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okay, moving now on to case 8

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we have four transaxial CT

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images.

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through the heart and

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aorta and pulmonary arteries

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from a

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ECG gated CT and

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so look at these four images and see

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if there's abnormality that you can identify

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or a few abnormalities we can identify and

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if there's an explanation.

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Take a few seconds.

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Okay.

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The top left image shows looks like

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a normal caliber or sending aorta a

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decent aorta main pulmonary artery and the branch vessels the

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right and left pulmonary arteries. Look a little bit dilated. Normally the

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main pulmonary artery should be a little

1:00

bit smaller than the medicine aorta measure the same level the

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ratio of sending aortic

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to main primary already normally is about 1.2.

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This main primary artery looks so dilate.

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As we come down to the sequential images

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through the heart we see that

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the right atrium is dilated and

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the right ventricle is dilated.

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I think that's readily apparent when we compare it to the

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normal size left atrium and left ventricle.

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So the key is what is causing these findings?

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Now we know that pulmonary hypertension can cause dilation

1:41

of main pulmonary artery.

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It can cause dilation of the right heart chambers as well. But usually

1:48

you get significant pulmonary hypertension in

1:51

addition to this to the dilatation.

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In fact

1:56

when you have pulmonary hypertension

1:59

You should have as the first physiological response abnormal thickening

2:02

or hypertrophy of the RV before

2:05

it starts to dilate over time. It will also start to

2:08

dilate.

2:09

but the first findings associated

2:12

with dilatation are

2:15

related to volume overload volume

2:18

overload is related to either value or

2:21

insufficiency in this case tricuspid or

2:24

pulmonary valve insufficiency or

2:28

patient

2:30

and that is the pathology in

2:33

this case.

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You'll notice here on this gated study that there is

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discontinuity of the interatrial septum.

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And this is an ostium secundum atrial

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septal defect.

2:48

There are others such as sent past

2:51

us in premium and science phenosis,

2:54

but the ASD that

2:57

involves the fossil valence is the astronom and this

3:00

is what it looks like by CT after the

3:03

clamshell closure devices

3:06

use to close the hole if the

3:09

if the anatomy of

3:12

the defect is favorable for percutaneous closure,

3:16

this is the the oscium secundum ASC

3:19

is the only one of the three that can

3:22

be closed burkitteniusly the ostium premium

3:25

and the science stenosis defects require

3:28

surgical closure.