الفهرس 
Embryollogy off Cardiiac Greatt VessellsOnly 14 pages are availabe for public view
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Abstract
Congenital heart disease is defined as abnormal development of heart structures during intrauterine life, resulting in more or less complex malformations of the heart and great vessels. Echocardiography is the initial diagnostic modality for patients with suspected congenital heart disease. Despite its excellent anatomic and functional assessment capabilities, in many patients this modality can be limited in its ability to delineate great artery and intra cardiac anomalies, pulmonary veins, and coronary arteries. Great advances in the field of computed tomography opened the window for new applications of the technique that help in solving great deals of the critical clinical problems. A fundamental understanding of the cardiac and extra cardiac anatomy forms the cornerstone of diagnostic pediatric cardiology and is the pre-requisite for the proper interpretation and management of different cardiac and vascular abnormalities in patients with congenital heart diseases. The development of multidetector computed tompgraphy (MDCT) has triggered a revolution in the study of extra cardiac vascular anomalies. The major advantage of MDCT is that it permits clear 3-dimensional of not only vascular structures but also airway and esophageal compression. The aim of the present study was to assess the role of Multi-detector Computed Tomography (MDCT) in diagnosis of extra-cardiac great vessels and their branches anomalies. This study included 60 patients with inconclusive echocardiographic diagnosis of extra cardiac vascular anomalies at diagnostic Radiology and Medical Imaging department at Tanta University Hospitals referred from cardiology and pediatric departments during the period from May 2015 to October 2016. All patients were subjected to detailed history taking, careful cardiac examination, as well as echocardiography examination by expert cardiologist and radiological examination in the form of MDCT including multi-planner reformatting (MPR), maximum intensity projection (MIP) and volume rendering technique (VRT) as well as minimum intensity projection (Minip). The 60 patients included in the present study were divided according to the final diagnosis into six groups; great arteries anomalies (52 patients) [aortic anomalies 39/52 and pulmonary anomalies 13/52], coronary anomalies (5 patients), transposition of great arteries (11 patients), aortic arch anomalies (14 patients), systemic venous anomalies (8 patient), and pulmonary venous anomalies (5 patient), with congenital anomalies of the aorta were the most frequent in the present study (n: 39), followed by aortic arch anomalies (n:14) , then pulmonary arteries anomalies (n:13), then transposition of great arteries (n:11), followed by systemic venous anomalies (n:8-(13.33%)), pulmonary venous anomalies presented with 5 cases (n:5) and lastly coronary arteries anomalies presented with five patients (n:5). Aortic coarctation was the most common extra cardiac vascular anomaly present study with accurate measures for cases of aortic coarctaion regarding its distance from vessels origin its length and degree of stenosis as well as its association as PDA at distance from it. from the current study ,we found that 320-MDCT with multiplanar reformmating and 3-dimensinal volume rendering technique has the great potential of providing anatomical data not confidentially obtained by other currently used imaging modalities ,it could disclose changes not seen by other techniques and can be used to verify findings seen with other modalities. These data has tremendous impact on the surgical decisions and plans. Helical CT with multidetector technology provides important information with high accuracy and specificity for anatomic details of congenital heart disease for referring cardiologist. The MDCT technique is minimally invasive but, although it carries the risk of ionizing radiation which is greatly minimized through examination with 320-MDCT scanners and contrast medium injection, still the wealth of information obtained overweigh the risk included. These risks by far more tolerable when compared to catheter angiography.