Atrial Septal Defect

Calcific aortic stenosis. Large deposits of calcium salts are evident in the cusps and the free margins of the thickened aortic valve, as viewed from above.

Pathogenesis of ventricular and atrial septal defects. (A) The common atrial chamber is being separated into the right and left atria (RA and LA) by the septum primum. Because the septum primum has not yet joined the endocardial cushion material, there is an open ostium primum. The ventricular cavity is being divided by a muscular interventricular septum into right and left chambers (RV and LV). SVC, superior vena cava; IVC, inferior vena cava. (B) The septum primum has joined the endocardi...

Calcific aortic stenosis of a congenitally bicuspid aortic semilunar valve.

<bold>Figure 21.18</bold> An atrial septal defect is an abnormal opening between the right and left atria. Basically, three types of abnormalities result from incorrect development of the atrial septum. An incompetent foramen ovale is the most common defect. The ostium secundum defect results from abnormal development of the septum secundum and causes an opening in the middle of the septum. Improper development of the septum primum produces an opening at the lower end of the septum known as an os...

Coronal view of the heart with a congenital ventricular septal defect. Oxygenated blood is allowed to travel from the left to right ventricle into the pulmonary trunk.

Coarctation of the aorta. A. Preductal type. B. Postductal type. The caudal part of the body is supplied by large hypertrophied intercostal and internal thoracic arteries.

<bold>Figure 33-35</bold> Magnetic resonance image of aortic coarctation in a 1 day old. Arrow indicates focal coarctation in the distal end of a hypoplastic aortic arch.

<bold>Figure 33-37</bold> Diagram of the cardiac anatomy and physiology in a 1-month-old infant with valvar aortic stenosis had a systolic pressure gradient of 70 mmHg across the aortic valve. The blood passing from left to right through the ductus must return again through the aortic valve, with the excess flow compounding the obstruction. The large atrial shunt, whether a true anomaly or a sprung foramen ovale, elevates left atrial pressure. The numbers below the chamber name are pressure measu...

<bold>Figure 33-39</bold> Echocardiogram 4 chamber view with color Doppler analysis demonstrates an apical musular ventricular septal defect. (LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; VSD, ventricular septal defect.)

<bold>Figure 27.9</bold> Secundum atrial septal defect (ASD) denoted by <italic>arrow.</bold><bold>A.</bold> Transesophageal echo image. <bold>B.</bold> Intracardiac echo image. RA, right atrium; LA, left atrium; Ao, aorta.

<bold>Fig CA 13-5 Ventricular septal defect.</bold> The pulmonary trunk is very large and overshadows the normal-sized aorta, which seems small by comparison. The pulmonary artery branches in the hilum and in the periphery of the lung are enlarged, and the pulmonary vascular volume is increased. The heart is enlarged and somewhat triangular.¹

<bold>Fig CA 2-1 Tetralogy of Fallot.</bold> (A) Frontal view shows right ventricular enlargement as a lateral and upward displacement of the radiographic cardiac apex (arrow). (B) On the lateral view, the enlarged right ventricle fills most of the retrosternal space (arrows).

<bold>Fig CA 2-1 Tetralogy of Fallot.</bold> (A) Frontal view shows right ventricular enlargement as a lateral and upward displacement of the radiographic cardiac apex (arrow). (B) On the lateral view, the enlarged right ventricle fills most of the retrosternal space (arrows).

<bold>Fig CA 5-10 Eisenmenger physiology</bold> in patent ductus arteriosus. There is an increased fullness of the central pulmonary arteries with an abrupt narrowing and paucity of peripheral vessels.

<bold>Fig CA 5-7 Single ventricle.</bold> (A) Frontal view from a right ventriculogram shows muscular tracts leading from the right ventricle to both great arteries, the valves of which (arrows) are at the same horizontal level. (B) A lateral view shows the anteriorly situated right ventricle (RV) communicating with the left ventricle (LV) via a ventricular septal defect (single arrows). (PA, pulmonary artery; Ao, aorta.)⁴

<bold>Fig CA 5-7 Single ventricle.</bold> (A) Frontal view from a right ventriculogram shows muscular tracts leading from the right ventricle to both great arteries, the valves of which (arrows) are at the same horizontal level. (B) A lateral view shows the anteriorly situated right ventricle (RV) communicating with the left ventricle (LV) via a ventricular septal defect (single arrows). (PA, pulmonary artery; Ao, aorta.)⁴

<bold>Fig CA 8-1 Coarctation of the aorta.</bold> Plain chest radiograph demonstrates the figure-3 sign (arrow points to the center of the 3).

