Radityo Prakoso©

Cardiac Sequential Segment

Analysis
Radityo Prakoso

Division of Pediatric Cardiology and Congenital Heart Disease

Department of Cardiology and Vascular Medicine
Faculty of Medicine Universitas Indonesia
Radityo Prakoso©

Disclosure

• nothing to be disclosed
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Sequential and Segmental

Analysis

The echocardiographic examination and the

interpretation is presented using a segmental approach
which requires complete definition of 8 features of
cardiac anatomy
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OVERVIEW
3 Segments
Cardiac

Great Arteries
Atrium
=
Ventricle

Atrioventricul ventricular-arterial
ar Junction Junction

2 junctions
Robert H.Anderson. Pediatric Cardiology. ed 3th. 2010
adityo Prakoso©
Sequential & Segmental
Analysis : Step by Step

1 2 3

6 5 4

7 8
 1 Cardiac Position

Where is the heart

located, and what is
the direction of the
cardiac apex?

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adityo Prakoso©

1 Cardiac Position

Levoposition Mesoposition Dextroposition

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2 Analysis of Other Body Organs

Situs Situs
Cardiac Situs
Abdominalis Pulmonalis

Situs
Situs Inversus Left Right
Solitus
(mirror Image) isomerism Isomerism
(usual)
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3 Atrial Arrangement

Right Atrium Left Atrium

Robert H.Anderson. Pediatric Cardiology. ed 3th. 2010

 3 Atrial Arrangement
4 possible Radityo Prakoso©
Topographic
Patterns

Lateralization Isomerism

Situs
Situs Inversus LA- RA-
Solitus
(mirror Image) isomerism Isomerism
(usual)
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Atrioventricular Valve
MITRAL
VALVE

TRICUSPID VALVE

Moss Adams. Heart disease : In infants, children and Adults.. 20

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Tricuspid Valve Mitral Valve

Two large papillary muscles

Three papillary muscles

Triangular orifice (midleaflet level) Elliptical orifice

Moss Adams. Heart disease : In infants, children and Adults.. 2

 4 Ventricle Mass Structure
Right
Left Ventricle
Ventricle

Trabecular : Trabecular :
coarse Fine

crescentic circular

Radityo Prakoso© Moss Adams. Heart disease : In infants, children and Adults.. 20
adityo Prakoso©

Ventricular Topology
Determine
position of
Right
Ventricle

Right hand Topology Left Hand Topology

Robert H.Anderson. Pediatric Cardiology. ed 3th. 2010

adityo Prakoso©

5 AV Connection : Biventricular
Concordan Discordan
Ambiguous
ce ce

Robert H.Anderson. Pediatric Cardiology. ed 3th. 2010

adityo Prakoso©

4 AV- Connection : Univentricular

Double Single Common
inlet Inlet Inlet

Robert H.Anderson. Pediatric Cardiology. ed 3th. 2010

adityo Prakoso©

6 Arterial Segment
Pulmonary
Aortic
Artery

No intrinsic features to differentiate

Aorta from Pulmonary Trunks
these are distinguished on basis of
Solitary Common
branching
Trunk trunk

Moss Adams. Heart disease : In infants, children and Adults.. 2

adityo Prakoso©

Arterial Trunk Relation

complete TGA Anterior
Right aorta Left
anterior anterior correcte
aorta aorta d TGA,
DILV
Right Main left
Lateral Pulmona lateral
Aorta ry Artery aorta

Dextropositio
n Aorta Right left
posterior posterior
Aorta aorta
posterior
aorta
TOF, DORV, AVSD Moss Adams. Heart disease : In infants, children and Adults.. 2
adityo Prakoso©

Ventriculo-Arterial Valve

Pulmonary valve Aortic valve

Empties into main pulmonary

Empties into ascending aorta
artery
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6 Analysis V-A Connection

Concordance Discordance DoubleOutlet

Single Outlet Common Outlet

Moss Adams. Heart

disease : In infants,
children and Adults.. 2013
adityo Prakoso©

Discordance

Double Outlet
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Single Outlet

Common Outlet
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Infundibular Morphology

Moss Adams. Heart disease : In infants, children and Adults.. 2

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Valve Morphology
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Overriding Straddling

VS
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Overriding in
VA valve
Overriding PT
Valve

Overriding AO
Valve

Moss Adams. Heart

disease : In infants,
children and Adults..
2013
adityo Prakoso©

Overriding in AV Valve

Moss Adams. Heart disease : In infants, children and Adults.. 2

adityo Prakoso©
Straddling
NEVER
occurs in
semilunar valves

involves the anomalous

insertions of
chordae tendineae
(tendinous cords) or
papillary muscles
into the contralateral
ventricle

Moss Adams. Heart disease : In infants, children and Adults.. 2

Radityo Prakoso© Atrial Arrangement:
Usual
Sequential Mirror-Imaged
Right-Isomerism

& Left-Isomerism

Segmental AV-connections
Analysis
One atrium to It’s Own ventricle Two atriums to one ventricle One atrium to two ventricles

Absent RAVC Absent LAVC

Concordant Discordant MIxed Double & Str. LAVV & Str. RAVV
Absent Absent
Inlet
Right Left
Ventricle
Usual Usual Right-
Atriums Atriums Isomerism
Dominant Indeterminate
Mirrored Mirrored Left- LV Dominant Ventricle
Atriums Atriums Isomerism RV

Two AV Two AV Two AV

valves valves valves
Common AV Common AV Common AV
valve valve valve

Anderson RH, Shirali G. Sequential segmental analysis. Ann Pediatr Cardiol. 2009 Jan-Jun; 2(1): 24-35
 Radityo Prakoso©
Sequential &
Segmental AV Valves
Analysis
2 Patent Common Straddling Overriding
1 patent &
Valves valve valve valve
1 atretic
valve
Right Left Right Left

Common Both Common Both

Ventricular Topology
Topography
Right Left
Handed Handed

Ventriculoarterial Junction
Concordant Discordant Double Outlet Single Outlet

RV LV
Indeterminate
Ventricle Common Pulmonary Aortic
Trunk Atresia Atresia

Anderson RH, Shirali G. Sequential segmental analysis. Ann Pediatr Cardiol. 2009 Jan-Jun; 2(1): 24-35
 Radityo Prakoso©
Sequential &
Segmental
Analysis
Arterial Relations
Aorta and PT are side-by-side Aorta posterior to the PT
Aorta Anterior to the PT

Right Exactly Anterior Left Right Left Right Exactly Posterior Left

Infundibulum

Subaortic
Subpulmonary Bilaterally Present Bilaterally Absent

Anderson RH, Shirali G. Sequential segmental analysis. Ann Pediatr Cardiol. 2009 Jan-Jun; 2(1): 24-35
adityo Prakoso©

Acknowledgments

Thank you to dr.Ardhia Kusuma Putri for contribution

completing this presentation
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 karajanh70@gmail.com

THANK YOU!