Ppt on eisenmenger syndrome

HEART DISEASES Lecture I Associate Professor Dr. Alexey Podcheko Spring 2015.

defects may progress to pulmonary hypertension and reverse of the shunt which will lead to cyanosis (aka Eisenmenger syndrome) Surgical or catheter-based closure of an ASD reverses the hemodynamic abnormalities and prevents complications, including heart/ LARGE ones progress to pulmonary hypertension and reverse of the shunt which will lead to cyanosis (aka Eisenmenger syndrome) VSD Morphology Infundibular VSD - below the pulmonary valve Clinical presentation of VSD Low Pitched HoloSystolic murmur,/

Ventricular Septal Defect in adults Dr. Mohamed Sofi MD; FRCP (London); FRCPEdin; FRCSEdin.

(high velocity), with small shunt Moderately restrictive VSD  moderate shunt Large / non-restrictive VSD  large shunt Eisenmenger VSD  irreversible pulmonary HTN and shunt may be zero or reversed Anatomic diagram illustrates the positions of different ventricular / early large left to right shunting with development of heart failure during infancy. In rare cases, Eisenmenger syndrome occurs sometime during late childhood to early adulthood. The right to left shunt causes cyanosis. CLINICAL MANIFESTATIONS/

Adult with operated congenital heart disease: what should we check for? January 15 th, 2016 16h-17h30.

) about Complete Atrio-Ventricular Septal defect in adults is/are correct? A) Isolated complete AVSD in adults is an aetiology of Eisenmenger syndrome B) In case of pulmonary stenosis or banding, it may be still surgically correctable C) In case of Eisenmenger syndrome, specific medical therapy increases life expectancy D) Mitral clip is a good percutaneous option for atrio-ventricular valve regurgitation E) Sub/


for ICD placement with his EF above 35%. Question 197 of 264 Which one of the following conditions is not considered a contraindication to pregnancy? A. Eisenmengers syndrome. B. Moderate primary pulmonary hypertension. C. The Marfan syndrome with aortic root dilatation. D. Moderately severe mitral regurgitation. The correct answer is D. The risk of pregnancy to the patient with pulmonary hypertension is so/


hypertension and increased tendency to develop pulmonary vascular resistance  right to left shunting  cyanosis (Eisenmenger syndrome) AV valvular insufficiency Atrioventricular Septal Defects (AV Canal Defect) Clinical Manifestations Heart failure and intercurrent /vascular bed to high systolic pressure and high flow, pulmonary vascular obstructive disease develops  Eisenmenger syndrome Ventricular Septal Defect Clinical Manifestations Small VSDs Asymptomatic Loud, harsh or blowing holosystolic murmur on/

Heart diseases in pregnancy. Cardiovascular changes during pregnancy: intravascular volume and cardiac output increase by 50%  Decrease in peripheral.

level; shunt flow right- to-left  Pregnancy complications: at term and during 1st postpartum week  High frequency of: spontaneous abortion, IUGR, preterm labor  Maternal mortality rate: primary pulmonary hypertention ~ 30%; Eisenmenger syndrome ~36%; secondary vascular pulmonary hypertention ~56%  Perinatal mortality due mainly to prematurity  Neonatal mortality rate: 12%  Preconception counseling: extreme risk from pregnancy; pregnancy is contraindicated! Acquired heart disease - Mitral stenosis/

Congenital Heart Diseases

as harsh "machinery-like" murmurs. A small PDA - no symptoms larger bore defects - lead to the Eisenmenger syndrome with cyanosis and CHF. The high-pressure shunt also predisposes affected individuals to infective endocarditis There is general agreement/volume overload that eventually causes pulmonary hypertension with reversal of flow and right-to-left shunts with cyanosis (Eisenmenger syndrome). Right-to-left shunts tetralogy of Fallot or transposition of great vessels cyanotic lesions from the outset and/

