Aortic Arch Abnormalities

Transcription

1 Aortic Arch Abnormalities IPOK Norman H Silverman MD, D Sc (Med.). FACC, FAHA. Stanford University & Lucile Packard Children s Hospital E mail: norm.silverman@stanford.edu. NHS.

2 Abnormalities Supravalvar Aortic Stenosis The Aortic Root in Marfan s Syndrome Interruption Hypoplasia High Aortic Arch Arch Laterality Coarctation Vascular Rings

3 Examination Technique A variety views should be used including :- Suprasternal coronal and sagittal imaging, Parasternal and Subcostal views of the aorta and its relations. The Imaging should be complemented by various Doppler modalities including Color flow imaging.

4 Normal Aortic Arch Echo

5 Normal Aortic Arch SSN Sagittal AAo IV RBr RPA D Ao

6 Aortic Arch Laterality Transducer alignment The arch direction follows the plane of the array Innominate Artery The innominate artery always bifurcates on the opposite side to the aortic arch. Lack of bifurcation may indicate that there is an anomalous subclavian artery Tracheal Rings or Esophagus The descending aorta can be recognized by the examiner either to the left (in left aortic arch) or to the right (in right aortic arch)

7 Innominate Artery Shows Arch Position Right Innominate, therefore left arch Left innominate, therefore right arch NHS.

8 Arch Laterality R Arch A Trachea A Left Arch

9 Tracheal Rings

10 Arch Laterality Left Arch Right Arch

11 Routine Arch Sweep

12 Normal Aorta: Color Imaging IV THYMUS TAO LCA AAo LSA LA RPA DAo

13 Supravalvar Aortic Stenosis

14 Supravalvar Aortic Stenosis

15 William s Syndrome

16 William s Syndrome

17 Supravalvar Aortic Stenosis RV LV Ao LA L Ax

18 Supravalvar Aortic Stenosis Ao RV LV Subcost. Coronal Ao P L Ax

19 Bicuspid Aortic Valve & Multiple Dissections

20 Aortic Dissection, Coarctation & Bicuspid Aortic Valve

21 Bicuspid Aortic Valve: Post Stenotic Dilatation AAo AAo LV

22 Marfan s Syndrome

23 Marfan s Syndrome Mariska Kemna

24 Marfan s Syndrome: Dilated Aortic Root RV P Sax. Ao RA LA DAo LX LA RV LA Ao

25 Marfan s Syndrome: Dilated Aortic Root Aortic Regurgitation

26 Marfan s Syndrome: Dilated Aortic Root

27 Marfan s Syndrome: Dilated Aortic Root

28 Coarctation

29 Coarctation Courtesy Diane Spicer

30 Coarctation

31 NHS. Pathological Varieties of Coarctation &Techniques of Display

32 DUCTUS SLING IN COARCTATION

33 Doppler of Coarctation

34 Coarctation A Ao Duct Beak PA Shelf DAo

35 Color Angiogram in Coarctation Tr Ao Arch Innominate Artery RPA L Subclavian Coarctation DAO NHS.

36 HYPOPLASTIC ISTHMUS

37 Ductus &? Coarctation: On Prostaglandin MPA Duct Isthmus LA LPA DAo? Coarct NHS.

38 Coarctation of the Aorta PA TAO DAO OFF PGE1 On PGE1 NHS.

39 Taussig- Bing Malformation and Coarctation IV TAO AAo PA Coarct LA D Ao

40 The Diversity of Coarctation

41 Coarctation-MRI 3 D Reconstruction Courtesy of Dr. Keren Hasbani

42 Coarctation: End - to - Side Anastomosis SSN Cor. IV PA Suture Line D Ao

43 Fifth Aortic Arch

44 PMW 07

45 Interrupted Aortic Arch: Associations Ventricular septal defect Catch 22 Syndrome Truncus arteriosus Aortopulmonary Window Taussig Bing Malformation

46 Aortic Arch Interruption Found with:- 22 Q- Truncus Arteriosus Taussig Bing Aortopulmonary Window VSD C B A

47 Aortic Arch Interruption

48 Type B Interruption AAo LSA PA D

49 Type B Interruption: Ductus & Descending Aorta MPA AAo LSA LA D A O Duct

50 Interrupted Aortic Arch Sagittal Plane Imaging MPA R L D LA D A O NHS.

51 INTERRUPTED ARCH TYPE B In. Vn In. A LSA AAo Duct D Ao

52 Interrupted Arch: 2 Different Doppler Signals a NHS.

53 Truncus with Interrupted Aortic Arch D A Ao LPA Tr RV * LV

54 The VSD in Interruption & Coarctation A4Ch. Ao P Lx RV LV RV LV Ao In Coarctation and interruption of the aortic arch, all the woe, lies below! Richard Van Praagh. LA

55 Arch Embryology

56 Arch Embryology

57 Right Aortic Arch Left Arch: Cervical Arch and Right Ductus

58 High ( Cervical ) Arch Right PA

59 Right PA High ( Cervical ) Arch

60 RAA- LPDA ALSCA DAA

61 Bronchoscopy RT Mainstem Bronchus Compression LT RT

62

63 Coronal Scan

64 Double Aortic Arch R L AAO

65 Double Aortic Arch

66 Fetal Double Aortic Arch

67 Double Aortic Arch

68 L Duct, Right Ao Arch

69 Interrupted Aortic Arch, R Desc. Ao & R Duct- Another Bronchial Vise

70 Right Arch with Aberrant Left Subclavian Left subclavian Left ductus Diverticulum of Kommerell's RING CP

71 Right Arch Mirror-image Branching and No Ring Right Arch Mirror Image Branching Left ductus From innominate NO RING CP

72 Right Aortic Arch Aberrant L subclavian artery and L arterial duct

73 Left Aortic Arch with Aberrant Right Subclavian Aberrant RT SCA CP

74 Left Duct with Right Aortic Arch

75 Resection of Kommerell s diverticulum and left subclavian artery transfer for recurrent symptoms after vascular ring division C.L. Backer, N. Hillman, C. Mavroudis, L.D. Holinger EJCTS Reoperations 7 Primary operations

76 Kommerell s Diverticulum

77 Kommerell s Diverticulum Aortic diverticulum

78 Left Ductus: Right Arch Potentially Isolated L subclav. Art NHS.

79 BILATERAL DUCTS WITH ABSENT CENTRAL PA S

80 Bilateral Ductus

81 Bilateral Ducts & Absent Central PA s Left Innominate and Duct Right Arch and Duct

82 MAPCA s LA D A O S Cost Sagittal S Sost Coronal P Sx

83 Pulmonary Artery Sling Front Back

84 CT Bronchial Tomography

85 Pulmonary artery Sling ECHO LPA

86 PA Sling

87 Pulmonary Artery Sling RPA LPA

88 Pulmonary Artery Sling PSX AO MPA RPA AO MPA LPA RPA LPA

89 Thank You!