Dilated Cardiomyopathy

Presentation by Dr Nassiba Alami - pediatric cardiologist at CHU Sainte-Justine - given at the McGill University's XIth Neonatal Conference  (2022)

Neonatal cardiac failure and cardiomyopathy (presentation in english) by Dr Nassiba Alami, pediatric cardiologist at CHU Sainte-Justine.

Insuffisance cardiaque néonatale et cardiomyopathie_eng.pdf

Insuffisance cardiaque néonatale et cardiomyopathie  (présentation en français) par Dre Nassiba Alami, cardiologue pédiatre au CHU Sainte-Justine

Insuffisance cardiaque néonatale et cardiomyopathie.pdf

Case of dilated cardiomyopathy identified since the prenatal period. 

More on fetal dilated cardiomyopathy here.

Subcostal view

Dilated IVC with significant retrograde flow in the subhepatic veins, suggesting increased RV end-diastolic pressure leading to increased right atrial pressure.,

PW-Doppler confirming that there is retrograde flow (consistently) at each cardiac cycle. Retrograde flow is in + velocities (red by colour). 

The inter-atrial shunt by colour Doppler indicates that it is left to right, indicating that the LA pressure is higher than the RA pressure. 

B-mode of the inter-atrial septum with the flap moving in both directions.

In this short-axis view in sub-costal, one may appreciate the pulmonary valve open and close - indicating that there is anterograde flow. The RV is significantly dilated. 

3 mmHg gradient (at least) between LA and RA (left to right), indicating higher LA pressure compared to RA pressure. 

One may appreciate already significant systolic dysfunction of both ventricles. The RV apex seems trabeculated. Both ventricles are dilated.

There is some mitral insufficiency.

Both atrio-ventricular valves open and close, indicating that there is anterograde flow from the atriums to the corresponding ventricles.

Severe systolic LV dysfunction at the level of the mid-cavity to apex. 

Parasternal views

Parasternal long axis view of the RV, showcasing opening and closure of the tricuspid valve. 

One may also appreciate the pulmonary valve open and close.

Parasternal long axis view outlining the severe LV dysfunction. The Aortic valve and Pulmonary valve are seen to open and close, as well as the mitral valve. The Aorta seems subjectively small, possibly from underfilling during fetal life. 

Aortic valve opening and closing. 

Flow going through the aortic valve

Parasternal short axis sweep indicating severe biventricular dysfunction and dilatation, LV worst than right. The RV apex is trabeculated.

Coronary arteries are seen in normal configuration.

Coronary arteries outlined.

Coronary arteries outlined.

M-Mode outlining severe systolic LV dysfunction

Apical views

Severe biventricular dysfunction.

Sweep outlining ventricular-arterial configuration.

Suprasternal views

Ductus is large and bidirectional

Ductus is large and bidirectional

PW-Doppler of the bidirectional PDA

Pulmonary veins connecting to the L.A.

Aortic arch seems unobstructed

Aortic valve and aortic root.

Pulmonary valve and pulmonary artery size

Dilated Cardiomyopathy Review Slides - PDF

dilated cardiomyopathy final.pdf

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