Congenital Heart Diseases Charles University of Prague 2 nd Faculty of Medicine Filip Koubek.

recurrence risks in single gene disorders and/or chromosomal abnormalities (Marfan, Noonan, and 22q11 deletion syndromes - DiGeorge, Holt – Oram syndrome) Others defects recurrence rate 2-4% Aortic stenose 13–18% VSD 6 – 10% Atrial/sign) – Significant shunt – Qp/Qs >1,5 – Paradoxical embolism – (Planned pregnancy) – prevention of paradoxical embolism – Eisenmenger sy (severe PAH with high pulmonary vascular resistance) – contraindication of closure Atrial septal defect - treatment ASD secundum – (if possible/

Out-patient Management of Pulmonary Hypertension Jameel A. Al-Ata, MD KAAUH & KFSH&RC-JED. Taif 14th annual cardiovascular conference, march 2006.

.g. central aorto- pulmpnary shunts ) may lead to the development of pulmonary hypertension. Palliative shunting operations ( e.g. central aorto- pulmpnary shunts ) may lead to the development of pulmonary hypertension. Eisenmenger syndrome; Increased pulmonary vascular resistance. Increased pulmonary vascular resistance. Bidirectional or right-to-left shunting through a systemic-to-pulmonary connection, such as a ventricular septal defect, patent ductus arteriosus, univentricular/


LV wall thickness ↑ LVOT & RVOT velocities CONGENITAL HEART DISEASES COMPLICATING PREGNANCY L to R Shunts R to L Shunts Eisenmenger Syndrome Obstructive Lesions Risk Assessment Timing of Intervension Mode of delivery Contraception Left-to-Right Shunts L → R shunting ↑ chances of/are very poor In cc TGA not complicated by cyanosis, ventricular dysfunction or heart block, pregnancy is well tolerated Eisenmenger syndrome 30 to 50 % risk of maternal death 74 % risk of fetal loss if mother survives Pregnancy is /


nephropathy, uric acid nephrolithiasis and gouty arthritis are rare but may occur. 7- Rheumatologic complications: 8- Gallstones: It is composed of calcium bilirubinate and consequent cholecystitis . 9- Arrhythmias Patients with Eisenmenger syndrome are at risk for sudden cardiac death, the etiology of which remains poorly defined . The choice of antiarrhythmic drugs are complicated by: -The presence of ventricular dysfunction and lung disease/

Atrial Septal Defect.  Outlines:  Defenition.  Embryology  Anatomy.  Physiology.  Pathophysiology.  Types.  Clinical features.  Diagnosis. 

-to-right shunt can alter the pulmonary vascular resistance leading to pulmonary arterial hypertension, even reversal of shunt and Eisenmenger syndrome. http://emedicine.medscape.com/article/162914-overview Cont.  Because of an increase in plasma volume during pregnancy, /ASD, and the shunt will reverse; a right-to-left shunt will exist. This phenomenon is known as Eisenmengers syndrome.Eisenmengers syndrome  Once right-to-left shunting occurs, a portion of the oxygen-poor blood will get shunted to the /

Acyanotic Heart Disease PRECIOUS PEDERSEN 1442. INTRODUCTION Left to right shunting lesions, increased pulmonary blood flow The blood is shunted through.

to-right shunt with increased flow of blood to the right ventricle, leading to hypertrophy and dilation and eventually to Eisenmenger syndrome Clinical presentation of VSD: ▪ Wide physiologic splitting of S2 and holosystolic murmur. Spontaneous closure of VSD occurs in /; ▪ The classic sign of a persistent PDA is a continuous “machine-like ” murmur. ▪ May lead to Eisenmenger syndrome, resulting in lower extremity cyanosis ▪ In the normal neonate, spontaneous closure of the ductus arteriosus in response to an/


at this point. Atrial arrhythmias Paradoxical embolism Right ventricular failure Tricuspid and mitral regurgitation Pulmonary Hypertension Eisenmenger’s syndrome Premature sudden death Rigby ML: Atrial Septal Defect. In Gatzoulis MA, et al. (eds):/ OF BLOOD INCREASED PULMONARY BLOOD FLOW IRREVERSIBLE PULMONARY VASCULAR INJURY (variable) INCREASED PULMONARY VASCULAR RESISTANCE Eisenmenger’s Syndrome (relatively uncommon) RIGHT-TO-LEFT SHUNTING OF BLOOD HYPOXIA AND ERYTHROCYTOSIS Adapted from Vongpatanasin W,/