<bold>Fig CA 8-2</bold> (A) <bold>Subvalvular aortic stenosis.</bold> Note the muscular ridge protruding from the upper portion of the ventricular septum (arrows). The ridge is approximately 2 cm below the aortic valve and encroaches on the outflow tract of the left ventricle. (B) <bold>Valvular aortic stenosis.</bold> Irregular thickening of aortic valve leaflets and relative rigidity of the left coronary cusp. (C) <bold>Supravalvular aortic stenosis.</bold> Narrowed segment (arrows) located just above the corona...

<bold><italic>FIGURE 4.31.</bold></bold> Apical four-chamber view recorded in a patient with an atrial septal defect after intravenous injection of contrast agent. Note the opacification of the right atrium and the right ventricle and the significant amount of contrast appearing in the left atrium, consistent with a right-to-left shunt at the atrium level, subsequently confirmed to be a secundum atrial defect.

<bold><i>FIGURE 8.19.</i></bold> Two patients with aortic stenosis are included. In both cases, different values for aortic stenosis jet velocity are obtained, yielding different measures of peak gradient. In patient A, the apical view underestimates the true velocity, which is optimally recorded from the right parasternal window. In patient B, the apical window again underestimates true velocity. In this case, the peak gradient was best recorded from the suprasternal notch.

<bold><italic>FIGURE 8.21.</bold></bold> This schematic demonstrates the relationship between aortic (<italic>Ao</bold>) and left ventricular (<italic>LV</bold>) pressure in the setting of aortic stenosis. The differences between peak instantaneous, peak-to-peak, and mean gradients are demonstrated.

<bold><italic>FIGURE 10.6.</bold></bold> A two-dimensional echocardiogram from a patient with severe aortic stenosis is shown. <bold>A:</bold> The long-axis view reveals an echogenic and very immobile aortic valve. <bold>B:</bold> The corresponding short-axis view suggests a high degree of calcification of the valve and minimal mobility during systole. LA, left atrium; LV, left ventricle; RV, right ventricle.

<bold><i>FIGURE 20.11.</i></bold> Transthoracic parasternal long-axis view of the ascending aorta recorded in a patient with significant valvular aortic stenosis and proximal aortic dilation. Note the dilation of the aorta at the level of the sinuses, sinotubular junction, and proximal ascending aorta. This represents poststenotic dilation. In many instances, dilation to the degree seen here may be due to both disease of the aortic valve and concurrent aortic aneurysm. Ao,...

A 60-year-old man with degenerative calcific aortic stenosis. A: Posteroanterior examination shows increased rounding of the left ventricular portion of the left heart border and dilatation of the ascending aorta (arrows). B: Lateral examination shows aortic valvular calcification (arrowheads) in the center of the cardiac silhouette and filling of the retrosternal air space by the dilated, calcified (arrows) ascending aorta. The left ventricle is not dilated.

A 25-year-old woman with coarctation of the aorta. There is increased curvature of the left ventricular contour of the left heart border. The aortic arch (Ao) is inconspicuous, and the left subclavian artery (small arrows) is dilated. Note the break in the shadow of the descending aorta (large arrow) just inferior to the aortic arch at the site of the aortic narrowing. Irregular erosions (arrowheads) on the underside of the left and right fourth ribs (rib notching) are seen.

A 46-year-old woman with secundum atrial septal defect. Mean pulmonary artery pressure is 20 mm Hg. A: The heart lies in the left chest. The pulmonary artery segment (PA) is greater in caliber than the aortic arch (Ao). The pulmonary artery branches of both lungs are all dilated, sharp edged, and extend nearly to the pleura. The narrow superior mediastinum and decreased concavity in the middle of the left heart contour are caused by cardiac rotation secondary to right heart dilatation. Furt...

