Download Interpretation of Paediatric Echo Reports

Acyanotic
Congenital Heart
Disease
Dr David Coleman
Consultant Paediatric Cardiologist
Our Lady’s Children’s Hospital, Crumlin
Dublin
Common Shunt Lesions
♥ Ventricular septal defect (VSD)
♥ Atrial septal defect (ASD)
♥ Patent ductus arteriosus (PDA)
* All 3 lesions can lead to Eisenmenger’s
Syndrome if a large lesion is not detected
and treated early enough
Common Stenotic Lesions
♥ Pulmonary stenosis (PS)
♥ Aortic stenosis (AS)
♥ Coarctation of the aorta (CoA)
VSD’s
♥ Commonest form of CHD
♥ Commonest types:
membranous (perimembranous) ~75%
muscular
♥ Can be single or multiple
VSD’s
♥ Symptoms relate to the degree of shunt
(VSD size, pulmonary vascular resistance)
if small:
no symptoms
if large (high pulmonary blood flow, CHF):
tachypnoea
dyspnoea
slow feeding
failure to thrive
sweating
VSD’s
♥ Exam (smaller VSD):
pink
normal pulses
normal S1 and S2
± systolic thrill
harsh pansystolic murmur LLSE
♥ ECG:
normal (smaller VSD)
or LVH ± RVH (larger VSD)
VSD’s
♥ Larger defect:
MDM @ apex (mitral flow murmur)
narrowly split S2 and loud P2
± S3
CXR: cardiomegaly
increased pulmonary vascularity
VSD’s
♥ Treatment options:
Nil (spontaneous closure)
Surgical closure
Device closure
ASD’s
♥ Three types:
secundum
primum
sinus venosus
♥ Commonest:
secundum
♥ Primum:
a form of atrioventricular
septal (canal) defect
Secundum ASD
♥ Usually no symptoms in childhood
♥ Exam:
pink
normal pulses
wide ± ‘fixed’ split S2
soft ESM @ ULSE
♥ ECG:
incomplete RBBB (95%)
♥ CXR:
often normal
sometimes pulmonary plethora
Secundum ASD
♥ Haemodynamic significance of ASD is
assessed to decide if closure appropriate
♥ Usually closed age 3-5 years (earlier if
symptomatic) or when diagnosed if later
♥ Two options for closure:
surgery - suture or patch
interventional catheter - device
Amplatzer ASD Occluder
PDA
♥ CHF symptoms if large ductus in very young
infant, otherwise often asymptomatic
♥ Exam:
pink
full volume pulses
harsh systolic (1st few weeks) or
continuous ‘machinery’ murmur
loudest under left clavicle
♥ ECG:
normal (small PDA)
LVH ± RVH (large PDA)
PDA
♥ CXR:
± cardiomegaly, pulm plethora
♥ Options for closure:
surgery - ligation
interventional catheter - coil(s) or device
Pulmonary Stenosis
♥ Usually asymptomatic
♥ Exam:
pink
normal pulses
± systolic ejection click
ESM loudest @ ULSE
if severe, S2 widely split (not fixed)
Pulmonary Stenosis
♥ ECG:
RAD, RVH
♥ CXR:
normal
± prominent MPA (post-stenotic
dilatation)
♥ Treatment of valvar PS (moderate/severe):
balloon valvuloplasty preferred
uncommonly surgical valvotomy
Aortic Stenosis
♥ Often asymptomatic;
otherwise SOB, syncope or chest pain on exertion
♥ Exam:
pink
small volume pulse, small pulse pressure
± LV lift
± systolic thrill (suprasternal, URSE)
± systolic ejection click
harsh ESM loudest @ URSE & radiating
to carotids
if severe, narrow split S2 (even reversed)
Aortic Stenosis
♥ ECG:
normal (mild AS)
LVH ± strain (more severe AS)
♥ CXR:
often normal
± dilated ascending aorta
♥ Treatment of valvar AS (moderate/severe):
balloon valvuloplasty
surgical valvotomy
Coarctation of the Aorta
♥ CHF in neonate if severe CoA;
often asymptomatic in older child
♥ Exam:
pink
reduced or absent femoral pulses
soft systolic murmur mid LSE
and/or mid left back
♥ ECG:
RVH in 1st few months of life,
LVH if older
Coarctation of the Aorta
♥ CXR:
cardiomegaly
evidence of CHF
rib notching (older child)
♥ Treatment:
surgery for ‘native’ CoA
balloon angioplasty for re-CoA