Left-Right Shunt Natural history & Principles of Management

aneurysm Cosh JA. Br Heart J 1957; 19: 13–22. Pulmonary vascular obstructive disease No definite data on incidence “Differential cyanosis” Eisenmenger patients do not tolerate PDA closure Aneurysm of the duct Described either pre- or postnatally Likely develops in the third trimester due to / was > 50 mmHg in 17% PAH was present in 13% of patients under 10 yrs 14% of those aged 11 to 20 years Eisenmenger syndrome 9% Craig RJ et al. Circulation 1968; 37: 805–15. Cherian G et al. Am Heart J 1983; 105: 952–7. /

Congenital Heart Disease. Aetiology and incidence The incidence 0.8% of live births. Maternal infection or exposure to drugs or toxins may cause congenital.

> 1.5: symptoms (+) Effort dyspnea (exercise intolerance) Palpitation (Af/AF) Paradoxical embolism Pulmonary hypertension Eisenmenger syndrome Atrial Septal Defect. signs : Right ventricular heave S 2 widely split and usually fixed Systolic murmur at left /develop CHF. Ventricular Septal Defect Clinical features Asymptomatic may present as cardiac failure in infants. rarely as Eisenmenger’s syndrome Systolic thrill and Harsh pansystolic murmur heard best at the left sternal border with radiation over the /


findings : s2 decreases in intensity , crescendo-decrescendo systolic murmur in the ULSB, cyanosis (shunt reversal ) Eisenmenger’s apex by RV Palpable dilated hypertensive pulmonary trunk Loud pulmonary closure sound Very short or no systolic mr/enlargement of pulmonary trunk& its branches persists Nonrestrictive vsd with elevated but variable PVR- enlargement of all 4 chambers Eisenmenger’s syndrome- oligemic lung fields, RA,LA, LV normal, RV occupies the apex Echocardiography Common locations of vsd -2d /

מבחן בילדים - חזרה יסמין א.פ. מועד יוני 2011 3 ילד נולד במשקל תקין לאחר הריון ולידה תקינים. בגיל 15 הילד מגיע למרפאה בליווי אמו, שמתלוננת על כך שהוא.

לחיים. 3.יכול להופיע בחולים עם VSD. 4.מדובר בתופעה בה יש לחץ דם ריאתי גבוה, ללא פגם מבני בלב. 5.מדובר בתופעה בה דפנות כלי הדם הריאתיים מתעבים ונסתמים בתגובה לזרימה ולחץ מוגברים. “The term Eisenmenger syndrome refers to patients with a ventricular septal defect in which blood is shunted partially or totally from/ a more fulminant course may occur.” (Chap. 427, p. 1601) “The pathologic changes of Eisenmenger syndrome occur in the small pulmonary arterioles and muscular arteries (<300 ?m) and are graded on the/

Klinik für Kinderherzchirurgie

) Ventricular Septal Defect (VSD >>> VSD) Klinik für Kinderherzchirurgie Ventricular Septal Defect (VSD >>> VSD) increased cellularity (muscular and interstitial) increased reactivity fixed contraction vascular wall sclerosis >> fixed pulmonary vascular resistance = Eisenmenger syndrome Ventricular Septal Defect (VSD) Klinik für Kinderherzchirurgie Ventricular Septal Defect (VSD) Cross-circulation: father as oxygenator, but potentially 200% mortality… C.W. Lillehei, Minneapolis 1954: VSD „King of Hearts/

