Sequential segmental analysis of heart
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This document discusses sequential segmental analysis of the heart. It begins by introducing the concept and origins in the 1960s. It then explains that sequential segmental analysis involves evaluating the heart in segments using a pattern recognition approach. This allows for comprehensive examination and minimizes error in detecting defects. The remainder of the document details the specific segments analyzed - atrial, ventricular, ventriculoarterial, and arterial - and describes the Van Praagh classification system for analyzing each segment.
Sequential segmental analysis of heart
- 1. SEQUENTIAL SEGMENTAL ANALYSIS OF HEART Dr Kunwar Sidharth Saurabh MS (Gen Surgery) M.Ch. CTVS (Resident)
- 2. So, That was the day…
- 3. AND NOW..
- 4. BASICALLY THE SEGMENTAL ANATOMY MEANS..
- 5. DOES THAT MAKES ANY SENSE????
- 6. OBJECTIVES • Identify cardiac segments and components. • Understand and apply segmental approach. • Review variations in cardiac connections. • To see basic imaging techniques. • Employ knowledge with case review.
- 7. 1960 • RICHARD VAN PRAAGH • AMERICA 1960 • MARIA VICTORIA DE LA CRUZ • MEXICO 1970 • ECHO CARDIOGRAPHY BROUGHT THE TERM SEQUENTIAL SEGMENTAL ANALYSIS
- 8. SEGMENTAL ANALYSIS. • Sequential approach to evaluating heart. • Evaluates the cardiovascular system in “segments”. • Based on pattern recognition of Normal. • Allows comprehensive examination of cardiac structure.
- 9. BUT WHY????
- 10. THE ANSWER IS .. • Congenital heart defect : Simple to very complex • Cardiac segment are constant (most of the time) • Approaching in sequence minimizes error rate. • Pattern recognition of normal is best for defect detection. • Early defect detection improves clinical outcomes.
- 11. • Congenital heart defect : Simple to very complex • Cardiac segment are constant (most of the time) • Approaching in sequence minimizes error rate. • Pattern recognition of normal is best for defect detection. • Early defect detection improves clinical outcomes. THE ANSWER IS ..
- 12. THE ANSWER IS .. • Congenital heart defect : Simple to very complex • Cardiac segment are constant (most of the time) • Approaching in sequence minimizes error rate. • Pattern recognition of normal is best for defect detection. • Early defect detection improves clinical outcomes.
- 13. THE ANSWER IS .. • Congenital heart defect : Simple to very complex • Cardiac segment are constant (most of the time) • Approaching in sequence minimizes error rate. • Pattern recognition of normal is best for defect detection. • Early defect detection improves clinical outcomes.
- 14. VAN PRAAG CLASSIFICATION SYSTEM { __ , __ , __ } VISCERO ATRIAL SITUS VENTRICULAR LOOP ORIENTATION POSITION AND RELATION OF GREAT VESSELS
- 16. BASIS • Cardiac connections are identified as : –Venoatrial –Atrio ventricular –Ventriculo arterial
- 17. BASIS • Cardiac connections are identified as : –Venoatrial –Atrio ventricular –Ventriculo arterial
- 18. BASIS • Cardiac connections are identified as : –Venoatrial –Atrio ventricular –Ventriculo arterial
- 19. ATRIAL SEGMENT •PULMONARY VENOUS CONNECTIONS •Usually 4 veins: 2 from each lung •SYSTEMIC VENOUS CONNECTIONS •Single SVC to RA roof. •Hepatic veins convergence with IVC to floor
- 20. ATRIAL SITUS ATRIAL SITUS SOLITUS • Position the atria normally occupy • Almost always corresponds to visceral situs – Viscero atrial situs is often used term
- 21. ATRIAL SITUS • ATRIAL SITUS INVERSUS – The viscera and atria are opposite (Mirror Image ) to normal.
