acyanotic Flashcards
developmental Source of atrial level communications: Secundum
too much breakdown of primary atrial septum = defect in floor of fossa ovalis
Developmental source of atrial level communications
Primum
lack of growth of the vestibular spine causing failure of fusion with the AV EC cushion (persistence of primary foramen
Developmental source of atrial level communications
Vestibular
improper fusion or musculainization of the vestibular spine which should form the anteroinferior muscular buttress
Developmental source of atrial level communications
sinus venosus
retained venovenous connection, anomlaous connection of R pulm vein to systemic venous (over-infolding of superior rim of the oval fossa)
Developmental source of atrial level communications
PFO
floor of oval fossa overlaps but doesn’t fuse. Present in 1/3 of people. It is a tunnel, not a hole. Located anteriorly
Lutembacher syndrome, what is it?
Lutembacher syndrome = ASD +MS (seen in rheumatic heart disease)
Syndrome of: ASD +MS (seen in rheumatic heart disease)
Lutembacher syndrome = ASD +MS (seen in rheumatic heart disease)
Carvallo sign
Carvallo sign = TR murmur increases with inspiration in setting of ASD and Pulm HTN
only 2 true atrial septal defects
defects in floor of oval fossa and the vestibular defect
Fetal echo signs of a secundum ASD
Absence of flap bowing into LA -> secundum ASD
in fetal echo, what does the absence of a flap bowing into the LA signifify
possible ASD
fetal echo, what does left to right flow in the atrial leve; signify
L->R flow: l obstruction, mitral valve disease, HLHS, torrential PV flow.
PFO size at time of discovery. what size is a significant PFO
<3mm= will close 3-6mm = not likely to be significant
what is the only true septal structure? what runs through it?
Anteroinferior Rim separates FO from the CS = true septal structure = Anteroinferior muscular buttress
Tendon of tadaro runs through it = attaches to central fibrous body
fetal echo of small 1-2 mm, what size is it, what follow up?
small.
if < 20 weeks, need to follow up
if > 20 weeks, probably gonna be small
ICD11, what are the 4 main categories of VSD?
1) perimembranous central
2) trabecular muscular
3) Inlet
4) Outlet
If there is loss of apical displacement of TV in a perimembranous VSD in A4C, what does this indicate?
there is inlet extension of the PM VSD (a Muscular inlet retains apical displacement of TV)
what kind of fibrous continuity in Juxtaarterial doubly committed -> has fibrous continuity of the Ao and Pulm valves
Juxtaarterial doubly committed -> has fibrous continuity of the Ao and Pulm valves
fibrous continuity of the Ao and Pulm valves
Juxtaarterial doubly committed ->fibrous continuity of the Ao and Pulm valves
fibrous continuity of TV/MV +/- TV/AoV
perimembranous VSD -> TV/MV +/- TV/AoV
fibrous continuity of perimembranous VSD
perimembranous VSD -> TV/MV +/- TV/AoV
MC Associated AVSD anomalies and features
- Conotruncus 18% most likely, Tet-Canal usually rastelli C (3 letters in Tet, A,B,C), TOF more common in Trisomy 21
pap muscle location in AVSD
Counterclockwise rotated: Pap muscles at 3 and 5 o clock
- AL more medial at 3 oclock (normal 4)
- PM more lateral at 5 oclock (normal 7)
Overall prevalence of unbalanced AVSD? more common type?
Overall prevalence of unbalanced 10-15%
75% RV dominant
Van Praagh: Partial Common AV Canal = Primum atrial septal defect (Van Praagh)
Anderson = AVSD with an atrial level shunt but no ventricular level shunt
Van Praagh: Transitional AVSD
Anderson = AV septal defect with small ventricular component
Anderson = AV septal defect with small ventricular component
Van Praagh: Transitional
Van Praagh: Intermediate Type AVSD
Anderson = AVSD with common AV junction and separate R and L valvar orifices with potential for shunting at atrial and ventricular levels
Tongue of tissue connects bridging leaflets, dividing into 2 separate orifices
Doesn’t reflect on size of primum ASD or VSD
Anderson = AVSD with common AV junction and separate R and L valvar orifices with potential for shunting at atrial and ventricular levels
Van Praagh: Intermediate Type