Teaching Reading Strategies on the Internet for Graduate Students

text articles helps you... brief up your content, boost your credibility, share what you find, and add notes. Exercise 16, p. 33 Eisenmenger syndrome is a condition that is present at birth, though it rarely causes any major problems before people have reached their 20s or 30s. The / tint (cyanosis) to the skin and other areas of the body. Source: iVillage Total Health. (2007). Eisenmenger syndrome. Retrieved 12 March 2007, from http://heart.health.ivillage.com/congenitalheartdisease/eisenmengerscomp.cfm 3/

- Describe the clinical features that point to the presence of a congenital heart malformation. - Describe the general classification of heart diseases.

usually within 6 to 8 weeks of life if defect is large.  Pulmonary Hypertension if defect is large.  Eisenmenger s syndrome. Depend on the size of the defect.  Loud harsh pansystolic heart murmur.  Palpable thrill.  Parasternal heave/ feeding, failure to thrive.  In adults : -Fatigue and dyspnea on exertion. -Palpitations. - Syncope -Stroke -Eisenmenger s syndrome  Heart murmur resulting from increased blood flow through pulmonary valve(systolic ejection murmur ).  Wide and fixed splitting of second/

ASD with Severe PHT R4 권성진.  Congenital heart disease in adult - Newly diagnosed - Already diagnosed patients without undergoing OP : Clinically insignificant.

in adult - Newly diagnosed - Already diagnosed patients without undergoing OP : Clinically insignificant lesion or Eisenmenger syndrome - Patients who underwent operation Cure : VSD, PDA New problem : TOF…  Clinical /> 2:1 - Contraindication : severe pulmonary hypertension !  Eisenmenger Syndrome - 1897 Vicktor Eisenmenger : 32 yr women with dyspnea, cyanosis, hemoptysis  Autopsy : large VSD - 1958 Paul Wood : “Eienmenger syndrome” - Elevated pulmonary artery resistance and severe pulmonary HT secondary /


RVF Family history Physical Examination: Cyanosis: Usually late in the natural history for non-respiratory causes. Clubbing – suggests Eisenmengers / Respiratory causes Respiratory system examination BMI, Neck height/width, Thyroid examination INITIAL DIAGNOSTIC WORK UP ECG CXray 2D/. N Engl J Med. 2002;346:896 –903. 2. Galie N et al. Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized,placebo-controlled study. Circulation. 2006;114:48 –54. 3. Galie N et /

The Heart. Cardiac Structure and Specializations Myocardium Myocardium Valves Valves Conduction system Conduction system Blood supply Blood supply.

pressures reach systemic levels Pulm pressures reach systemic levels R to L shunt R to L shunt Eisenmenger Syndrome Eisenmenger Syndrome Altered hemodynamics of CHD Altered hemodynamics of CHD Dilation, hypetrophy or both Dilation, hypetrophy or both Decreased/and variable degrees of superimposed acute plaque change, thrombosis, and vasospasm The dominant cause of the IHD syndromes is insufficient coronary perfusion relative to myocardial demand, due to chronic, progressive atherosclerotic narrowing of the /

CARDIOVASCULAR SYSTEM Presented by Prof.Ahmed Mohy.

failure 4-So,pressure in Rt.side exceeds that of Lt.side& reversal of shunt occurs ie. Rt.-Lt.shunt (EISENMENGER’S SYNDROME) CYANOSIS Patent Ductus Arteriosus (PDA) The ductus arteriosus, serves to shunt blood from pulmonary artery to aorta during intrauterine/ VSD II-CHD with RT-LT SHUNT CYANOTIC GROUP OF DISEASES 1-FALLOT’S TETRALOGY 2-TRANSPOSITION OF GREAT VESSELS 3-Eisenmenger’s complex FALLOT’S TETRALOGY 1- High VSD 2- Dextroposition of aorta 3- Pulmonary stenosis 4- Right ventricular hypertrophy /

