0:00

The next case belongs to patients who have had

0:03

cardiac surgeries. There's four different types of surgeries here

0:06

shown.

0:07

And four different patients with four

0:10

different types of surgeries, and these are all post-operative

0:13

Mr. Examinations and based on the post-operative appearances.

0:16

I'd like for the audience to make

0:19

a to come

0:22

to conclusion as to what what the patient

0:25

was probably born with in terms of the congenital defect. So, let's

0:28

have the polling questions while we look at these cases, please.

0:32

Okay, so the four choices are either repetitology or

0:35

fellow.

0:35

A arterial switch procedure done

0:38

for dtga or in atrial switch procedure done

0:41

for dtag, which stands for detranspose great

0:44

arteries or a Fontana procedure. I'm going

0:47

to I'm going to show these four cases first and then we will go

0:50

through we'll take a pull and show these and discuss the answers case

0:53

a

0:55

the patient may have had either of these following procedures

0:58

only one.

1:00

This is case b.

1:03

Case C and lastly case D. So

1:06

let's start with case a let's take a poll

1:09

of what the audience thinks the patient.

1:11

May have had done for their congenital heart defect.

1:14

Okay, RTL switch procedure accident very educated

1:17

audience. As far as congenital heart disease is concerned notice

1:20

the pulmonary arteries are draped in front of the auto what's

1:23

known as Napoleon's hat the coronary arteries seem to

1:26

have a rising. Abnormally. The left is has an

1:29

entire course seems realizing slightly towards

1:32

on a clock. It's arising more towards the love

1:35

the clock a position of the ten

1:38

o'clock position rather than expected. The aortic root is dilated this

1:41

particular configuration. The pulmonary artery is being in front of the aorta draped

1:44

over his typical for an arterial switch procedure known as

1:47

a comment.

1:49

This patient was born with a transposition of the

1:52

great entries.

1:53

Implying the authorized from the right ventricle the pulmonary

1:56

arteries arose from the left ventricle and they were switched when they

1:59

switched the coronary artery is also switched and the

2:02

crony obstruction or kinking is a complication this procedure

2:05

for the more iotic root dilutations are complications procedures

2:08

can be seen in the third is in the third image here

2:11

the typical finding of pulmonary arteries depross

2:14

the aorta in front of the OTA as a finding

2:17

for an arterial switch procedure. This can

2:20

lead to the complication of pulmonary artery stenosis common is complications after arterials

2:23

which are our YouTube obstruction stenosis iot

2:26

crude delegation and Crone reality obstruction.

2:29

But the this this picture on

2:32

the left showing the pulmonary arteries

2:35

across the ascending Toyota is a typical

2:38

finding for an arterial switch procedure has been performed for

2:41

Day transposition of the great arteries.

2:44

Okay case number B a case b can we

2:47

have a polygen please? This patient has had a surgical procedure

2:50

for

2:51

congenital heart disease and which surgical procedure

2:54

and which control heart disease?

2:56

Can the audience um, take a poll take

2:59

a walk again? Okay, the question, unfortunately, neither

3:03

of the water's got the correct

3:06

answer here. The correct answer is C atrial switch

3:09

procedure for transposition of the great arteries notice

3:12

that this the right ventricle is dilated. This

3:15

track has been insufficiency. The pulmonary veins

3:18

are draining into the right side of the heart. So this patient was

3:21

also born with a transpositional great arteries as in the previous patient

3:24

of the in up to

3:27

the 1990s early 1990s. The surgery that

3:31

was performed for an arterial switch was an atrial switch procedure. So

3:34

instead of switching the great arteries what the surgeon has

3:37

done here is connected the pulmonary veins to the right side

3:40

of the heart. So the the Palm ravenous blood goes in the

3:43

right atrium right ventricle and the right ventricles connect to the aorta. So

3:46

the right vertical functions as a systemic ventricle and

3:49

because it's it's functioning against high blood pressure it

3:52

eventually fails. That's what leads to the right

3:55

clinical advantage.

3:56

A good station. This patients had an atrial

3:59

switch procedure. The SVC has been baffled

4:02

into the left side of the heart notice that this patient

4:05

has svcs stenosis a typical location for baffle obstruction lower

4:08

end of the SVC common location for Superior as

4:11

we see to left atrium baffle obstruction.

4:14

This patients had an atrial level switch for transposition

4:17

of the great entries. The complications here are right

4:20

ventricular validation track has been sufficiency and stenos

4:23

in the lower SVC. You can see the pulmonary veins

4:26

can be seen draining to the right side of the heart as we see goes

4:29

into the left side of the heart atrial switch procedure for transposition the

4:32

great entries not commonly performed in this current

4:35

ERA. However, there will be a significant number of survivors of

4:38

the atrials which procedure that present for MRI. The role

4:41

of MRI is to evaluate the venous baffles and the

4:44

function of the ventricles spreading the right ventricle, which is

4:47

still connected to the aorta. Okay case numbers

4:50

see this patient has had a surgery

4:54

for congenital heart disease and the type of surgery performed

4:57

can be

4:58

Can be figured out from

5:01

these pictures the correct answer will be either one

5:04

of the following.

5:06

Okay, good, excellent Fountain procedure. This patient

5:09

has a single ventricle notice that there's a single ventricle in

5:12

this patient not too ventricles the SVC and

5:15

ivca connected directly the pulmonary arteries. The single

5:18

ventricle is connection to the aorta. This patients are the four-time procedure

5:21

total Cave of pulmonary connection commonly out

5:24

is connected directly to the SVC and IVC and the single

5:27

ventricle functions as a systemic ventricle and connected to

5:30

the aorta. This has patients headache Fontan procedure for

5:33

single ventricular hypoplastic left-hand syndrome in

5:36

this particular case.

5:38

Case number G. There's only one right answer

5:41

now.

5:43

This these MRI images belong to a patient has had

5:46

a heart surgery in the past.

5:48

And the correct, correct?

5:51

And so would be either of these four what has this patient

5:54

had.

5:55

Okay to charge your fellow repaired excellent the abnormalities

5:58

shown a dilated right ventricle. The

6:01

outflow tract region of the right clinical is very thin and discard

6:04

patients had an outro attract patch for

6:07

relief of pulmonary outflow tract obstruction and was

6:10

born with tetralgia fallow harmonic insufficiency is

6:13

the major residual hemodynamic effect in survivors of tetralogy of

6:16

fallow that leads right ventricularization the patch

6:19

and the outflow track region, which was repaired maybe scarred notice

6:22

the scarring in the right 24 hour track daily features

6:25

of repair technology of fellow.

6:28

So full cases for diagnosis technology of fellow Fountain procedure

6:31

atrial switch for translational

6:34

grade arteries and arterial switch for transpositional great

6:37

arteries all very common and important

6:40

indications for referral to adult kitchen hard disease practices

6:43

and MRI in particular because MRI can

6:46

clearly evaluate intercontiac and extra cardiac structures

6:49

for anatomy physiology Form and Function in patients

6:52

with prepared congenital heart disease a class one

6:55

indication a very important indication of economic MRI.