prof julene s carvalho - royal brompton hospital documents...prof julene s carvalho head of brompton...
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Prof Julene S Carvalho Head of Brompton Centre for Fetal Cardiology
Consultant Fetal and Paediatric Cardiologist Professor of Practice, Fetal Cardiology
Molecular & Clinical Sciences Research Institute, SGUL
Big aorta, big pulmonary artery
London 24 January 2020
How big is too big and does it matter?
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Vessel size
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Big aorta and pulmonary artery
Objectives
• To exclude structural heart disease
• To appreciate relative sizes of the aorta and PA
• To make objective measurements
• To have a plan
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Big aorta and pulmonary artery
Objectives
• To appreciate relative sizes of the aorta and PA
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PAAo SVC
RT
LT
Vessel number Vessel size Vessel arrangement Vessel alignment
PAAo
SVC
Right
Left
Ant
Post
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Big aorta and pulmonary artery
Objectives
• To appreciate relative sizes of the aorta and PA
• To make objective measurements
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http://fetal.parameterz.com
http://fetal.parameterz.com
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Big aorta and pulmonary artery
Objectives
• To make objective measurements
• To exclude structural heart disease
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Big aorta, small PA or both?Case 1- 36 weeks
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Tetralogy of Fallot
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Case 2- 19 weeks
Small aorta or big PA?
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Coarctation
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27 weeks 33 weeks
Coarctation
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Case 3- 21 weeks
Big pulmonary artery?
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Vmax = 2m/s
Pulmonary stenosis
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Case 4- 21 weeks
Big aorta
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Aortic aliaising
67cm/s
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67cm/s
Ao Vmax = 154cm/s
Valvar aortic stenosis
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Valvar pulmonary stenosis … mother: likely Noonan
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Case 4- 21 weeks
Referred for ‘big pulmonary artery’
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No structural abnormality
What next?
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Sonographer referral for ‘big aorta’No structural cardiac abnormality
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‘Big-gish’ aortaNo structural cardiac abnormality
Z-score = + 1.86
Family history of aortic aneurysm/ dissection
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Patient referred for ‘bicuspid aortic valve’ - 23 weeksNo structural cardiac abnormality - ‘aorta a bit big’?
Bicuspid valve?
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Patient referred for ‘bicuspid aortic valve’
Normal looking aortic valve at 31-week follow up
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Patient self-referred ‘for reassurance’No structural cardiac abnormality - 20 weeks - prominent PA?
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http://fetal.parameterz.com
No structural cardiac abnormality - 20 weeks - prominent PA = 4.6mm?
http://fetal.parameterz.com
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Big aorta and pulmonary artery
Objectives
• To exclude structural heart disease
• To have a plan
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Big aorta and pulmonary arterySummary
• Family history • Consider bicuspid aortic valve • Consider possibility of aortopathy • Consider possibility of genetic syndrome:
• Exclude obvious cardiac abnormality
• Aortic and pulmonary stenosis • Rescan to exclude minor lesions that may evolve
• May still remain unexplained
• Marfan, other collagen disorders • Noonan syndrome (pulmonary stenosis, ? progression)
• Calculate Z-scores and follow up if > +2
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Thank you