A rare case in a rural doctor’s office
I see some odd things in my clinic. One recent diagnostic dilemma was a man in his late fifties with shortness of breath.
He had been born with a ventricular septal defect and had undergone surgery for this in his infancy. During his lifetime, he had seldom gone to doctors and always thought he was in fairly good health, maybe just of a weak constitution. A smoker since age 13, he had a morning cough and got a little winded running up and down the basement stairs or shoveling snow in the winter.
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Source: Kevin, M.D. - Medical Weblog - May 2, 2015 Category: Journals (General) Authors: A Country Doctor, MD Tags: Conditions Primary care Pulmonology Source Type: blogs
Cardiac Surgeon Prints 3D Heart to Prep for Challenging Surgery
MRI of patient’s heart used to build the 3D printed model.
Though ventricular septal defects are fairly common and surgically treated, it’s best to plan the approach ahead of time. Since it’s usually done once the patient is opened and on bypass, there’s critical time wasted analyzing the anatomy and deciding on a plan. Richard Kim, a cardiac surgeon at Children’s Hospital Los Angeles (CHLA) , faced with a patient that had an unusual defect in the heart decided to print a 3D model of the actual heart produced from an MRI of the organ.
The replica allowed Dr. Kim to work out the best app...
Source: Medgadget - January 30, 2015 Category: Technology Consultants Authors: Editors Tags: in the news... Source Type: blogs
Rastelli procedure
Brief Review
Abstract: Rastelli procedure is done in cases of D-Transposition of great arteries with left ventricular outflow tract obstruction and ventricular septal defect, when arterial switch is not feasible.
Rastelli procedure is done in case of D-Transposition of great arteries (D-TGA) with ventricular septal defect and left ventricular outflow obstruction as arterial switch is not feasible. The ventricular septal defect is widened and the infundibular septum resected, followed by baffling of the left ventricle to the aorta.1
In the series of forty patients reported by Brown JW and associates2, the right ventricul...
Source: Cardiophile MD - January 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery d-TGA D-TGA with LV outflow obstruction Rastelli procedure Straddling tissue from tricuspid valve across the LV ouflow tract Source Type: blogs
Hepato clavicular view for left ventriculography
Brief Review
Abstract: LAO (left anterior oblique) 40 degrees with 40 degrees cranial angulation is known as hepato clavicular view. It is used to profile inlet ventricular septal defects.
Hepato clavicular view with forty degree left anterior oblique and forty degree cranial angulation is used for visualizing the inlet ventricular septum. It is thus needed to see atrioventricular septal defects (endocardial cushion defects) and posterior muscular ventricular septal defects. This view has more cranial angulation and less lateral angulation than a conventional left anterior oblique (LAO) view. LAO view for aortography t...
Source: Cardiophile MD - January 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Source Type: blogs
Obligatory right to left shunt at the atrial level
Short Notes
Abstract: Obligatory right to left shunt at the atrial level occurs in tricuspid atresia, pulmonary atresia with intact interventricular septum and total anomalous pulmonary venous connection.
Obligatory right to left shunt at the atrial level means that the right to left shunt is mandated by the physiology in such a way that postnatal survival is not possible without that shunt.
Tricuspid atresia
The obligatory right to left shunt at atrial level is needed in tricuspid atresia because there is no other outlet for the right atrium. Blood returning to the right atrium from the vena cavae and coronary sinus rea...
Source: Cardiophile MD - January 11, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology obligatory right to left shunt at the atrial level TAPVC tricuspid atresia Source Type: blogs
Coronary sinus atresia
Brief Review
Abstract: Coronary sinus atresia is usually a congenital anomaly. Sometimes it is acquired, due to an AV fistula involving the middle cardiac vein which becomes grossly enlarged and impinges on the coronary sinus ostium and closes it off.
Congenital atresia of the right atrial ostium of the coronary sinus can lead to different pathways for drainage of coronary venous outflow. In some cases, coronary venous outflow may move through a persistent left superior vena cava into the left brachiocephalic vein. From the left brachiocephalic vein it reaches the right atrium through the right superior vena cava.1,2 In...
Source: Cardiophile MD - January 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Indicators of large left to right shunt
Brief Review
Abstract: Indicators of a large left to right shunt are cardiac enlargement, presence of flow murmurs and third heart sound and a wide pulse pressure in case of patent ductus arteriosus.
Left to right intracardiac or extracardiac shunts typically increase the pulmonary blood flow. In a large left to right shunt, the Qp/Qs (ratio of pulmonary to systemic blood flow) is more than 2:1. Features of large shunts depends on the level of the shunt and also whether it is pre-tricuspid (before the tricuspid valve) or post tricuspid. The pre-tricuspid shunts are shunts at the level of great veins and at the atrial lev...
