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Case Analysis
Rodelio D. Lim, MD
Alejandro E. Arevalo, MD
Objectives
2. To analyze cardiovascular clinical
situations utilizing the principles of
science
3. To recognize and describe the
common cardiovascular lesions
4. To explain the pathogenesis of these
lesions utilizing the basic principles
of pathology
5. To make a clinico-pathologic
correlation
Case No. 1
View from the Right atrium View from the Left atrium
This diagram depicts a ventricular
septal defect (VSD) in the This is the heart of a premature stillborn with
membranous septum. There is a left- Trisomy 13 in which a ventricular septal
to-right shunt, the severity of which defect is visible in the membranous septum.
depends upon the size of the defect. About 90% of VSD's are in the membranous
Over time, about half will close septum and 10% in the muscular septum.
spontaneously. Persons with VSD's (as
with most cardiac defects) are at
greater risk for infective endocarditis.
Ventricular Septal Defect
Opened
This diagram depicts an aortic
coarctation of the post-ductal (adult This fetal heart demonstrates an aortic
type) variety. There is aortic outflow coarctation of the pre-ductal (infantile)
obstruction, leading to increased pulse variety. There is aortic outflow
pressures in upper body and obstruction, leading to aortic root dilation.
extremities, while pulse pressures in The pulmonic trunk is also visible. This
the lower extremities are reduced. female fetus was found to have a 45, X
Increased collateral circulation through karyotype, consistent with Turner's
intercostal arteries can result in "rib syndrome. Congenital anomalies often
notching". include the heart.
The aorta is opened longitudinally revealing a coarctation.
In the region of the narrowing, there was increased
turbulence that led to increased atherosclerosis.
1. Which of these congenital heart diseases in
the course of time will lead to pulmonary
hypertension?
2. Discuss briefly the pathogenesis of pulmonary
hypertension.
Grade 3 Grade 4
Using basic principles of pathology,
discuss briefly the pathogenesis of
the 4 grades of the lesion.
Life begins with a heart beat . . . . . .
……… and ends in a heart beat.