A power point presentation about common cardiac anomalies with diagrammatic illustrations.

1. CLASSIC IMAGING SIGNS OF CONGENITAL CARDIOVASCULAR ABNORMALITIES MOHAMMA D AMIR JJM MEDICAL COLLEGE DAVANGERE INDIA 1

2. Figure 1. Transposition of the great arteries compared with normal anatomy. (a) Chest radiograph obtained in a neonate shows narrowing of the superior mediastinum, enlargement of the cardiac silhouette with abnormal convexity of the right atrial border, and increased vascular flow—typical features of transposition of the great arteries. (b) Same image as a with a superimposed drawing shows the characteristic cardiomediastinal silhouette: the egg-on-a-string sign. (c) Chest radiograph obtained in another neonate shows the normal appearance of the mediastinum, with a normal thymic shadow. (d) Drawing shows the pattern of blood flow (arrows) through the heart with transposition of the great arteries. The aorta (1) arises from the right ventricle (2), and the pulmonary artery (3) arises from the left ventricle (4). Communication between the systemic and the pulmonary circulation—an interatrial septal defect (5), an interventricular septal defect (6), or both—sustains life by allowing oxygenated blood from the left atrium (7) to mix with deoxygenated blood from the right atrium (8) before it flows via the right ventricle to the aorta and via the left ventricle to the pulmonary artery. 2

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4. Figure 2. Type I TAPVR. (a, b) Chest radiograph obtained in a neonate (b the same as a with a superimposed drawing) reveals the classic snowman sign, sometimes referred to as a figure-of-eight sign. (c) Drawing shows the return flow of venous blood (arrows). Instead of draining into the left atrium (1), the pulmonary veins (2, 3) converge behind the heart to form a common pulmonary vein (4) that connects to the vertical vein (5), which joins the left innominate vein (6). The left innominate vein drains into the superior vena cava (7). Since all of the systemic and pulmonary venous blood enters the right heart, survival is maintained by a right-to-left shunt through a communication at the level of the atrial septum (8). 9 right atrium, 10 right ventricle, 11 left ventricle. (d) Frontal view obtained with angiocardiography in a neonate shows the aberrant cardiovascular anatomy: The upper left heart is bordered by the vertical vein; the superior part of the heart, by the left innominate vein; and the upper part of the right heart, by the dilated superior vena cava 4

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6. Figure 3. Partial anomalous pulmonary venous return. (a, b) Chest radiograph obtained in a patient with a heart murmur (b the same as a with a superimposed drawing) demonstrates a prominent curvilinear opacity that extends downward from the right hilum: the scimitar sign. (c) Drawing shows the pattern of blood flow (arrows). The luminal diameter of the scimitar vein (1), which may drain all or part of the right lung (2), enlarges as the vein descends below the diaphragm (3) to empty into the inferior vena cava (4). Occasionally, the vein may empty directly into the right atrium (5) 6

7. Figure 4. Endocardial cushion defect. (a, b) Lateral view obtained with angiocardiography (b the same as a with a superimposed drawing) shows shortening of the left ventricular inflow tract and elongation and narrowing of the left ventricular outflow tract, which together produce the characteristic gooseneck sign. (c) Drawing (anteroposterior view) of an endocardial cushion defect shows the concavity of the medial margin of the left ventricle (1) below the mitral valve and resultant narrowing of the left ventricular outflow tract (2). 7

8. Figure 5. Tetralogy of Fallot. (a, b) Chest radiograph obtained in an infant with a right-sided aortic arch (b the same as a with a superimposed drawing) shows the characteristic boot-shaped sign produced by upturning of the cardiac apex because of right ventricular hypertrophy and by the concavity of the main pulmonary artery. (c) Drawing depicts the pattern of blood flow (arrows) with the characteristic ventricular septal defect (1), infundibular pulmonary stenosis (2), overriding aorta (3), and right ventricular hypertrophy (4). The oxygen-rich blood in the left side of the heart (5) mixes with oxygen-poor blood in the right side of the heart (6) before it proceeds to the aorta (7). 8

9. Figure 6. Aortic coarctation with associated rib notching. (a, b) Frontal view (a) and close-up frontal view (b) obtained with chest radiography in a young man with hypertension show the figure-of-three sign formed by prestenotic and poststenotic dilatation of the aorta, with an intervening indentation at the site of coarctation and with bilateral rib notching caused by pressure from intercostal blood vessels. (c, d) Chest radiograph in a child (d the same as c with a superimposed 3) shows clear rib notching despite less pronounced coarctation. (e, f ) Left anterior oblique view of the chest, obtained with barium esophagography (b the same as a with a superimposed reversed 3), shows an indentation in the esophageal contour because of pressure from the coarctated aorta. 9

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11. Figure 7. Localized (postductal or adulttype) aortic coarctation. Drawing shows a focal constriction of the aorta (1) just beyond the origin of the left subclavian artery (2) and the ligamentum arteriosum (3). The contour of the aorta is deformed by both pre- and poststenotic dilatation, and the left subclavian artery is dilated. 4 left common carotid artery, 5 innominate artery, 6 right heart structures, 7 left heart structures, 8 pulmonary artery. 11

12. Figure 8. Tubular hypoplasia (preductal or infantile-type aortic coarctation). Drawing shows a focal constriction of the aorta (1) above the level of the ductus arteriosus (2) and a lengthy narrowed segment of the aortic arch (3) after the origin of the innominate artery (4). 5 left common carotid artery, 6 left subclavian artery, 7 right heart structures, 8 left heart structures, 9 pulmonary artery 12

13. Figure 9. Ebstein anomaly. (a, b) Frontal (a) and lateral (b) views obtained with chest radiography in an infant show massive cardiomegaly with decreased pulmonary flow. (c) Frontal view (same as a with a superimposed drawing) best depicts the box-shaped heart, an appearance caused by enlargement of the right atrium and hypoplasia of the pulmonary trunk. (d) Drawing shows the pattern of blood flow (arrows) caused by downward displacement of the tricuspid valve (1), with resultant formation of a common chamber (3) consisting of the right ventricle (2) and the dilated right atrium (4), and by the rightto- left shunt of blood through a defect at the atrial level (5). 6 left atrium, 7 left ventricle, 8 aorta, 9 pulmonary artery. 13

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