B O S S CHD prevalence rate at birth 6.16 per live births
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1 Coarctation of the Aorta (COA)
2 B O S S CHD prevalence rate at birth 6.16 per live births
3 COA coarctation of the Aorta LV
4 Coarctation of the Aorta with PDA without PDA Prominent posterior infolding/shelf Simple Complex: + VSD, AS, MS, CTA sin.
5 Coarctation of the Aorta Diagnosis may be difficult If PDA opened no discrepant pulses no murmur heart is normal COA is hidden by PDA PGE
6 LV dysfunction Diminished stroke volume of LV Increased LVEDP, LAp Pulmonary venous congestion - PAH Dimin. i Myocardial perfusion - metabolic acidosis i Compensatory mech.: LVEDV/Frank-Starling m, HR, MYO contr
7 Coarctation of the Aorta Neonatal Adult Symptoms Heart failure Hypertensis UE Murmur - + Discrepant pulses + / - (PDA) + Differential cyan. + / - (PDA, VSD) - RTG cardiomegaly Rib notching ECG dominant RV Hypertr. LV Imaging ECHO ACG, MRI
8 Critical COA, newborn
9 Critical COA
10 Critical COA, newborn
11 Pharmacological promote of PDA patency Prostaglandin E1 (Aloprostan) in continual i.v. infusion Inicial dose 0,025 µg/kg/min., maintaining 0, µg/kg/min. CAVE: apnoic pause, hyperpyrexia
12 Critical newborn, PDA - prostaglandin
13 Angiocardiografy g Neonatal COA + hypoplastic aortic arch + patent PDA
14 Treatment/COA Resection/COA + anastomosis end-to-end Subclavian flap aortoplasty - Waldhausen s technique Resection/COA + reversal Waldhausen aortoplasty. t Aortic arch aortoplasty using a homograft Extraanatomical by-pass Pulmonary banding at 1/3 operated newborns (complex coarctations ti with a large left-to-right t shunt
15 COA resection and anastomosis end-to-end
16 Waldhausen s aortoplasty of the aortic isthmus
17 COA resection and reversal Waldhausen s aortoplasty
18 COA resection and aortic arch aortoplasty Amato s technique
19 Asymmetric 4CH view, foetus /COA 26th W. RA LA RV LV
20 Stenosis of aortic isthm COA/ foetus 26.th W AO * LA COA DAO
21 Coarctation of the Aorta Neonatal Adult Symptoms Heart failure Hypertensis UE Murmur - + Discrepant pulses + / - (PDA) + Differential cyan. + / - (PDA, VSD) - RTG cardiomegaly Rib notching ECG dominant RV Hypertr. LV Imaging ECHO ACG, MRI
22 Diastolic runoff patern - DAO
23 LCAR AOA COA RPA DAO
24 Diastolic runoff patern - COA 4.2 m/s (70 torr)
25 Severe adult coarctation of the aorta Rib notching
26 Extraanatomical by-pass
27 Balloon Angioplasty/ RECOA
28 1999 APL RECOA: aneurysm 2004
29 30 o RAO, 20 o CAUD. Stenting ti RECOA
30 Interrupted aortic arch (IAA)
31 Embryonic arch diagram
32 Interrupted aortic arch A1 B1 C1 B2 B1 RAA
33 Interrupted aortic arch
34 Interrupted aortic arch
35 Interrupted aortic arch p Fetal dg.
36 Interrupted aortic arch Fetal dg.
37 Interrupted aortic arch B1 RCAR BCT LCAR LCAR RSA AO PA * DAO A B C
38 Interrupted aortic arch A1 LCAR AOA LSA PA * DAO
39 *
40 Interrupted aortic arch Symptoms and treatment = neonatal COA Diagnosis heart failure ECG: dominant RV RTG: kardiomegaly, pulmonary vascularity Differential cyanosis (not in a large VSD) Treatment anastomosis DAO and AOA VSD closure
41 Persistent Truncus Arteriosuss (PTA)
42 PTA - persistent truncus arteriosus
43 Persistent truncus arteriosus
44 Persistent truncus arteriosus
45 Persistent truncus arteriosus
46 Persistent truncus arteriosus
47 Persistent truncus arteriosus
48 PTA - persistent truncus arteriosus
49 Persistent truncus arteriosus
50 Persistent truncus arteriosus Clinical features cyanosis heart failure Accentuated periph.pulses ( diastole!) click, murmur, continuous AS, AI ECG: biventricular hypertrophy, dominant RV RTG: cardiomegaly, pulmonary congestion Treatment t VSD closure, truncal valve - LV Conduit RV pulmonary arteries
51 Anomalous pulmonary venous connection (Total: TAPVC) (Parcial: PAPVC)
52 Total anomalous pulmonary venous connection Intracardiac infracardiac (infradiafragm.) supracardiac
53 TAPVC - totální anomální návrat plicních žil
54 Supracardiac TAPVC (LVV)
55 Supracardiac TAPVC (LVV)
56 Supracardiac TAPVC (LVV)
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