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Objective Early risk assessment of pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CHD) is crucial to ensure timely treatment. We hypothesize that applying artificial intelligence (AI) to chest x-rays (CXRs) could identify the future risk of PAH in patients with ventricular septal defect (VSD).
It can occur in severe pulmonary hypertension, there can be right atrial enlargement, as the severe hypertrophy of the right ventricle causes elevation of right ventricular end diastolic pressure, and later on right atrial enlargement. In VSD Eisenmenger and PDA Eisenmenger, you would not expect right atrial enlargement.
Transcript of the video: Eisenmenger syndrome is an important complication of large left to right shunts which develop later due to development of pulmonary vascular obstructive disease and severe pulmonary hypertension. Diagrammatic representation of VSD Eisenmenger. It is also called Eisenmenger complex. But, leave that alone.
Crochetage sign on ECG in ASD ECG in ASD with severe pulmonary hypertension: Tall R’ in V1, ST depression in inferior leads and V2-V5, and T inversion in inferior leads and V1-V6 are seen. The sign has been described in VSD with biventricular hypertrophy in children.
Curious minds might ask, can’t we decompress LV it self by creating a small VSD. This is to create a small regulatory orifice in the IAS ( A complicated term for a small ASD ) to decompress the LA and reduce pulmonary congestive symptoms. Probably in the thin membranous area. Patel RB, Silvestry FE, Komtebedde J, et al.
Right atrial hypertrophy as in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension. But in a VSD with pulmonary hypertension A wave is not prominent. It will not occur in the presence of a large VSD which equalizes both right ventricular and left ventricular pressures.
Patients with marked LVH ( especially those with longstanding hypertension ) often manifest not only ST-T wave changes that are typical for LV "strain" but also symmetric T wave inversion as seen here in lead V5. Clearly, the R=S waves in today's tracing are not as deep as occurs with the Katz-Wachtel phenomenon.
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