A 55-year-old woman with atrial septal defect and pulmonary hypertension. The pulmonary artery is dilated. The dramatic difference between the caliber of the hilar and lobar pulmonary arteries and the segmental branches is typical of pulmonary hypertension. However, these segmental arteries branch and extend toward the pleura, which is typical of shunt vessels.

A case of complex congenital heart disease. Patient has situs inversus, dextrocardia, is status-post tetralogy of Fallot repair, and presents with symptoms of right-sided heart failure. A: Axial gradient echo images showing dextrocardia and right ventricular dilation. B: Sagittal gradient-echo images showing free pulmonary regurgitation (arrow) at the site of previous infundibular resection.

Aortic valve dilation in a newborn with critical aortic stenosis. An antegrade catheter is positioned in the left ventricle via the patent foramen ovale.

<bold><italic>Figure 13-16</bold> Calcific aortic stenosis.</bold> Congenital bicuspid aortic valve. Valve leaflets are thick and crusted with calcium and frozen in position. This valve is both stenotic and insufficient.

<bold><italic>Figure 13-21</bold> Ventricular septal defect.</bold> This defect is at the upper end of the interventricular septum.

<bold><italic>Figure 13-22</bold> Tetralogy of Fallot: a right-to-left cardiac shunt.</bold> The defects are: 1) misplacement (rightward shift) of the aortic valve so that the aortic orifice catches unoxygenated blood coming through the 2) ventricular septal defect in a right-to-left shunt because 3) pulmonary artery stenosis obstructs pulmonary blood flow, which increases right ventricular pressure, causing 4) right ventricular hypertrophy.

<bold>FIGURE 11-37. Calcific aortic stenosis of a congenitally bicuspid aortic valve.</bold> The two leaflets are heavily calcified, but there is no commissural fusion.

Auscultation, subvalvular membranous stenosis - Supravalvular aortic stenosis causes the jet to strike the aorta, producing an ejection murmur indistinguishable from that associated with valvular aortic stenosis except that there is no ejection click

Auscultation, ventricular septal defect - A small ventricular septal defect causes a holosystolic murmur that often has a slight midsystolic accentuation. The second sound is not altered

Auscultation, ventricular septal defect - Moderate ventricular septal defect permits left-to-right shunting but maintains left-ventricular-to-right ventricular pressure gradient. The increased flow through the mitral valve causes an early diastolic "flow" (ventricular filling) murmur

Atrial septal defect, isolated - Coronal view of heart with an isolated atrial septal defect allowing blood to flow between the atria

Defect, aortic - Heart demonstrating normal anatomic position of aorta (Ao) in an example of supravalvular aortic stenosis with bilateral superior caval veins. Pulmonary trunk (PT), r. sup. vena cava (RSCV), l. sup. vena cava (LSCV)

Defect, secundum atrial septal - A chest radiograph of a two-year-old patient with secundum atrial septal defect (ASD). Note cardiomegaly, right atrial prominence, upturned apex, and increased pulmonary vascular markings

Defect, secundum atrial septal - Chest radiograph of 21-year-old patient with secundum atrial septal defect (ASD). Note nearly normal heart size, prominence of left heart border with lifting of apex, prominence of the main pulmonary a., and increased pulmonary vascular markings

Tetralogy of Fallot - Chest x-ray showing features of tetralogy of Fallot: diminished pulmonary vascularity, concave pulm. a., rt.aortic arch, and rt. descending aorta. Note oval-shaped heart w/ laterally displaced and elevated cardiac apex leading to "boot" shaped silhouette

Ventricular septal defect - Chest X-ray showing features of ventricular septal defect: increased pulmonary vascularity, moderate cardiomegaly, and left ventricular dilation producing "sagging" or "drooping" of the cardiac apex. Left atrial enlargement is also present

Ventricular septal defect - Removal of a portion of the r. ventricular wall revealing three types of septal defects: 1, membranous; 2, muscular; 3, subpulmonic