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complicated congenital cardiac disease

Posted Sun, 05/24/2009 - 06:42 by xiaomei zhu
Images

figure 1

figure 2

figure 3

figure 4


Clinical History:

male, 33 years old. He has cyanosis and figure clubbinig for many years. Ultrasound suggested that he had complicated heart disease but the detail was not known.


Findings:

figure1: right atrium collecting boold from superior and inferior vena cava drains into left ventricle instead of right ventricle.

figure2: pulmonary artery and aorta arise from left cventricle(double outlet of LV) and there is a ventrical septal defect between  the large left ventricle and small right ventricle.

figure3: aorta is located right anteriorly to pulmonary artery(transposition of the large artery)

figure4: right coronary artery and left main coronary artery originate from right and left coronary sinus normally.


Diagnosis:

1 right atrium draining to left ventricle and VSD

2 double outlet of left ventricle

3 transposition of great artery


Discussion:

Cardiovascular imaging is a rapidly evolving field that requires familiarity with the appearances of pediatric and adult cardiovascular diseases on chest  radiographs as well as images obtained with computed tomography, magnetic resonance imaging, and angiography. To accurately identify congenital  bnormalities affecting the heart and vessels of the thorax, radiologists must recognize the imaging features and understand their pathophysiologic origin.

there are several tips for detecting congenital malformations of heart, which are summarized by our cardiovascular group in our hopital.

1 contrast media delivery: high flow rate at first period, low flow rate at second period and saline flash at the last period to make sure there is proper contrast media filling in right heart and superior vena cava.

2 scan protocol: we suggest using descending aorta at the diaphgramatic level to monitor the contrast media during bolus tracking. The scan should cover thoracic inlet and cardiac apex. the direction is caudocranial to reduce motion artifact due to bad breath hold. Temporal resolution should be high enough to reduce the cardiac motoin artifact. We use dual source CT and protocol is chest pain which can reduce X-ray radiation and offer better images of heart and vessels including coronary arteries.

3 dignosis: we should observe pulmonary circulation and systemic circulation very detailly. Four chamber of heart, pulmonary draining , superior and infeiror vena cava draining. aorta , pulmonary artery and coronary artery should be checked one by one.


References / Suggested Reading:

No.


Author

xiaomei zhu

resident

the first affiliated hospital of Nanjing medical university