Source: Cardiophile MD - December 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Cardiac enlargement flow murmurs large left to right shunt third heart sound Wide pulse pressure Source Type: blogs
Echocardiogram after TOF repair
Echocardiogram with video
Post TOF repair echo in PLAX view
Echocardiogram after repair of Tetralogy of Fallot (TOF) from the parasternal long axis (PLAX) view showing the hyperechoic region of the patch which was used to close the ventricular septal defect. The aortic over-ride is no more present. Ao: aorta; RV: right ventricle; LV: left ventricle; LA: left atrium.
Post TOF repair M-mode echo
M-mode echocardiogram after repair of TOF showing the abnormal septal motion which is biphasic and not in line with the movement of the posterior wall which shows regular contractions and relaxations.
Mild PR after TOF repair
The s...
Source: Cardiophile MD - December 19, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs
Normal colour Doppler echocardiogram – video
Normal colour Doppler echocardiogram
Echocardiogram video with detailed explanation
Echocardiogram in parasternal long axis view
Parasternal long axis view is usually the first view obtained during echocardiography. It is obtained by keeping the transducer in the left parasternal region, with the subject in the left lateral position. The beam cuts the heart in its base to apex axis (long axis). Aortic root (Ao) and valves, left ventricle (LV), left atrium (LA), mitral valve, chordae tendinae, papillary muscles, interventricular septum (IVS) and part of the right ventricle are imaged in this view. Cross section of the de...
Source: Cardiophile MD - December 19, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs
Ellis-van Creveld syndrome
Ellis-van Creveld syndrome is an autosomal recessive disorder with single atrium as the hallmark cardiovascular defect. Single atrium is sixty percent of the cases. Other cardiac defects like those of mitral and tricuspid valve, patent ductus arteriosus, ventricular septal defect and even hypoplastic left heart syndrome have been described.
The affected individuals have short limbs and hence short stature, short ribs, polydactyly and dysplasia of teeth and nails. The syndrome was described by Richard WB Ellis and Simon van Creveld [Ellis RWB and van Creveld S. A syndrome characterized by ectodermal dysplasia, polydactyly,...
Source: Cardiophile MD - November 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Cardiology MCQ: Ellis-van Creveld syndrome
Most common cardiac anomaly in Ellis-van Creveld syndrome:
a) Ventricular septal defect
b) Patent ductus arteriosus
c) Single atrium
d) Single ventricle
Correct Answer:c) Single atrium
Single atrium is seen in 40 – 60% cases of Ellis-van Creveld syndrome. Other cardiac defects like those of mitral and tricuspid valve, patent ductus arteriosus, ventricular septal defect and even hypoplastic left heart syndrome have been described. Mutations in two genes – EVC and EVC2 situated on the same chromosome have been documented in Ellis-van Creveld syndrome. It is an autosomal recessive disorder. Other features are sho...
Source: Cardiophile MD - November 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Plastic bronchitis
Plastic bronchitis is seen after:
a) ASD repair
b) Arterial switch
c) Fontan repair
d) VSD closure
Correct answer: c) Fontan repair
Plastic bronchitis is characterised by marked obstruction of the large airways due to the formation of bronchial casts with rubber like consistency. Elevated central venous pressure leading to endobronchial lymph leakage is thought to be the mechanism of plastic bronchitis in post Fontan state. Plastic bronchitis can occur in those without heart disease as well. In those due to inflammatory lung disease, the casts are cellular (type I casts) while in those with underlying heart disease, the ca...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Gibson’s area
Gibson’s area is:
a) 1st left intercostal space, left sternal edge
b) 2nd left intercostal space, left sternal edge
c) 3rd left intercostal space, left sternal edge
d) 4th left intercostal space, left sternal edge
Correct answer: a) 1st left intercostal space, left sternal edge
Gibson’s area: 1st left intercostal space, left sternal edge, where the Gibson’s murmur (continuous murmur of patent ductus arteriosus) is best heard.
2nd left intercostal space, left sternal edge is the pulmonary area where the events from the pulmonary valve like pulmonary component of second heart sound, murmurs of pulmonary ste...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
VSD with pulmonary atresia : Management issues
VSD with Pulmonary atresia is a complex form of cyanotic heart disease .Though it’s a close companion of Tetrology of Fallot physiologically, it is a vastly different entity in embryological and anatomic terms.
TOF is cono truncal anomaly where abnormal anterior displacement of conal septum result in malalignment VSD, RVOT obstruction ,aortic override and RVH.
While ,pulmonary atresia with VSD is not a primary cono truncal anomaly, the defect occurs much earlier than TOF in fetal life , where the origin of PA fails to materialise,(Fetal arteritis?) and which triggers a series of anatomical disarray in pulmona...
Source: Dr.S.Venkatesan MD - November 23, 2014 Category: Cardiology Authors: dr s venkatesan Tags: cardiology congenital heart disese aorto pulmonary collaterals hemoptysis in mapcas pulmonary atresia and vsd K S murthy KM cherian madras medical mission Innova children's hospital pulmonary atresia vsd tetrology single vs multiple stage unifocal Source Type: blogs
