A SURGEONS' GUIDE TO CARDIAC DIAGNOSIS

Transcription

1 A SURGEONS' GUIDE TO CARDIAC DIAGNOSIS PART II THE CLINICAL PICTURE DONALD N. ROSS B. Sc., M. B., CH. B., F. R. C. S. CONSULTANT THORACIC SURGEON GUY'S HOSPITAL, LONDON WITH 53 FIGURES Springer-Verlag Berlin Heidelberg GmbH 1967

2 ISBN ISBN (ebook) DOI / All rights, especially that of translation into foreign langnages, reserved. It is also forbidden to reproduce this book, either whole or in part, by photomechanical means (photostat, microfilm and/or microcard) or by other procedure without written permission from Springer-Verlag by Springer-Verlag Berlin Heidelberg Originally published by Springer-Verlag Berlin Heidelberg New York in Library of Congress Catalog Card Number Title-No. 1361

3 Foreward to Part II Since Part I of this book was written, cardiac surgery has progressed rapidly, although the principles of diagnosis remain unchanged. At the same time cardiac surgeons have largely graduated from the role of operating technicians to that of practical cardiologists, having made many contributions in the fields of diagnosis and treatment. For this reason the scope of this book is now too elementary and limited to be of particular value to cardiac surgeons, but it is hoped that it will outline their every day problems and serve as a guide to students and postgraduate trainees. I am indebted to Dr. Hywel Davies for reading the manuscript and to my secretary, Mrs. K. Hasler, for her help and advice. London, April 1967 D.N. R.

4 Part II: The Clinical Picture Introduction Section I Congenital Heart Disease Cyanotic Congenital Heart Disease Fallot's Tetralogy. Anatomy Pulmonary valve stenosis with closed septum and reversed atrial shunt Transposition of the great vessels 3. Eisenmenger syndrome 4. Tricuspid atresia Total anomalous pulmonary venous drainage 6. Truncus arteriosus Pulmonary arterio-venous fistula 8. Ebstein's anomaly Pulmonary Stenosis with a Reversed Atrial Shunt Anatomy... Differential Diagnosis. Eisenmenger's Syndrome Anatomy.... Symptomatology

5 Differential Diagnosis within the Eisenmenger Group Indications for Surgery Transposition of the Great Vessels..... Anatomy and Embryology Differential Diagnosis. Principles of Treatment. Corrected Transposition. Total Anomalous Pulmonary Venous Drainage..... Anatomy and Embryology Ebstein's Disease.... Symptomatology... Principles of Treatment. Acyanotic Congenital Heart Disease. Obstructive Lesions Pulmonary Stenosis. Anatomy..... Functional Right Ventricular Obstruction. Congenital Aortic Stenosis Anatomy..... Indications for Surgery v

6 VI Functional Aortic Stenosis (Hypertrophic, Aortic Stenosis). 37 Coarctation of the Aorta. 38 Definition. 38 Types 38 Anatomy Indications for Treatment Left-to-right Shunts. 41 Persistent Ductus Arteriosus Anatomy Indications for Surgery Atrial Septal Defect. 45 Anatomy Persistent Foramen Ovale Fossa Ovalis (Ostium Secundum) Defect 46 Ostium Primum Atrial Septal Defect (see Endocardial Cushion Defcct) 48 Sinus Venosus Atrial Septal Defect Differential Diagnosis of Atrial Septal Defect Differential Diagnosis within the Atrial Septal Defect Group. 49 Indications for Treatment Anomalies of Pulmonary Venous Drainage 50 Endocardial Cushion Defects 51 Embryology Indications for and Principles of Treatment 53 Ventricular Septal Defect 53 Definition.. 53 Classification 53 Anatomy The Pulmonary Artery Pressure in Ventricular Septal Defect Indications for Surgery -60 Principles of Treatment 61

7 VII Aortopulmonary Defect Anatomy.... Truncus Arteriosus Embryology Section II Acquired Heart Disease..... Traumatic Lesions of the Heart Inflammatory Lesions Rheumatic Mitral Valve Disease Mitral Stenosis.. Pathology.. Principles of Treatment. Congenital Mitral Stenosis. Mitral Regurgitation. Pathology and Principles of Treatment Rheumatic Aortic Stenosis Definition and Pathology.... Principles of Treatment Subaortic Stenosis Aortic Regurgitation Pathology

8 VIII Principles of Treatment. Tricuspid and Pulmonary Valve Disease Constrictive Pericarditis Pathology Principles of Treatment Ischaemic Heart Disease. Surgery of the Major Blood Vessels Arterial Embolism Aortic Aneurysm.... Obliterative Disease of the Arteries Index