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Radiology
Hypoplastic Left Heart, Mitral Atresia
Built from Obstetric Imaging
What’s inside
9 sections · 68 slides
Overview
- What this session covers
The condition in plain words
A heart born with only one working pump
- One side of the heart never grows
- Why the baby is fine before birth
- The formal definition
- Labelled anatomy of a hypoplastic left heart
- Reading that picture
- The normal heart, for comparison
- 0.1–0.6
- The numbers behind those figures
- Why so few affected babies are actually born
Why it happens
Genes, syndromes and the anomalies that travel with it
- The cause is rarely one single thing
- Chromosome and gene findings
- Anomalies outside the heart
- Other heart defects that travel with it
- No flow, no growth
- Why blocked flow shrinks a chamber
The forms of the disease
Two common routes, and four rarer ones
- Two main routes to the same end point
- Form one: mitral and aortic atresia
- Four-chamber view in mitral atresia
- What that scan is showing you
- Three-vessel and trachea view with a tiny aorta
- What to notice in the upper chest view
- Form two: critical aortic stenosis
- Four-chamber view in critical aortic stenosis
- Telling the two forms apart on the scan
- Rarer forms worth knowing
- Mitral atresia with double-outlet right ventricle
- Unbalanced atrioventricular septal defect
- Coarctation, interrupted arch and Shone complex
What happens at birth
Silent in the womb, catastrophic when the duct shuts
- Silent before birth, healthy at delivery
- What happens when the duct closes
- Keeping the duct open
What the scan shows
Four-chamber, five-chamber and three-vessel views
- Why this defect is rarely missed
- Four-chamber view: mitral and aortic atresia
- Flow runs backwards through the foramen ovale
- How the pressure backs up into the lungs
- Reading the pulmonary vein Doppler
- Reversed a-wave in the pulmonary veins
- What that trace is telling you
- Four-chamber view when aortic atresia is the cause
- Five-chamber view
- Three-vessel and trachea view
- How the rarer forms look on ultrasound
- The signs to carry away
- What else can look like this
- An unbalanced AVSD can mimic a single ventricle
- Tricuspid atresia and single ventricle
Care before birth
Testing, surveillance and a planned delivery
- The first steps after the diagnosis
- Follow-up through the pregnancy
- Planning the delivery
- Is there any treatment before birth?
Surgery after birth
A transplant, or three staged operations
- Two options since 1980
- The staged route, in order
- Stage one: the Norwood procedure
- Stage two: the Glenn procedure
- Stage three: the Fontan procedure
- The three staged operations, side by side
- The hybrid procedure
Outcome and counselling
What the referring physician needs to know
- What the referring physician needs to know
- Why two sets of survival figures disagree
- Living with a Fontan circulation
- The brain matters as much as the heart
- Key points
- Suggested readings
- References
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition