Tricuspid atresia differential diagnosis: Difference between revisions

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* [[Abnormal hemoglobin]] like [[methemoglobin]], [[polycythemia]]
* [[Abnormal hemoglobin]] like [[methemoglobin]], [[polycythemia]]
* Peripheral [[cyanosis]] for e.g. [[sepsis]], [[hypoglycemia]], [[dehydration]], and [[hypoadrenalism]].
* Peripheral [[cyanosis]] for e.g. [[sepsis]], [[hypoglycemia]], [[dehydration]], and [[hypoadrenalism]].
{| class="wikitable"
|+
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disorders
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical Presentation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Electrocardiogram Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Echocardiography Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |X-Ray Findings
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"|'''[[Tetralogy of Fallot]]''' <ref name="MorrisFelner1975">{{cite journal|last1=Morris|first1=Douglas C.|last2=Felner|first2=Joel M.|last3=Schlant|first3=Robert C.|last4=Franch|first4=Robert H.|title=Echocardiographic diagnosis of tetralogy of Fallot|journal=The American Journal of Cardiology|volume=36|issue=7|year=1975|pages=908–913|issn=00029149|doi=10.1016/0002-9149(75)90081-8}}</ref><ref name="pmid1428277">{{cite journal |vauthors=Kothari SS |title=Mechanism of cyanotic spells in tetralogy of Fallot--the missing link? |journal=Int. J. Cardiol. |volume=37 |issue=1 |pages=1–5 |date=October 1992 |pmid=1428277 |doi=10.1016/0167-5273(92)90125-m |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Multifactorial
* [[Polymorphism (biology)|Genetic polymorphisms]]
* Maternal [[rubella]]
* Poor prenatal nutrition
* Maternal [[alcohol]] use
* Maternal [[diabetes]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Cyanosis]] on exertion
* [[Exertional dyspnea]]
* [[Palpitation|Palpitations]]
* [[Fatigue]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* CBC: [[Anemia]] or [[polycythemia]].
* [[Coagulation]] profile.
* Arterial blood gas: Low [[oxygen saturation]] and [[acidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Right ventricular hypertrophy]]
*[[Right bundle branch block]]
*[[Tachycardia]]
* Rate of [[QRS complex|QRS]] change predicts [[Ventricular arrhythmias|ventricular arrhythmia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[Echocardiography]] may show:
* Residual [[Ventricular septal defect|VSD]] or [[Atrial septal defect|ASD]]
* RV outflow tract obstruction
* Abnormal valvular anatomy
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* The '''boot-shaped''' [[heart]] appearance
* Normal [[heart]] size
* [[Pulmonary]] vascular marking may be normal or decreased
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"|'''[[Total anomalous pulmonary venous connection|Total Anomalous Pulmonary Venous Connection]]''' <ref name="ZhangZhang2016">{{cite journal|last1=Zhang|first1=Ziming|last2=Zhang|first2=Li|last3=Xie|first3=Feng|last4=Wang|first4=Bing|last5=Sun|first5=Zhengxing|last6=Kong|first6=Shuangshuang|last7=Wang|first7=Xinfang|last8=Dong|first8=Nianguo|last9=Wang|first9=Guohua|last10=Lv|first10=Qing|last11=Li|first11=Yuman|last12=Li|first12=Ling|last13=Xie|first13=Mingxing|title=Echocardiographic diagnosis of anomalous pulmonary venous connections|journal=Medicine|volume=95|issue=44|year=2016|pages=e5389|issn=0025-7974|doi=10.1097/MD.0000000000005389}}</ref><ref name="pmid389559">{{cite journal |vauthors=Chen JT |title=Radiologic demonstration of anomalous pulmonary venous connection and its clinical significance |journal=CRC Crit Rev Diagn Imaging |volume=11 |issue=4 |pages=383–422 |date=October 1979 |pmid=389559 |doi= |url=}}</ref><ref name="GathmanNadas1970">{{cite journal|last1=Gathman|first1=Gary E.|last2=Nadas|first2=Alexander S.|title=Total Anomalous Pulmonary Venous Connection|journal=Circulation|volume=42|issue=1|year=1970|pages=143–154|issn=0009-7322|doi=10.1161/01.CIR.42.1.143}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Multifactorial
*[[Polymorphism (biology)|Genetic polymorphisms]]
* Maternal [[rubella]]
* Poor prenatal nutrition
* Maternal [[alcohol]] use
* Maternal [[diabetes]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Tachypnea]]
* [[Palpitation|Palpitations]]
* [[Cyanosis]]
* [[Failure to thrive]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Arterial blood gas: Low [[oxygen saturation]] and [[acidosis]]
* [[Coagulation]] profile.
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Right ventricular hypertrophy]] with a qR pattern
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Right ventricular hypertrophy]]
*Right ventricular loading
*Paradoxical septal motion
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Prominence of the [[pulmonary]] arteries
* Mild enlargement of [[heart]]
* The classic '''snowman''' sign is seen in supracardiac subtype
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"|'''[[Tricuspid atresia|Tricuspid Atresia]]''' <ref name="BeppuNimura1978">{{cite journal|last1=Beppu|first1=S|last2=Nimura|first2=Y|last3=Tamai|first3=M|last4=Nagata|first4=S|last5=Matsuo|first5=H|last6=Kawashima|first6=Y|last7=Kozuka|first7=T|last8=Sakakibara|first8=H|title=Two-dimensional echocardiography in diagnosing tricuspid atresia. Differentiation from other hypoplastic right heart syndromes and common atrioventricular canal.|journal=Heart|volume=40|issue=10|year=1978|pages=1174–1183|issn=1355-6037|doi=10.1136/hrt.40.10.1174}}</ref><ref name="pmid7049815">{{cite journal |vauthors=Thiene G, Anderson RH |title=The clinical morphology of tricuspid atresia. Atresia of the right atrioventricular valve |journal=G Ital Cardiol |volume=11 |issue=12 |pages=1845–59 |date=1981 |pmid=7049815 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Multifactorial
*[[Polymorphism (biology)|Genetic polymorphisms]]
* Maternal [[rubella]]
* Poor prenatal nutrition
* Maternal [[alcohol]] use
* Maternal [[diabetes]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Respiratory difficulties  as nasal flaring or muscle retractions
* [[Cyanosis]]
* Growth retradation
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arterial blood gas|Arterial blood gases]]
* [[Complete blood count|CBC]]: [[Polycythemia]]
* [[Coagulation]] profile
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Tall [[P wave|P waves]] indicate atrial enlargement.
* First-degree [[atrioventricular block]].
* Frontal plane [[QRS complex|QRS]] axis may be leftward.
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Echocardiography may show
* Defect size
* Pulmonary [[blood flow]]
*[[Ventricular function]]
* Valve abnormalities
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Smooth convexity of right [[heart]] border is absent
* Lower part of right [[heart]] border is limited to the [[spine]]
* Prominency of the [[pulmonary artery]] depends on their [[blood]] flow
* [[Cardiac]] size may be normal or enlarged
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"|'''[[Transposition of the great vessels|Transposition of the Great Arteries]]''' <ref name="MahleGonzalez2013">{{cite journal|last1=Mahle|first1=William T.|last2=Gonzalez|first2=Javier H.|last3=Kreeger|first3=Joseph|last4=Marx|first4=Gerald|last5=Duldani|first5=Gul|last6=Silverman|first6=Norman H.|title=Echocardiography of transposition of the great arteries|journal=Cardiology in the Young|volume=22|issue=6|year=2013|pages=664–670|issn=1047-9511|doi=10.1017/S1047951112001503}}</ref><ref name="Warnes2006">{{cite journal|last1=Warnes|first1=Carole A.|title=Transposition of the Great Arteries|journal=Circulation|volume=114|issue=24|year=2006|pages=2699–2709|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.105.592352}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Multifactorial
*[[Polymorphism (biology)|Genetic polymorphisms]]
* Poor prenatal nutrition
* Maternal [[alcohol]] use
* Maternal [[diabetes]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Prominent [[cyanosis]] within hours of birth
*[[Congestive heart failure]]
*
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Arterial blood gas|Arterial blood gases]]: [[Hypoxemia]]
* Hyperoxia test
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Right ventricular hypertrophy]]
* [[Right axis deviation]]
* Varying degrees of [[Atrioventricular block|AV block]]
* [[Q waves]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[Echocardiography]] may show:
* Relationship between [[great vessels]]
* Associated anatomic lesions
* [[Coronary artery]] origin and branches
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* The classic '''egg on string''' appearance
* [[Pulmonary]] vascular marking may be normal or increased
|}


==References==
==References==

Revision as of 17:56, 14 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Keri Shafer, M.D. [2] Priyamvada Singh, MBBS [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

Differentiating Tricuspid Atresia from other Diseases

Patients with tricuspid atresia should be differentiated from other cardiac and non-cardiac causes of cyanosis.