Internal Medicine Board Review Cardiology

CXR Cyanotic Lesions Not likely for an IM board Tetralogy most common – young person with cyanosis and squatting Eisenmenger’s (secondary pulm HTN with conversion to right-to-left shunt) most commonly occurs with VSD Ebstein’s / aortic rupture during surgery Pregnancy and Heart Disease High risk Eisenmenger’s syndrome Severe pulmonary HTN Severe aortic stenosis/LVOT obstruction Coarctation of the aorta with obstruction Marfan’s syndrome with aortic root > 43 mm Symptomatic systemic ventricular dysfunction /

Pregnancy and Heart Disease. Physiology Blood volume increases (about 50%) Hg concentration falls “physiologic anemia of pregnancy” Cardiac output increases.

balloon valvuloplasty or surgical intervention Fetal effects included –Intrauterine growth retardation –Premature delivery –Reduced birth weight –Increase in cardiac defects In general regurgitant valvular lesions are well tolerated during pregnancy Eisenmenger Syndrome High risk of maternal morbidity and mortality Death usually occurs between the first few days and weeks after delivery, but the cause is unclear Patients should be advised against pregnancy/

七院聯合病例討論會 三軍總醫院 R2 李宗翰 / Vs. 喩永生主任.

Conditions directly affecting pulmonary arteries Primary pulmonary hypertension Toxin-induced (ie, anorexic agents) Vasculitis Granulomatoses, collagen-vascular disorders, arteritis Hepatic cirrhosis/portal disease Congenital heart disease (Eisenmenger syndrome [ASD, VSD, PDA]) Infection Human immunodeficiency virus Causes of pulmonary hypertension Conditions affecting pulmonary parenchyma Chronic obstructive lung disease Infiltrative/granulomatous diseases Sarcoidosis, pneumoconiosis, radiation, fibrosis/

Congenital Heart Disease

lower respiratory tract infections (begin at 1-2month); If the defect is large and pulmonary vascular resistance is very high (Eisenmenger’s reaction) – shortness of breath, dyspnea on exertion, chest pain, cyanosis; Ventricular Septal Defect Listen at the back /in the LA and will reverse the shunt → right-to-left shunt will exist (this phenomenon is known as Eisenmenger’s syndrome). Clinical Signs & Symptoms Atrial Septal Defect Clinical Signs & Symptoms • Most are asymptomatic, but may have easy /

Michael Pieters Dept. of Diagnostic Radiology Bloemfontein CONGENITAL HEART DISEASE WITH LEFT TO RIGHT SHUNT.

cardiac size  Normal pulmonary flow  Later infancy and childhood  Mild cardiomegaly  Triangular cardiac silhouette  Left atrium normal  distinguishes uncomplicated ASD from other L->R lesions)  Main pulmonary artery enlarged  Eisenmenger syndrome findings  Seen in pulmonary hypertension  Large central pulmonary arteries  Peripheral pulmonary artery tapering ASD IMAGING – CHEST RADIOGRAPHY  Mild to moderate cardiomegaly  Increased pulmonary vascularity  No left atrial dilatation ASD IMAGING/


location (less O2 ), metabolic disorders (DM) 5 Non cardiac malformation : 10 - 15% CHD (e.g. Cleft lips) Kartagener Syndrome (bronchiectasis, sinusitis paranasal, dextrocardia) AHD : - infection (RF, diphtheriae) - neonatus (Coxsackie B virus) 6 CONGENITAL HEART DISEASE (CHD/– –Depends on the size and pressure between RV and LV – –Pressure LV > RV  L-R shunt – –L-R, R-L (Eisenmenger S)  VSD, ASD – –Defect <<  small shunt – –Defect >>  large shunt – –Septum muscle contraction  diameter – –Other /

Chest Pain in Children MUHAMMAD ALI Cardiology Division Department of Child Health University of Sumatera Utara.

