Echocardiography in Adult Congenital Heart Disease

Transcription

1 Echocardiography in Adult Congenital Heart Disease Michael Vogel Kinderherz-Praxis München

2 CHD missed in childhood Subsequent lesions after repaired CHD Follow-up of cyanotic heart disease

3 CHD missed in childhood Atrial septal defect, Sinus venosus defect Coarctation of the Aorta

4 Atrial septal defect Sinus venosus Defect 18-23% present with atrial flutter

5 Atrial septal defect RV LV RV LV Long axis 4 chamber

6 Atrial septal defect RV Transoesophageal

7 3D transthoracic echo Anatomic Specimen 3D Echo

8 Sinus Venosus defect LA LA RA RA Subcostal

9 Sinus Venosus defect Subcostal Transoesophageal

10 Coarctation of the Aorta treatable cause of Hypertension

11 Coarctation of the aorta MRI best Image Blood pressure and femoral artery pulse most important

12 Coarctation of the aorta difficult imaging of aortic arch in adults

13 Coarctation of the aorta Doppler gradient more diagnostic

14 Coarctation of the aorta Abnormal Doppler flow in abdominal aorta

15 Subsequent lesions in repaired CHD DCRV SubAS after surgical or spontaneous closure of VSD

16 Perimebranous VSD 4 Chamber view in 2000 Spontaneous closure 11 years ago (2001) New murmur, Normal P 2 ECG: RVH

17 Echocardiography of adult congenital heart disease Double chambered right ventricle RV RA Ao Short axis in 2012

18 Echocardiography of adult congenital heart disease Double chambered right ventricle RA RV RV Subcostal

19 Echocardiography of adult congenital heart disease Subaortic Stenosis Ao Ao LV LV 4 chamber view

20 Echocardiography of adult congenital heart disease Follow-up of Common cyanotic heart defects Tetralogy of Fallot Transposition after atrial repair

21 Echocardiography of adult congenital heart disease Tetralogy of Fallot

22 Echocardiography of adult congenital heart disease Tetralogy of Fallot Pulmonary regurgitation with RV Dilatation TV incompetence RV dysfunction LV dysfunction Aortic root dilatation

23 Echocardiography of adult congenital heart disease Tetralogy of Fallot Pulmonary regurgitation leads to RV Dilatation and TV incompetence

24 RV Function: Volumetric data by transthoracic 3D-echo Echocardiography of adult congenital heart disease Tetralogy of Fallot

25 Echocardiography of adult congenital heart disease Tetralogy of Fallot RV Function: TAPSE

26 Echocardiography of adult congenital heart disease Tetralogy of Fallot s-wave e- wave a-wave RV Function: TAPSE and myocardial Doppler

27 Echocardiography of of adult congenital heart disease Tetralogy of Fallot LV Ao Aortic root dilatation

28 Echocardiography of adult congenital heart disease Transposition after atrial repair Baffle obstruction Tricuspid valve Dysfunction Systemic (right ventricular) dysfunction

29 Measurement of IVA and pressure-volume loops s wave 0 e wave a wave Myocardial Doppler Conductance catheter

30 Dobutamine 10 mcgs/kg/min Baseline Before IVA= 7m/s 2 During IVA= 2.8m/s Pressure Volume Ees 2.8 ml/mmhg Ees 1.8 ml/mmhg

31 Correlation between change in IVA and end-systolic elastance in 12 patients with TGA after Mustard 400 % Change IVA r = 0.68 p < % Change Ees

32 Thank you for your attention

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