Prepared by: Dr. Majid Al-Homiedan
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL PULMONARY
BLOOD FLOW
In the more common adult type, the aortic narrowing occurs at or
just distal to the level of the ductus arteriosus (double bulge
represents prestenotic and poststenotic dilatation). In the
infantile variety, there is a long segment of narrowing lying
proximal to the ductus (obligatory right-to-left shunt and early
congestive heart failure). There is a relatively high incidence of
coarctation in women with Turner's syndrome. Characteristic double
bulge in the region of the aortic knob (figure-3 sign on plain
chest radiographs and reverse figure-3, or figure-E, sign on the
barium-filled esophagus). There may be rib notching (usually
involving the posterior fourth to eighth ribs) but rarely
developing before age 6 years. OF ACYANOTIC CONGENITAL HEART
DISEASE WITH NORMAL DDXPULMONARY BLOOD FLOW
Valvular, subvalvular, and supravalvular types. Bulging of the
right superior mediastinal silhouette (poststenotic dilatation of
the ascending aorta) is often seen with valvular stenosis.
Increased convexity or prominence of the left heart border (overall
heart size often normal). Substantial cardiomegaly reflects left
ventricular failure and dilatation.
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL PULMONARY
BLOOD FLOW
Common anomaly found in isolated form or in combination with
other abnormalities. The stenosis is most common at the level of
the pulmonary valve (supravalvular or infundibular stenosis can
occur). Must be differentiated from normal idiopathic poststenotic
dilatation of the pulmonary artery in adolescents and young adults,
especially women. Poststenotic dilatation of the pulmonary artery,
often associated with dilatation of the left main pulmonary artery.
The heart size is initially normal (right ventricular hypertrophy
and dilatation if severe pulmonary stenosis causes systolic
overloading of the right ventricle).
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL PULMONARY
BLOOD FLOW
Diffuse thickening of the left ventricular endocardium with
collagen and elastic tissue. A common cause of cardiac failure
during the first year of life. The pulmonary vascularity remains
normal until congestive heart failure supervenes.
Striking globular cardiac enlargement (often with left-sided
prominence); small aortic knob.DDX OF ACYANOTIC CONGENITAL HEART
DISEASE WITH NORMAL PULMONARY BLOOD FLOW
Includes hypoplastic left heart syndrome, mitral stenosis and
insufficiency, aortic insufficiency, cor triatriatum, aberrant
pulmonary origin of left coronary artery, and cardiomyopathy.
Hypoplastic left heart syndromeDDX OF ACYANOTIC CONGENITAL HEART
DISEASE WITH NORMAL PULMONARY BLOOD FLOW