, such as aortic stenosis (AS), subaortic stenosis, severe pulmonary stenosis (PS), and pulmonary vascular obstructive disease (Eisenmengers complex), may cause chest pain. Mild stenotic lesions do not cause ischemic chest pain. Chest pain from severe /x-ray films may be abnormal in patients with AS and PS and are definitely abnormal in patients with Eisenmengers syndrome, with a marked prominence of the main pulmonary artery segment. Echocardiography and Doppler studies permit accurate determination of/


Decreased Impedance of systemic circulation eg Post stenotic dilatation aorta Chronic severe AR, PDA. Early P2 Due to Type B WPW Syndrome Reversed splitting in LBBB In proximal type: Delayed activation of LV In peripheral type: There is prolonged mechanical systole (primarily / normal split with normal respiratory variation S2 in Eissenmenger syndrome ASD Eissenmenger syndrome: S2 narrow fixed split VSD Eisenmenger syndrome: Single Loud P2 PDA Eisenmenger syndrome: Closely split S2 with Loud P2 THANK U


and artery number (alveolar-arterial [ALV/Art] ratio) as they relate to age. Platelet dysfunction ↑Serotonin EISENMENGER SYNDROMEEisenmenger syndrome” was coined by Paul Wood. Defined as CHD with initial large systemic-to-pulmonary shunt that induces /subsequent dysregulation of arginine metabolism and reduced NO bioavailability1 Pulmonary parenchymal and vascular injury from acute chest syndrome Increased oxidant burden Impaired LV diastolic function 1. Nat Med. 9 2003:496-500 Pulmonary Arterial/

Internal Medicine Board Review- Cardiology

of High Yield Areas Congenital Heart Disease Diagnoses ASD, VSD, Bicuspid AV Rare But Deadly Cardiac Conditions - Brugada Syndrome, HCM, Long QT syndrome, WPW ACS therapies: ASA, BB, ACE-I, Heparin, 2b/3a, Lytics Stable CAD therapies - ACE-I/ they present in adult life were likely moderately restrictive in childhood Likely to result in Eisenmenger’s syndrome and severe pulmonary hypertension Eisenmenger’s syndrome End-stage of congenital heart disease with initial L>R shunt Persistent increase in pulmomary/

Cardiac Disease in Pregnancy. Physiological Changes in the Cardiovascular System During Pregnancy A thorough knowledge –essential In order to understand.

cardiomyopathy Other Congenital heart disease Left → right shunt ① atrial septal defect ② ventricular septal defect ③ patent ductus arteriosus No shunt ① pulmonary artery stenosis ② coarctation of the aorta ③ Marfan syndrome right → Left shunt: Tetralogy of Fallot 、 Eisenmengers syndrome Rheumatic heart disease Mitral incompetence: isolated can tolerance pregnancy, delivery and puerperium. Mitral stenosis: 1Blood volume (during pregnancy) 2Blood volume back to the heart (intrapartum and early/

Pregnancy in women with heart disease fetus point Dr. M.Moshfeghi OBS&GYN fellowship of perinatology Shariati.Hospital,TUMS.

(pulmonary vascular disease) Maternal cyanosis Poor maternal functional class History of arrhythmia Maternal anticoagulants Pulmonary hypertension Eisenmenger syndrome, Preterm delivery and fetal growth retardation at least 50 percent, 15 to 25 percent of pregnancies / a favorable effect is exerted on a growth- retarded fetus, Pregnancy is contraindicated in women with Eisenmenger syndrome because of high maternal mortality risk, fetal risks, risk of thromboembolism CARPREG risk index Four predictors/

Congenital heart diseases. These are abnormalities in the cardiocirculatory structures or function that are present at birth, even if it is discovered.

