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Chest Pain in Children and Adults

Mitral Regurgitation: New Concepts

Diastolic and Systolic Function

Changing the Outcome of CAD

The system assumes that flow through the heart is normal and begins with properly identifying the atria, and their position in the chest. In a normal individual there are two atria, each with venous inflow. One must identify the inferior and superior vena cava inflows into the right atrium and, where possible, identify four pulmonary veins into the left atrium.

Following the normal sequence of flow, one then identifies the atrioventricular valves and ventricles. Normally there are two atrioventricular valves, tricuspid and mitral. The tricuspid valve is committed to the right ventricle and the mitral valve to the left ventricle. Normally both the atrial and ventricular septa are intact.

Again following the normal sequence of flow, blood should emerge out of the ventricles into the great vessels. The pulmonary artery, taking flow to the lungs, is normally committed to the right ventricle while the aorta, taking blood to the systemic circuit, is normally committed to the left ventricle.

The pulmonary artery emerges from the right ventricle and passes anterior to the aorta. The pulmonary artery then bifurcates and is differentiated from the aorta that forms an arch, giving off vessels to the head and neck. The pulmonary artery and aorta "criss-cross" as they arise from their respective ventricles.

Given these normal sequences and relationships the terms previously mentioned are used to describe abnormal hearts. Chambers, valves, or vessels may be absent (atretic) or small (hypoplastic). Relationships between chambers and valves may be concordant (normal) or discordant. In addition, chambers or valves may be doubly committed or normally committed. An outline of the disorders is presented in Table 1.

TABLE I
Outline of Congenital Heart Disorders Discussed in This Book

1. When chambers and valves are in normal sequence and position
   
   
   1. When shunting is predominant
      1. Atrial septal defects (secundum, primum, sinus venosus, and coronary sinus)
      2. Ventricular septal defects (subarterial, muscular, inlet, and perimembranous)
      3. Atrioventricular septal defects (AV canal defects)
      4. Patent ductus arteriosus
         
         
   2. When stenosis or obstruction is predominant
      1. Absent atrioventricular connections (tricuspid and mitral atresia)
      2. Absent or obstructed ventriculo-great arterial connections (pulmonary atresia, aortic)
      3. Obstructed great arteries (coarctation of the aorta, aortic atresia)
      4. Obstructed venous inflow (total anomalous pulmonary venous return)
         
         
   3. Anomalous valve position (Ebsteins's anomaly)
      
      
2. When chambers and valves are not in normal sequence or relationship
   
   
   1. Anomalies of relationships between atria and ventricles
      1. Double-inlet or right ventricle (with univentricular heart)
      2. Atrioventricular discordance (corrected transposition)
         
         
   2. Anomalies or relationships between ventricles and great vessels
      1. Tetralogy of Fallot
      2. Double-outlet right and left ventricles
      3. Truncus arteriosus
      4. Ventriculo-great arterial discordance (transposition of the great vessels)

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