Cardiologia Croatica, Vol. 11 No. 1-2, 2016.
Pregledni rad
https://doi.org/10.15836/ccar2016.8
Echocardiographic Indicators of Simple Adult Congenital Heart Diseases.
Jadranka Šeparović Hanževački
; Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
Sažetak
Adult congenital heart diseases (ACHD), in addition to complex heart defect diagnosed in childhood, also include very simple singular heat defects that are diagnosed only in adulthood due to their minor hemodynamic influence and severity. The indicators of simple ACHD on the left side of the heart and the aorta are signs the left ventricle (LV) has been remodeled by volume, pathological morphology of the valve (most commonly bicuspid aortic valve (BAV) disease and myxomatous mitral valve disease), and coarctation of the aorta. Volume load of the LV due to increased inflow into the left side of the heart leads to eccentric hypertrophy of the LV (normal wall thickness, increased volume, and ball-like shape) proportionate to the severity of the hemodynamic defect – the greater the regurgitation or shunt volume, the greater the dilation of the heart. Dilatation of the ascending aorta is also common in BAV. Volume load on the LV causes concentric hypertrophy (low systolic and diastolic volume, thickened walls). The most common natural causes of volume load on the LV are: congenital aortic stenosis, subaortic stenosis (isolated subaortic fibrous ring and subaortic membrane), coarctation of the aorta (more often associated with BAV), and conditions after previous surgical procedures. Other than the size of the cavities and the thickness of the walls and the left and right heart, the dynamic relationship of pressure changes during the cardiac cycle is important as well. When this relationship is disrupted, the ventricular or inter-atrial septum is displaced towards the area of lower pressure. Pressure load of the right ventricle (RV) causes the septum to be displaced towards the left in the systole and create a so-called D-shaped left ventricle. Volume load of the RV causes the septum to be displaced to the left in the diastole, causing a so-called D-shaped left ventricle in the diastole. In conclusion, we can group the echocardiographic indicators of simple and less severe ACHD into 5 basic categories: 1) size and morphology of the LV; 2) size of the right atrium, position of the inter-atrial septum; 3) size and morphology of the RV; 4) pulmonary hypertension; 5) flow pressure gradient across the aortic and pulmonary valve (AV/LVOT and PV/RVOT). Finding any of these indicators (with or without accompanying cardiologic signs and symptoms) should raise suspicion of the existence of ACHD, which should then be established or eliminated from the differential diagnosis.
Ključne riječi
echocardiography; adult congenital heart disease; volume overload; pressure overload
Hrčak ID:
153647
URI
Datum izdavanja:
23.2.2016.
Posjeta: 2.582 *