Cardiac causes (starts with 't'):

Other less common causes are- pulmonary atresia, hypoplastic left heart syndrome, anomalous systemic venous connection.

Non-cardiac causes:

Disorders Etiology Clinical Presentation Laboratory Findings Electrocardiogram Findings Echocardiography Findings X-Ray Findings
Tetralogy of Fallot [1][2] Multifactorial

Echocardiography may show:

  • Residual VSD or ASD
  • RV outflow tract obstruction
  • Abnormal valvular anatomy
  • The boot-shaped heart appearance
  • Normal heart size
  • Pulmonary vascular marking may be normal or decreased
Total Anomalous Pulmonary Venous Connection [3][4][5] Multifactorial
  • Prominence of the pulmonary arteries
  • Mild enlargement of heart
  • The classic snowman sign is seen in supracardiac subtype
Tricuspid Atresia [6][7] Multifactorial
  • Respiratory difficulties as nasal flaring or muscle retractions
  • Cyanosis
  • Growth retradation
  • Tall P waves indicate atrial enlargement.
  • Frontal plane QRS axis may be leftward.
 Echocardiography may show
Transposition of the Great Arteries [8][9]

Multifactorial

Echocardiography may show:

  • The classic egg on string appearance
  • Pulmonary vascular marking may be normal or increased

References

  1. ↑ Morris, Douglas C.; Felner, Joel M.; Schlant, Robert C.; Franch, Robert H. (1975). "Echocardiographic diagnosis of tetralogy of Fallot". The American Journal of Cardiology. 36 (7): 908–913. doi:10.1016/0002-9149(75)90081-8. ISSN 0002-9149.
  2. ↑ Kothari SS (October 1992). "Mechanism of cyanotic spells in tetralogy of Fallot--the missing link?". Int. J. Cardiol. 37 (1): 1–5. doi:10.1016/0167-5273(92)90125-m. PMID 1428277.
  3. ↑ Zhang, Ziming; Zhang, Li; Xie, Feng; Wang, Bing; Sun, Zhengxing; Kong, Shuangshuang; Wang, Xinfang; Dong, Nianguo; Wang, Guohua; Lv, Qing; Li, Yuman; Li, Ling; Xie, Mingxing (2016). "Echocardiographic diagnosis of anomalous pulmonary venous connections". Medicine. 95 (44): e5389. doi:10.1097/MD.0000000000005389. ISSN 0025-7974.
  4. ↑ Chen JT (October 1979). "Radiologic demonstration of anomalous pulmonary venous connection and its clinical significance". CRC Crit Rev Diagn Imaging. 11 (4): 383–422. PMID 389559.
  5. ↑ Gathman, Gary E.; Nadas, Alexander S. (1970). "Total Anomalous Pulmonary Venous Connection". Circulation. 42 (1): 143–154. doi:10.1161/01.CIR.42.1.143. ISSN 0009-7322.
  6. ↑ Beppu, S; Nimura, Y; Tamai, M; Nagata, S; Matsuo, H; Kawashima, Y; Kozuka, T; Sakakibara, H (1978). "Two-dimensional echocardiography in diagnosing tricuspid atresia. Differentiation from other hypoplastic right heart syndromes and common atrioventricular canal". Heart. 40 (10): 1174–1183. doi:10.1136/hrt.40.10.1174. ISSN 1355-6037.
  7. ↑ Thiene G, Anderson RH (1981). "The clinical morphology of tricuspid atresia. Atresia of the right atrioventricular valve". G Ital Cardiol. 11 (12): 1845–59. PMID 7049815.
  8. ↑ Mahle, William T.; Gonzalez, Javier H.; Kreeger, Joseph; Marx, Gerald; Duldani, Gul; Silverman, Norman H. (2013). "Echocardiography of transposition of the great arteries". Cardiology in the Young. 22 (6): 664–670. doi:10.1017/S1047951112001503. ISSN 1047-9511.
  9. ↑ Warnes, Carole A. (2006). "Transposition of the Great Arteries". Circulation. 114 (24): 2699–2709. doi:10.1161/CIRCULATIONAHA.105.592352. ISSN 0009-7322.

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