1. Congenital heart defects Anatomic consideration Dr. Yasser Salem

2. Defects from abnormal cardiac development Defects of cardiac positioning Defects of atrial septation Defects of ventricular septation Defects of A.V. canal and A.V. valves Defects of cono-truncal development and semi-lunar valves Defects in aortic arch Defects in venous system (systemic or pulmonary)

3. Variants of Situs (sidedness) Solitus Inversus Ambiguous –Left isomerism –Right isomerism

4. Situs solitus Left Right

5. Situs inversus Right Left

6. Situs ambiguous Left isomerism Left

7. Situs ambiguous Right isomerism Right

8. Situs

10. Situs ???? LA RA

11. Cardiac position

12. Defects of cardiac positioning Levocardia (normal orientation)

13. Defects of cardiac positioning Mesocardia –Centrally located heart or –Inferior base apex axis

14. Defects of cardiac positioning Dextrocardia

15. Defects of cardiac positioning Dextrocardia –Isolated dextrocardia (with situs solitus) accompanied by severe cardiac anomalies e.g. A.V. or V.A. discordance single ventricle or heterotaxy syndrome –Dextrocardia with situs inversus less likely to be accompanied with other anomalies

16. Defects of cardiac positioning Levocardia (normal orientation)

17. Atrio-ventriculo-arterial sequence

19. Concordance Normal sequence AV & VA Discordance Reversed sequence AV & VA Corrected TGA = AV discordance + VA discordance

20. Atrio-ventriculo-arterial sequence Corrected TGA = AV discordance + VA discordance

23. Concordant flow with spatial discordance

24. Discordant flow with spatial concordance

26. Defects from abnormal cardiac development Defects of cardiac positioning Defects of atrial septation Defects of ventricular septation Defects of A.V. canal and A.V. valves Defects of cono-truncal development and semi-lunar valves Defects in aortic arch Defects in venous system (systemic or pulmonary)

28. Defects of atrial septation

29. Embryologic cardiac tube

30. Defects of atrial septation

33. P.F.O. Ostium secundum defect Ostium primum defect Sinus venosus A.S.D. Single atrium Septal aneurysm

34. Defects in ventricular septation 1.Outlet conal defect, conal septal hypoplasia, sub-pulmonary defect, infundibular defect, supracristal defect, doubly committed juxta-arterial defect 2.Membranous peri-membranous defect, para- membranous defect, conoventricular defect 3.Inlet peri-inlet defect, AV canal type defect, AV septal defect, endocardial cushion defect. 4.Muscular 1 2

36. Gerbode defect

37. Defects of A.V. canal & A.V. valves A.V. canal defect Tricuspid and mitral valve defects Ebstien anomaly

38. Defects of A.V. canal & A.V. valves A.V. canal defect –Atrial communication –Ventricular communication –Abnormal A.V. valve development

39. Defects of A.V. canal & A.V. valves A.V. canal defect –Complete Rastelli A Rastelli B Rastelli C

40. Defects of A.V. canal & A.V. valves A.V. canal defect –Complete –Transitional –Partial

41. Defects of A.V. canal & A.V. valves A.V. canal defect –Complete Balanced ventricles Unbalanced ventricles

43. Defects from abnormal cardiac development Defects of cardiac positioning Defects of atrial septation Defects of ventricular septation Defects of A.V. canal and A.V. valves Defects of cono-truncal development and semi-lunar valves Defects in aortic arch Defects in venous system (systemic or pulmonary)

44. Defects of conotruncal development & semilunar valves

45. Tetralogy of fallot DORV Transposition of great arteries T.G.A. Truncus arteriosus Pulmonary stenosis and atresia Aortic stenosis and subaortic membrane

46. Tetralogy of fallot

49. McGoon ratio Definition –Diameter of left plus right pulmonary arteries at the pre-branching point divided by diameter of descending aorta at the level of diaphragm Normal 2.1 More than 1.2 adequate for V.S.D. closure Less than 0.8 inadequate

50. Tetralogy of fallot Nakata index TNPAI total neo-pulmonary artery index

51. DORV F4F4 TGA

52. F4F4 DORVTGA DORV

53. Types in relation to great arteries –Sub-aortic –Sub-pulmonic –Doubly committed –Non committed

54. Truncus Arteriosus

56. T ransposition of G reat A rteries D-type PFO VA discordance Connecting vessel (PDA)

57. Transposition of Great Arteries L-type AV discordance VA discordance

58. Corrected TGA = AV discordance + VA discordance Transposition of Great Arteries L-type

59. Defects in aortic arch

60. Right side aortic arch

61. Defects in aortic arch Coarctation of Aorta

62. Defects of pulmonary venous drainage Total anomalous pulmonary venous drainage Partial Anomalous pulmonary venous drainage

63. Defects of systemic venous drainage Persistent left SVC Interrupted IVC