0:00

The history should be available. I'm going

0:03

to play the

0:05

gonna show some still images here case number

0:08

four is actually a 54 year old

0:11

man.

0:12

With increasing Insurance of bread and NMR was

0:15

performed. They said three chamber view notice the left ventricle left

0:18

atrium right ventricle aortic route ascending

0:21

aorta.

0:22

And this is a oblique sagittal

0:25

view right ventricle harmonic artery.

0:29

Iotic Arch listening Iota right atrium. Now

0:32

I'm going to show some some cine images which are

0:35

very important in this particular case.

0:37

This is the three chamber View.

0:40

Notice the left ventricle right ventricle back

0:43

to Atrium iot Groot.

0:46

Just going to let that play for a minute.

0:49

And now we're going to see the oblique sagittal view

0:52

here. Actually this cine was what I wanted. So just

0:55

play within a minute when I show this me.

0:57

Okay. So this is the cine view right ventricle right

1:00

ventricular outflow tract goes the key images here. So

1:03

we have a combination now. I'm going to go back to the still images

1:06

because it's still images have most of the

1:09

information here. So here we have a 54 year

1:12

old man with increase Insurance of bread.

1:14

Three chamber View and oblique's natural

1:17

view of the right ventricles. The correct answer is five

1:20

choices here if we can put up the phone, please.

1:23

Yeah.

1:24

So it's five choices here. This is a congenital heart condition.

1:27

Is it a double Outlet right ventricle is a

1:30

great vessels transposed is the

1:33

isolated harmonic stenosis of the trunk is a trunk usarteriosis or

1:36

is a tetralogy of fallow.

1:39

So three chamber View and an oblique exchange of view

1:42

of the right ventricle or right 24 hour track view. Can we

1:45

have trunkus arteriosis unfortune?

1:48

That's not the right answer. The right answer is a

1:51

tetralogy of fallow notice all the features of

1:54

Technology of fellow present a Yota overrides the

1:57

right ventricle. There's this vsd ventricular separate defection

2:00

notice the defect in the septum. There is harmonic stenosis.

2:03

I'm going to show the cine again notice the

2:06

defacing the right ventricular outfit track and there's right ventricular hypertrophy

2:09

all the classical findings of Technology of fallow.

2:12

Trump is arteriosis when a single vessel arises from the

2:16

Arises from the heart and gives rise to the auto and

2:19

the pulmonic artery. This is not a case of Trancas arteriosis

2:22

doubled out. It's not a double Outlet right ventricle. It's

2:25

not the great verses are not transpose. There's not

2:28

isolated harmonics nurses a key findings in technology of

2:31

fallow. Once again, the city images. This is

2:34

the Sydney image notice the vsd aorta overriding

2:37

the two ventricles.

2:39

Okay findings of tetralogy of fallow.

2:42

and then on the

2:44

oblique sagittal view noticed the pulmonic stenosis

2:47

seen as defacing the right ventricular outflow tract

2:50

and consequent right ventricular hypertrophy key findings

2:53

of Technology of fellow.

2:55

Any questions before you before we go to the next questions

2:58

instead of questions based on a tetralogy of fellow. So

3:01

next question based on I'm just going to keep this keep this

3:04

up is falling primary and

3:07

tomical repair which of the following

3:09

Is the Communist hemodynamic complications technology of

3:12

fellow has to be repaired?

3:14

As it is a cyanotic congenital heart disease

3:17

and typical repairs performed by relief of

3:20

right ventricular off retract obstruction and by closure of the ventricular defect.

3:24

So following repair patients are not completely cured residual

3:27

hemodynamic effects can occur

3:30

and the Communist human Dynamic abnormalities is

3:34

one of the following one of the Five Below.

3:37

Tricuspid insufficient and that's not the right answer

3:40

the right answer. It's pulmonic insufficiency. So they're right answers d

3:44

Called Monica and sufficients. Yes strike us but insufficients in can occur but

3:47

that's not the primary abnormality user track us but insufficient secondary to

3:50

dilated right ventricle. So relief of our VO2

3:53

obstruction requires resection of the right ventricular output tract region

3:56

or all the pulmonic valve leaflets and

3:59

following resection of the right clinical

4:02

outflow attract either by a muscle bundle a section up harmonic

4:05

valve resection harmonic insufficiencies, the

4:08

key finding and that's the key hemodynamic abnormality after that after

4:11

correction of tetralgia fellow and a large volume

4:14

of adult congenital practices is follow-up

4:17

of patients with tetralogy of

4:20

calculation of research and function of harmonic registration.

4:23

And right ventricular volumes says as

4:26

the harmonic valve becomes insufficient the

4:29

right ventricle keeps dilating and at some point harmonic valve

4:33

repair and maybe needed to further

4:36

prevent irreversible RV

4:39

dysfunction. So harmonic insufficiency is a

4:42

key finding after a pair of techn.

4:44

Of the others can occur that can be some residual harmonics

4:47

nurses track husband insufficient of panaker, but it's usually secondary to

4:50

rvalitation. They can be residual vsds

4:53

iot growth can be dilated and based natural fellow, but

4:56

that's not the primary abnormality. The primary abnormality is pulmonic

4:59

insufficiency after a pair of tetralogy of

5:02

hello.

5:03

Question number three, so harmonic insufficiency can

5:06

occur and at some point right ventricle May Fail and

5:09

before that failure occurs, the harmonic valve may

5:12

need to be replaced either percutaneously or by surgical repair. So right

5:15

ventricular volumes are a key parameter to

5:18

monitor after repair of controls your

5:21

fellow and there is a threshold when it's considered that

5:24

harmonic ground replacement is needed. So question number three asks what

5:27

the threshold is can we put question number three

5:30

on please. So let me read out the question. So when when should

5:33

the harmonic boundary be replaced after repair of control

5:36

your fallow? Is it at 90 to 130 150

5:39

to 117 17200 or

5:42

250? Ml per square meter father right ventricular size.

5:45

The correct answer is 150 is

5:48

15.

5:50

So when the right?

5:53

When the right ventricular volume exceed 150 to

5:56

170 ml per square meter.

5:59

The harmonic valve should be replaced

6:02

that's considered the thresholds or repair

6:05

of tetralogy of fellow. So

6:08

after repair of tetralogy of fallow pulmonic

6:11

insufficiency is the primary hemodynamology

6:14

and serial MRIs

6:17

performed typically every one to three years and when

6:20

the right ventricle reaches 150 to 170 MLS

6:23

per square meter indexed.

6:25

For the pulmonic valve replacement is considered. It's

6:28

the control geofollow a common

6:31

the Communist cyanotic and general heart disease VST Toyota

6:34

overriding the right ventricle, right ventricular outfitractor abstraction

6:37

and write ventricular hypertrophy and atomic repair

6:40

consists of vsd patch repair and relief of

6:43

RV obstruction. The primary human Dynamic complication

6:46

adult survivors is residual harmonic insufficiency. Same

6:49

CMR cardiacomar is used

6:52

to guide the timing of common replacement which should be

6:55

performed before the right one of the severely dilated typically.

6:58

When the index and diastolic volume reaches 150

7:01

ml per square meter harmonic bound replacement is considered,

7:04

okay.