《Cardiac Valves assesment and identification》.doc

Cardiac Valves: Assessment and Identification Atrial Septal Defects The different types of atrial septal defect (ASDs) are: sinus venosus, secondum and primum. In order to remember the anatomic locations of the atrial septal defects one can remember the letters VSP which localized each atrial septal defect from cranial/top of the atria to caudal/bottom of the atria: V- venosus, S - secondum, P -primum- Sinus venosus ASDs are seen with PAPVR- Secundum ASDs are the commonest type- Primum ASDs are seen with Down syndrome Ventricular Septal Defects There are four major locations of ventricular septal defects: membranous, muscular, anterior and posterior.The membranous ventricular septal defects are more common (80%) and occur in the fibrous portion of the septum closer to the base of the heart. The muscular ventricular septal defects exist in the muscular portion of the septum closer to the apex of the heart. Prosthetic Cardiac Valves Localizing cardiac prosthetic valves can be difficult. There are a number of strategies that can be employed to aid in characterizing the type of prosthetic valve. The best strategy involves assessing the location of the valve and then determining the orientation and direction of flow. Additional aids which serve as adjunts are the statistical nature of valve replacement and including patient history.The location of the cardiac valves is best determined on the lateral radiograph. A line is drawn on the lateral radiograph from the carina to the cardiac apex. The pulmonic and aortic valves generally sit above this line and the tricuspid and mitral valves sit below this line. Keep in mind that sometimes the aortic root can be inferiorly displaced which will shift the aortic valve below this line. The aortic and pulmonic valves are generally above the red line and the mitral and tricuspid valves generally lie below it. A second technique to further localize prosthetic valves involves drawing a second line which is perpendicular