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CONGENITAL AORTIC DISEASE

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LOOK FOR KINK OF DESCENDING AORTA ON LATERAL CHEST RADIOGRAPH. MEASUREMENT OF GRADIENT ACROSS KINK MAY BE NECESSARY TO DIFFERENTIATE FROM COARCTATION ... – PowerPoint PPT presentation

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Title: CONGENITAL AORTIC DISEASE


1
CONGENITAL AORTIC DISEASE
2
EMBRYOLOGY HYPOTHETICAL DOUBLE AORTIC ARCH
(Edward JE)
3
NORMAL LEFT AORTIC ARCH DEVELOPMENT
4
AORTIC ANOMALIES
5
AORTIC ARCH ANOMALIES
  • RIGHT ARCH
  • DOUBLE ARCH
  • CERVICAL ARCH
  • COARCTATION
  • INTERRUPTED AORTIC ARCH
  • PSEUDOCOARCTATION
  • ABERRANT RIGHT SUBCLAVIAN ARTERY
  • PATENT DUCTUS ARTERIOSIS

6
AORTIC ARCH ANOMALIES PRESENTATION
  • VASCULAR RING
  • STRIDOR, WHEEZE, INFECTION, DYSPHAGIA
  • ASSOCIATED CARDIAC DISORDERS
  • CYANOSIS, CONGESTIVE HEART FAILURE

7
RIGHT AORTIC ARCH MOST COMMON TYPES
  • MIRROR IMAGE
  • ABERRANT LEFT SUBCLAVIAN
  • ISOLATED LEFT SUBCLAVIAN

8
MIRROR IMAGE RIGHT AORTIC ARCH
9
MIRROR IMAGE RIGHT AORTIC ARCH DEVELOPMENT
10
MIRROR IMAGE RIGHT AORITIC ARCH IN ASYMPTOMATIC
ADULT
11
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12
MIRROR IMAGE RIGHT AORTIC ARCH
  • CYANOTIC HEART DISEASE IN 98
  • TETRALOGY, TRUNCUS, TRANSPOSITION,TRICUSPID
    ATRESIA
  • RARE...VASCULAR RING NO HEART DEFECT
  • INDENTS RIGHT SIDE OF TRACHEA ESOPHAGUS

13
ABERRANT LEFT SUBCLAVIAN RIGHT AORTIC ARCH

14
ABERRANT LEFT SUBCLAVIAN RIGHT AORTIC ARCH
DEVELOPMENT
15
ABERRANT LEFT SUBCLAVIAN RIGHT AORTIC
ARCH ASYMPTOMATIC ADULT
16
ABERRANT LEFT SUBCLAVIAN RIGHT AORTIC
ARCH ASYMPTOMATIC ADULT
17
AB LEFT SUBCLAVIAN RIGHT ARCH ANEURYSM OF LEFT
SUBCLAVIAN ARTERY
18
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19
ABERRANT LEFT SUBCLAVIAN RIGHT AORTIC ARCH
  • MOST COMMON RIGHT ARCH
  • RARELY CAUSES SYMPTOMS
  • RARELY FORMS A VASCULAR RING THAT AFFECTS ESOPH,
    TRACHEA
  • DIVERTICULUM OF KOMMERELL
  • INDENTS POSTERIOR ESOPHAGUS

20
ISOLATED LEFT SUBCLAVIAN RIGHT AORTIC ARCH

21
ISOLATED LEFT SUBCLAVIAN RIGHT AORTIC ARCH
DEVELOPMENT
22
ISOLATED LEFT SUBCLAVIAN ARTERY RIGHT AORTIC
ARCH SIGNS AND SYMPTOMS OF LEFT ARM ISCHEMIA
23
ISOLATED LEFT SUBCLAVIAN RIGHT AORTIC ARCH
  • RARE CAUSE OF ARM ISCHEMIA
  • DECREASED PULSE, FATIGUE, DISCOMFORT
  • SUBCLAVIAN STEAL SYNDROME

24
DOUBLE AORTIC ARCH
25
DOUBLE AORTIC ARCH DEVELOPMENT
26
DOUBLE AORTIC ARCH CHILD WITH RECURRENT PNEUMONIA
27
DOUBLE AORTIC ARCH CHILD WITH DYSPHAGIA
28
64-YEAR-OLD WOMAN BROUGHT TO ER AFTER MVA
29
ASYMPTOMATIC ADULT
30
DOUBLE AORTIC ARCH
  • MOST COMMON COMPLETE VASCULAR RING
  • STRIDOR, WHEEZE, INFECTION, DYSPHAGIA
  • CONGENITAL HEART DISEASE IS RARE
  • INDENTATION OF BOTH SIDES ESOPHAGUS