artery pressure, as a result of increase of the pulmonary vascular resistance which causes reverse shunt Rt-Lt. (Eisenmenger syndrome) which is irreversible In small VSD there is high resistance to the flow through the VSD so there is /, in the 1 st year of life, Without surgical repair, most patients will develop pulmonary hypertension and some reach to Eisenmenger syndrome (10%), but 5% wall develop infundibular & pulmonary stenosis. Those with supracristal VSD at risk for aortic regurgitation. Small /


% ANZCOTR 2013 REASON FOR TRANSPLANT HEART LUNG n = 182 1986 - 2013 ANZCOTR 2013 Primary Pulmonary Hypertension 47 Eisenmengers Syndrome 37 Congenital Heart Disease 26 Cystic Fibrosis 25 Alpha-1-Antitrypsin Deficiency 13 Emphysema 6 Cryptogenic Fibrosing Alveolitis 5 Other/for Transplant Single Lung 1990 - 2013 AAT 16% Emphysema 51% IPF 25% Misc 6% Bronchiectasis 1% Other PH / Eisenmengers / CF 1% ANZCOTR 2013 REASON FOR TRANSPLANT SINGLE LUNG 1990 - 2013 n = 476 ANZCOTR 2013 Reason for Transplant Bilateral /

Congenital Heart Disease and Cardiac Imaging Modalities

stenosis, pulmonary stenosis, aortic coarctation Cyanotic: Tetralogy of Fallot, Ebstein’s anomaly, transposition of the great arteries, Eisenmenger’s syndrome, truncus arteriosus, tricuspid atresia, total anomalous pulmonary venous return “5 Ts and 2 Es” The heart is formed/left subclavian at site of ligamentum arteriosum. 2-5 times more common in men Associated with Turner’s syndrome, bicuspid aortic valve, ventricular septal defect, patent ductus arteriosus, mitral stenosis or regurgitation, or aneurysms /


with Incrs PBF (largeVSD+ NO PS) Persistent Truncus SV without PS TAPVC Cyanosis with PAH and Diminished PBF (eisenmenger- defnd as nonreactive PAH resulting in a R to L shunt at atrial,ventricular or great artery level) / accentuated Systolic murmur in pulmonary area is insignificant or absent Pulmonary and/or TR murmurs may be present EISENMENGER SYNDROME-DIFFERENTIATION ASD VSD PDA CYANOSIS UNIFORM DIFFERENTIAL CARDIOMEGALY PRESENT ABSENT PARASTERNAL IMPULSE HEAVING MILD 2nd SOUND WIDE FIXED SPLIT/


venous hum, mammary souffle  Tachycardia  LAD : elev. Diaphragm  Increased ventricular voltage  Increased LV diastolic dimension  Increased LV wall thickness  ↑ LVOT & RVOT velocities  L to R Shunts  R to L Shunts  Eisenmenger Syndrome  Obstructive Lesions  Risk Assessment  Timing of Intervension  Mode of delivery  Contraception  L → R shunting ↑ chances of PH, RV failure, arrhythmias  Degree of shunting not affected : SVR & PVR ↓ to similar degree/

The Univentricular Repair: Indications, Procedures, Outcomes and Controversies Karyn P. Luna, M.D.

or infertility and menstrual disorders were common. W Drenthen et al. Heart 2006 In the absence of Eisenmenger physiology, pregnancy in the context of cyanotic heart disease has been associated with 30% incidence of maternal cardiovascular/: Pregnancy Pregnancy is contraindicated in patients with severely reduced pulmonary blood flow or with severe pulmonary vascular disease (Eisenmenger syndrome) or if ventricular function is poor. Cyanosis poses a significant risk to the foetus, with a live birth/

LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095.

