ACHD/Transeptal puncture/TAVR/Mitral Flashcards
How about congential AS?
generally successful 5% AR, eventually need AVR.
- ASDs types (4) - where? associations
- common presentations for boards
- dont close if pa pressures ?
- murmur is generally?
- PE
- Secundum –> fossa ovalis, primum –> inf with AV cannal defects or issues ithe MV; sinus venosus asd assocaiated w/ anamolysis pulm venous return. Coronary sinus ASD <1%
- AF/ paradox embolism
- > 2/3 systolci
- increased flow across RVOT.
- murmur as above. fixed split
post ASD what to do?
dapt 6 mo… abx ppx x 6mo
MC congenital abn
common association ith above
PE
when to close
vsd
enrocarditis
loud holo murmur w/ thrill
endocarditis CLASS IQp/Qs >2 , LV volume overload, hx of IE. IIA - PhTN as lson as not >2/3 systemic with qpqs >1.5
when can you close VSD
Muscular pretty much only
PFO what is it
PFO data for closure
with pfo and asd closure immediate risk of
Best device
secundum from top and primum from below come together.
4 trials most improtant is respect 1000 subjects, CVA , followed for 5 years, pfo is supperior to medical therapy at reducign recurrent ischemic events.
periprocedure a feb
Gore cardioform and helix
PDA association
WP of pop has pfo
How common is pda?
When to close it?
endocarditis. generally close it
25%
second most common 10%
B.E. audible murmur. can get heart failure
what is used for the ts puncture
Where do you want to puncture
Technique
mullens sheath -0.032 wire, transeptal needle, brocenbrought needle
Fossa ovalis (posterior structure
Mullins sheath in position and introduce needle. pigtail at level of ao valve
needle below the AV valve. can do dye staining of IVS
most important rf for TS puncture
stich perforation
abscence of Echo guidance
got throgh but there is a gap between vein and ao
Where do you want to puncture fore each transspetal procedure
PFO closure high and center
Mitral clip/ high and rightwards , think of big curve to mae really high (4.5 cm above)
dead center for tandem
low for laa, prec mitral valve replacment, and
medial for pul vein
THM never accept a puntcure outside of fossa ovalus
High puncture through septum for
Mitra clip
Low near mitral valve for
pretty much everything except mitraclip.
advantage of baylis
dont need to push which helps prevent going through LAA.
improves time
LAA closure metanalysis
who can get LAA
prevents hemorrhagiv strok and CV/unexplained death and prevention major bleeding….
CHADS2 >=2 or chads VASC >=3 need to be suitible fore short term AC.
RAS how to test severity in lab
BP med should be on?
- 70% visually need 2 angles PA and LAO
- can do prssure gradient 10 mmhg mean, hyperemic peak difference of 20, can also do ffr <0.8 but done use papefering use do 50 mc/kg or papverine 30 mg
Shuold be on ACE unless there is bilateral
