Prepared by:

Dr. Majid Al-homiedan

 Most common congenital
cardiac lesion. The
magnitude of the shunt
depends on the size of the
defect, the relative
compliance of the ventricles,
and the difference in atrial
pressure. May be combined
with mitral stenosis
(Lutembacher's syndrome)
and cause a substantial
increase in the workload of
the right ventricle.
 Increased pulmonary
vascularity; enlarged right
atrium, right ventricle, and
pulmonary outflow tract;
normal left atrium and left
ventricle; small aorta.
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED
PULMONARY BLOOD FLOW
 Common congenital
cardiac anomaly. The
magnitude of the shunt
depends on the size of the
defect and the difference
in ventricular pressure.
There may also be a shunt
from the left ventricle to
the right atrium.
 Increased pulmonary
vascularity; enlarged right
ventricle, pulmonary
outflow tract, left atrium,
and sometimes left
ventricle (may be normal);
normal right atrium;
normalDDXor small aorta.
OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED
PULMONARY BLOOD FLOW
 Ductus extends from the bifurcation of the pulmonary
artery to join the aorta just distal to the left subclavian
artery (shunts blood from the pulmonary artery into the
systemic circulation during intrauterine life). The aortic end
of the ductus (infundibulum) is often dilated to produce a
convex bulge on the left border of the aorta just below the
knob.
 Increased pulmonary vascularity; enlargement of the left
atrium, left ventricle, aorta, and pulmonary outflow tract;
normal right atrium; enlarged or normal right ventricle.

DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED

PULMONARY BLOOD FLOW
 Low atrial septal
defect combined
with a high
ventricular septal
defect. Most often
occurs in children
with Down's
syndrome.
 Increased
pulmonary
vascularity;
nonspecific globular
enlargement of the
heart (enlargement
of allDDXcardiac
OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED
PULMONARY BLOOD FLOW
 Uncommon anomaly in
which a communication
between the pulmonary
artery and the aorta (just
above their valves) is
caused by a failure of the
primitive truncus
arteriosus to separate
completely.
 Increased pulmonary
vascularity; enlargement
of the left ventricle, left
atrium, and pulmonary
outflow tract (similar to
patent ductus arteriosus
but usually a less
prominent DDXaortic knob).
OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED
PULMONARY BLOOD FLOW
 Rupture usually occurs into the right ventricle (occasionally
the right atrium). Causes a sudden large left-to-right shunt
with the acute onset of chest pain, shortness of breath, and
a cardiac murmur.
 Rapid increase in pulmonary vascularity and enlargement
of the right ventricle and the pulmonary outflow tract.

DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED

PULMONARY BLOOD FLOW
 Unusual anomaly in which
there is a communication
between a coronary artery
and a cardiac chamber or the
pulmonary artery. The right
coronary artery most often
communicates with, in order
of frequency, the right
ventricle, right atrium,
coronary sinus, or pulmonary
artery.
 Increased pulmonary
vascularity; enlargement of
the pulmonary outflow tract;
enlargement of the right
ventricle or both the right
atrium and the right ventricle
(depending on the site of the
fistula).
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED
PULMONARY BLOOD FLOW
 One (or more) of the
pulmonary veins is
connected to the right
atrium or its tributaries.
Virtually indistinguishable
from an atrial septal
defect radiographically. A
scimitar sign (crescent-
like anomalous venous
channel) on the right if
associated with
hypoplasia of the right
lung.
 Increased pulmonary
vascularity; enlarged right
atrium, right ventricle,
and pulmonary outflow
tract; normal left atrium
and left ventricle; small
aorta.DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH INCREASED
PULMONARY BLOOD FLOW