Prepared by:

Dr. Majid Al-Homiedan

DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL

PULMONARY BLOOD FLOW
 In the more common adult‌ type, the
aortic narrowing occurs at or just
distal to the level of the ductus
arteriosus (double bulge represents
prestenotic and poststenotic
dilatation). In the infantile variety,
there is a long segment of narrowing
lying proximal to the ductus
(obligatory right-to-left shunt and
early congestive heart failure).
There is a relatively high incidence
of coarctation in women with
Turner's syndrome.

 Characteristic double bulge in the

region of the aortic knob (figure-3
sign on plain chest radiographs and
reverse figure-3, or figure-E, sign on
the barium-filled esophagus). There
may be rib notching (usually
involving the posterior fourth to
eighth ribs) but rarely developing
before age 6 years.
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL
PULMONARY BLOOD FLOW
 Valvular, subvalvular, and supravalvular types. Bulging of
the right superior mediastinal silhouette (poststenotic
dilatation of the ascending aorta) is often seen with
valvular stenosis.
 Increased convexity or prominence of the left heart border
(overall heart size often normal). Substantial cardiomegaly
reflects left ventricular failure and dilatation.

DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL

PULMONARY BLOOD FLOW
 Common anomaly found in
isolated form or in combination
with other abnormalities. The
stenosis is most common at the
level of the pulmonary valve
(supravalvular or infundibular
stenosis can occur). Must be
differentiated from normal
idiopathic poststenotic dilatation
of the pulmonary artery in
adolescents and young adults,
especially women.

 Poststenotic dilatation of the

pulmonary artery, often
associated with dilatation of the
left main pulmonary artery. The
heart size is initially normal
(right ventricular hypertrophy
and dilatation if severe
pulmonary stenosis causes
systolic overloading of the right
ventricle).
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL
PULMONARY BLOOD FLOW
 Diffuse thickening of the
left ventricular
endocardium with
collagen and elastic
tissue. A common cause
of cardiac failure during
the first year of life. The
pulmonary vascularity
remains normal until
congestive heart failure
supervenes.

 Striking globular cardiac

enlargement (often with
left-sided prominence);
small aortic knob.
DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL
PULMONARY BLOOD FLOW
 Includes hypoplastic left
heart syndrome, mitral
stenosis and insufficiency,
aortic insufficiency, cor
triatriatum, aberrant
pulmonary origin of left
coronary artery, and
cardiomyopathy.

Hypoplastic left heart syndrome

DDX OF ACYANOTIC CONGENITAL HEART DISEASE WITH NORMAL
PULMONARY BLOOD FLOW