%302.6% Interstitial Pneumonitis 11.1%21.7%30.9% Pulmonary Vascular Disease 88.8%75.8%41.3%10.1% Eisenmenger’s Syndrome 11.1%54.2%51.6%70.6% Pulmonary Fibrosis, Other 66.6%86.7%165.0%242.1% Surfactant Protein /. 2012 Oct; 31(10): 1045-1095 PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival for Congenital Diagnoses (Transplants: January 1990 - June 2010) ISHLT 2012 Eisenmenger’s vs. Other: p = 0.5078 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by/

>>0 >>1 >> 2 >> 3 >> 4 >> Diagnostic Ultrasound 10/5/2015 1 Dr.sai krishna.

or mast cell tumour, and histiocytic diseases. Patchy mixed patterns are seen with advanced fibrosis (cirrhosis), hepatocutaneous syndrome and feline amyloidosis. The classic appearance of cirrhosis is a hyperechoic parenchyma with hypoechoic regenerative nodules, free peritoneal /sai krishna >>0 >>1 >> 2 >> 3 >> 4 >> Tricuspid dysplasia: Similar to MVD Eisenmenger’s syndrome and other malformations: Eisenmenger’s syndrome, a communication between the right and the left side of the heart (at the level of /


Evidence is conflicting whether migraine is associated with right to left shunt via PFO or ASD Pulmonary hypertension and Eisenmenger syndrome — The development of pulmonary vascular injury is related to the degree and duration of right heart volume overload./ pulmonary valve stenosis resulting in elevated right heart pressures, and thus right- to-left shunt, or Eisenmenger syndrome Clinical presentation Depend on the degree of left-to- right shunt Hyperdynamic right ventricular impulse due to large/


arteries, the vessels within the lung being normal or small. When the pulmonary hypertension is part of Eisenmengers syndrome (greatly raised pulmonary arterial resistance in association with atrial septal defect, ventricular septal defect or patent ductus/arteries, the vessels within the lung being normal or small. When the pulmonary hypertension is part of Eisenmengers syndrome (greatly raised pulmonary arterial resistance in association with atrial septal defect, ventricular septal defect or patent ductus/

Mehdi Mousavi M.D. Interventional Cardiologist Assistant Professor Alborz University of Medical Sciences

a condom correctly.  A vasovagal response occurring in a patient with idiopathic PAH or secondary PH, such as Eisenmenger syndrome, could be life- threatening, and many physicians therefore avoid use of an IUD in such patients.  For / venous thrombosis are at risk of paradoxical embolus and stroke.  In the setting of severe pulmonary vascular disease (Eisenmenger syndrome), maternal mortality may approach 50%.  The volume load of pregnancy may compromise the poorly functioning right ventricle and /

Paediatrics 2 Cardiothoracic & renal. What we will cover: Cardiac problems; Congenital heart disease Rheumatic fever Infective endocarditis Respiratory.

close by 3-4yrs Surgery 3-6m if significant Risks: arrhythmia, sudden death, IE, AV prolapse/AR, Eisenmenger’s Patent Ductus Arteriosus Causes: rubella, prematurity, prenatal hypoxia, malformations 1-2/1000 live births Failure to close/surgical excision Others Transposition great arteries Truncus arteriosus AVSD (Down’s syndrome) Complex e.g. tricuspid atresia Aortic stenosis Pulmonary stenosis Hypoplastic left heart syndrome Rheumatic fever Now rare in developed world Abnormal immune response to preceding/


arterioles Large main & large central pulmonary arteries taper down rapidly to very small vessels Seen in Eisenmenger’s syndrome Precapillary PAH PRUNING PULMONARY EMBOLISM Westermark sign Hampton’s hump Fleischner’s sign- prominent central pulmonary/‘waterfall sign’ ‘Hilar comma sign’ Associated right aortic arch (33%) Concave PA segment ELEVATED RIGHT HILUM Eisenmenger’s syndrome PACEMAKER BIVENTRICULAR PACING RA LEAD RV LEAD PACEMAKER PROBLEMS LEAD FRACTURE DISPLACED RV LEAD DISPLACED RA LEAD ICD CARDIAC /

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