31
CERVICAL AORTIC ARCH
32
CERVICAL AORTIC ARCH
  • RIGHT AORTIC ARCH
  • LEFT AORTIC ARCH

33
CERVICAL AORTIC ARCH
34
CERVICAL ARCH RIGHT SUBCLAVIAN FROM DIVERTICULUM
35
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36
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37
RIGHT CERVICAL ARCH ABERRANT LEFT SUBCLAVIAN
ARTERY
38
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39
CERVICAL AORTIC ARCH
  • OFTEN NO SYMPTOMS
  • TRACHEAL OR ESOPHAGEAL COMPRESSION
  • WHEEZING, STRIDOR, COUGHING
  • CHOKING, RECURRENT PNEUMONIA
  • PALPABLE SUPRACLAVICULAR MASS
  • CONGENITAL HEART DISEASE
  • TEF, VSD, PDA
  • COARCTATION OF DESCENDING AORTA

40
COARCTATION
41
COARCTATION
  • 5 OF CONGENITAL HEART DISEASE
  • POSTDUCTAL
  • ADULT TYPE
  • COARCTATION DISTAL TO DUCTUS OR LIGAMENTUM
    ARTERIOSUM
  • JUXTADUCTAL
  • INFANTS AND CHILDREN
  • HYPOPLASIA OF TRANSVERSE AORTIC ARCH AND AORTIC
    ISTHMUS.
  • DUCTUS AT AREA OF COARCTATION
  • AORTIC ARCH INTERRUPTION
  • 95 HAVE PDA, 50 HAVE VSD

42
COARCTATION
  • AORTIC KNOB
  • FIGURE 3 AORTIC KNOB
  • DILATED ARTERIES
  • COLLATERALS ARTERIES
  • LEFT SUBCLAVIAN ARTERY
  • ASCENDING AORTA
  • RIB NOTCHING
  • LEFT VENTRICLE
  • HYPERTROPHY
  • ENLARGEMENT

43
FIGURE 3 AORTIC KNOB PRE AND POST STENOTIC
DILATION
44
COARCTATION FIGURE 3 AORTA KNOB
45
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46
COLLATERAL VESSELS
47
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48
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49
COARCTATION
50
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51
COARCTATION LEFT VENTRICULAR ENLARGEMENT
52
CHEST RADIOGRAPH DILATED LEFT SUBCLAVIAN ARTERY
53
RIB NOTCHING
54
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55
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56
W???
57
34-YEAR-OLD MAN AUTOMOBILE ACCIDENT
58
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59
COARCTATION
  • AORTIC VALVE
  • MAJORITY DEFORMED OR BICUSPID
  • 10 HAVE CEREBRAL ANEURYMS
  • AORTIC DISSECTION
  • CHD HEART DISEASE COMMON
  • ASSOCIATED ANOMALIES
  • TURNER SYNDROME,

60
HEMOPTYSIS 10 YEARS POST COARC REPAIR AORTOBRONCHI
AL FISTULA
61
COARCTATION VERSUS PSEUDOCOARCTATION
62
PSEUDOCOARCTATION
63
PSEUDOCOARCTATION
  • KINK AT INSERTION SITE OF LIGAMENTUM ARTERIOSUM
  • MINIMAL GRADIENT ACROSS DEFORMITY

64
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65
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66
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67
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68
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69
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70
PSEUDOCOARCTATION
  • ARCH BUCKLED AT LIG. ARTERIOSUM

71
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72
PSEUDOCOARCTATION
  • MOST OFTEN DISCOVERED AS A MEDIASTINAL MASS ON PA
    CHEST RADIOGRAPH
  • LOOK FOR KINK OF DESCENDING AORTA ON LATERAL
    CHEST RADIOGRAPH
  • MEASUREMENT OF GRADIENT ACROSS KINK MAY BE
    NECESSARY TO DIFFERENTIATE FROM COARCTATION

73
  • ABERRANT
  • RIGHT SUBCLAVIAN ARTERY

74
ABERRANT RIGHT SUBCLAVIAN ARTERY DEVELOPMENT
75
ABERRANT RIGHT SUBCLAVIAN ARTERY
76
ABERRANT RIGHT SUBCLAVIAN ARTERY
  • MOST COMMON ARTERIAL ANOMALY IN CHEST
  • ALMOST ALWAYS AN INCIDENTAL FINDING
  • OBLIQUE INDENTATION, POSTERIOR ESOPHAGUS
  • CAN OCCUR WITH OTHER ANOMALIES

77
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78
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79
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80
ABERRANT RIGHT SUBCLAVIAN ART AORTIC DISSECTION
81
LIGAMENTUM ARTERIOSUM
82
BOVINE AORTIC ARCH
83
THE END
84
PATENT DUCTUS ARTERIOSIS
85
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86
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87
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