips;
rash on the trunk;
swelling or erythema of the hands or feet;
red eyes (conjunctival injection)
swollen lymph node in the neck of at least 15 millimeters. Kawasaki's Disease Myocardial Infarction Myocarditis PATHOLOGY
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