Abnormal Vascular connections Flashcards
PDA, AP collaterals, Anomalous CA
PDA’s purpose in utero is to
maintain fetal blood flow by connecting AO and PA bypassing the lungs
Typically the ductus arteriosus closes after _____ hours following birth
12 Hours
could be a day in fetals who are full gestation (40weeks)
Within the first 3 weeks the PDA should permanently be sealed by the tissue
ligamentum arteriosum
It’s important for the PDA to stay open with what birth defects?
list 5 defects
- CoA
- Pulmonary atresia with intact IVS
- HLHS
- TOF with pulmonary atresia
- transposition of the great arteries
PDA murmur sounds like
continuous machinery unless PDA is very large
PDA causes volume overload to what side of the heart
left side, due to pulmonary over circulation
How to classify the severity of PDA
-small
-moderate
-large
- Small: L-R shunt, high velocity with diastolic run off, diastolic flow reversal in abdominal AO
- Moderate: Bidirectional flow due to PHTN,
- Large: bidrectional shunt, PHTN
- severe right to left shunt when systemic dependant on PDA
(pulmonary atresia, CoA, IAA)
What is a AP collateral?
vessels that aris off the AO and aid in pulmonary circulation
AP collaterals are common with
tetralogy of Fallot/ pulmonary atresia
lung dysplasia
How can you differentiate a AP collateral from a PDA?
- PDA usually enters the main PA near the LPA orgin with a direct course (not tortuous)
- Collaterals usually originate lower on the DAO and cannot be followed all the way due to their tortuous nature
Collaterals velocity is typically lower than PDA’s
AP windows is a rare direct communication between the
AAO and the main PA
shunt is usually L-R
What are the types of Anomalous coronary artery
- LCA off the RCA
- Right coronary sinus off the left coronary sinus
- anomalous left coronary off the pulmonary artery (ALCAPA)
How to determin anomalous left coronary aretery off the right CA
color doppler will exhibit blue color flow between the great vessels in PSAX
How to determin anomalous right coronary aretery off the left CA
color doppler will exhibit red color flow coursing between the great vessels in PSAX
ALCAPA can be associated with
CoA
infants with decreased systolic function or dilated CM
Echo signs of ALCAPA
- dilated right coronary system
- decreased LV function
- retrograde flow in the left CA
- abnormal diastolic flow into the PA
- MR
What are the 3 abnormalities associated with the heart that can lead to sudden death in young adults when performing stenous activities?
- anomalous coronary arteries
- idiopathic hypertropic subaortic stenosis (IHSS)
- Hypertropic cardiomyopathy (HCM)
What phase does flow happen in the coronary arteries
diastole