- 22. ATRIAL SITUS ATRIAL SITUS AMBIGUOS • Atrial isomerism or Heterotaxy syndrome • “Bilateral sidedness” of structures – Left atrial isomerism – Right atrial isomerism
- 23. HETEROTAXY FEATURES- VENOATRIAL Left Atrial Isomerism • Interrupted IVC • Bilateral SVC • LSVC to CS • Atrial septum primum + • Pulmonary veins ipsilateral • CAVSD Right Atrial Isomerism • Continuos IVC • Bilateral SVC • Absent CS • Common Atrium • TAPVC • CAVSD
- 24. VANPRAAG SYSTEM (VISCEROATRIAL) {X , __ , __ } VISCERAL SITUS THORACO- ABDOMINAL SITUS ATRIAL SITUS • THREE TYPES OF SITUS – – SITUS SOLITUS { S,__,__} – SITUS INVERSUS { I,__,__} – SITUS AMBIGUOS {A,__,__}
- 25. VANPRAAG SYSTEM (VISCEROATRIAL) {X , __ , __ } • Determining the position of visceral organs. – SOLITUS (S) – INVERSUS (I) – AMBIGUOS (A) VISCERAL SITUS THORACO- ABDOMINAL SITUS ATRIAL SITUS
- 26. VANPRAAG SYSTEM (VISCEROATRIAL) {X , __ , __ } • Pulmonary Sidedness usually reflects atrial sidedness • Useful for identifying morphologic RA VISCERAL SITUS THORACO- ABDOMINAL SITUS ATRIAL SITUS
- 27. VANPRAAG SYSTEM (VISCEROATRIAL) {X , __ , __ } • Identify the morphologic RA. • Atrial situs and thoracoabdominal situs are usually concordant. VISCERAL SITUS THORACO- ABDOMINAL SITUS ATRIAL SITUS
- 28. VANPRAAG SYSTEM (VISCEROATRIAL) {X , __ , __ } • DESIGNATION – – If ALL letters recorded as S { S,__,__} – If ALL letters recorded as I { I,__,__} – If ANY letter recorded as A {A,__,__}
- 30. ATRIOVENTRICULAR CONNECTION • Type and mode of connection between atria and ventricles. • Types of AV connection – – Concordant – Discordant – Common – Double inlet – Single
- 32. Discordant RA TO MORPHOLOGIC LV LA TO MORPHOLOGIC RV SEEN IN – •VENTRICULAR INVERSION •CORRECTED TRANSPOSITION
- 33. Common BOTH ATRIA CONNECTED TO BOTH VENTRICLE BY COMMON VALVE SEEN IN – COMPLETE AVSD
- 34. Single Usually seen in Tricuspid Atresia
- 35. Double Inlet
- 36. VENTRICULAR SEGMENT • Described based on morphology • Morphology best defined by internal features. • “LOOPING” pertains to the RV position in relation to the LV. – Normal is rightward loop (“D” for dextro) • Describes the spatial position of the ventricles.
- 37. VENTRICULAR SEGMENT • Ventricular Looping – If RV loops to the Right – “D” Loop If RV loops to the left – “L” Loop
- 38. VANPRAAGSYSTEM(Ventricular loop orientation) {__, x , __ } • Relation of Morphologic RV as compared with Morphologic LV – Dextro loop { __, D, __} – Levo loop { __, L, __} – Cannot be determined {__, X, __}
- 39. VENTRICULOARTERIAL CONNECTION • CONCORDANT – MPA arises from morphologic RV – Aorta arises from morphologic LV Irrespective of spatial location of ventricles NORMAL – Great Arteries typically cross
- 40. VENTRICULOARTERIAL CONNECTION • DISCORDANT- Aorta arises from morphologic RV MPA arises from LV PARALLEL VESSELS Usually seen in TGA
- 41. VENTRICULOARTERIAL CONNECTION • DOUBLE OUTLET VENTRICLE
- 42. ARTERIAL SEGMENT • Position of Aorta in relation to Pulmonary Artery. • NORMALLY Aorta is located posterior and to the right of MPA ( at the level of semilunar valves) • Conus anatomy may be useful
- 44. VANPRAAGSYSTEM(POSITIONAND RELATIONOF GREAT VESSELS) { __,__,X} • Aorta is posterior to and rightward of MPA • Situs solitus {__,__,S} • Aorta is posterior to but inverted leftward of MPA • Situs Inversus {__,__,I} • Transposition : Usually applies when Aorta from RV and MPA from LV – Aorta is anterior and Right of MPA • D – Transposition {__,__, D-TGV} – Aorta is anterior and left of MPA • L – Transposition {__,__,L-TGV}
- 45. Example Step 1 – Determine Viscero-Atrial Situs Visceral situs RECORD LETTER “S”
- 46. Cont.. • Step 1 - Determine Viscero-Atrial Situs Thoracoabdominal situs RECORD LETTER “S”
- 47. Cont.. • Step 1 - Determine Viscero-Atrial Situs Atrial situs RECORD LETTER “S”
- 48. Cont.. If ALL letters recorded as “S” – Situs Solitus {S,__,__}
- 49. Cont.. • Step 2 – Determine Ventricular Loop Orientation Morphologic RV on Left : Levo Loop {__ ,L, __}
- 50. Cont.. • Step 3 – Position and relation of great vessels Aorta is anterior and leftward of MPA : L Transposition {__,__,L-TGV}
- 51. Cont .. • So, findings are – {S, L , L-TGV} – Situs solitus with levocardia – Levotransposition of great vessels – Atrio-ventricular and Ventriculo arterial Discordance Diagnosis – Congenitally Corrected L-TGA.
- 52. RED BULL, GOOGLE AND WIKIPEDIA FOR MAKING THIS POSSIBLE