SHa24/016003

READ WITH EXEPERT Riyadh SA FEB 2013 SHAHRABAN ABDULLA CONSULTANT PEDIATRIC CARDIOLOGIST LATIFA HOSPITAL DHA

2.5 years old presented to hospital at age of 6 month with history of excessive crying and interrupted feeding since birth.

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What is the Differential Diagnosis

A- Pericardial cysts B- Pericardial effusion C- Atrial diverticulum

MRI showed: presence of an enormous right atrium diverticulm arising from right atrial appendage it did appear to have pericardium in front of it.

Underwent exsion right atrial diverticulm

Apical four-chamber view showing a large, perfused diverticulum (D) arising from the right atrial wall.

Diverticulum of the right atrium is a rare congenital heart anomaly.

Kobza R et al. Eur J Echocardiogr 2003;4:223-225 Copyright Š 2003, The European Society of Cardiology

increased risk of supraventricular arrhythmias and thrombus formation.

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EM 1 year and 8 months was referred to pediatric cardiology clinic in March 2011 for assesment of cardiac murmur.

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Coronary Artery Fistula A coronary artery fistula (CAF) is classified as an abnormality in the termination of a coronary artery.

CAF was described in 1865 by Krause

CAF is a rare congenital anomaly, accounting for approximately 0.2%–0.4% of congenital cardiac anomalies .

CAFs have an estimated prevalence of 0.002% in the general population CAF arises from the right coronary artery (RCA) in approximately 50% of patients, the left coronary artery (LCA) in approximately 42% of patients, and both the RCA and LCA in approximately 5% of patients

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CAF

The majority of patients are usually asymptomatic.

It is very rare to diagnose a CAF in the neonate.

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CAF draining into the right atrium in a 54-year-old man with shortness of breath.

Zenooz N A et al. Radiographics 2009;29:781-789

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Š2009 by Radiological Society of North America

CAF draining into the right ventricle in a 7-year-old boy with dyspnea.

The most common clinical presentation of CAF is a continuous heart murmur.

If symptoms develop, most

patients present later in life with: Dyspnea Right ventricular enlargement or dysfunction related to progressive enlargement of the fistula and an increase in the left-to-right shunting

Zenooz N A et al. Radiographics 2009;29:781-789

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Š2009 by Radiological Society of North America

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One year eight month born at 27/52 one of triplet, 2D Echocardiogram at day 6 showed PDA with volume overload, received three doses of Indomethacin, follow up Echo. On day 82 showed moderate size PDA with raised pulmonary pressure, on D110 showed moderate size PDA improved pulmonary pressure. She also had chronic lung disease.

At age of six and half months was admitted with bilateral pneumonia and showed signs of increase right ventricular pressure, was started on Sildenafil, Lasix and Digoxin.

She underwent cardiac catheterization on February 2012 showed large PDA which was closed

by Amplatzer.

Follow up 2D Echocardiogram done showed Aortic arch obstruction and device was oversize, in June 2012 underwent removal of device by resection and end to end anastmosis.

9 years old male, was diagnosed at age of two years and nine month when he was referred to LH from PHC due to developmental delay, found to have ejection systolic murmur GIII/VI over left and right base, 2D Echocardiogram done.

CT chest Aorogram done on 30/12/12 showed: A local constriction at the aorta distal to the origin of the left subclavian artery indicating the level of the coarctation with the rest of the aortic arch show normal caliber.

A few intercostal collaterals is noted.