acyanotic

Question 1

developmental Source of atrial level communications: Secundum

Answer 1

too much breakdown of primary atrial septum = defect in floor of fossa ovalis

Question 2

Developmental source of atrial level communications

Primum

Answer 2

lack of growth of the vestibular spine causing failure of fusion with the AV EC cushion (persistence of primary foramen

Question 3

Developmental source of atrial level communications

Vestibular

Answer 3

improper fusion or musculainization of the vestibular spine which should form the anteroinferior muscular buttress

Question 4

Developmental source of atrial level communications

sinus venosus

Answer 4

retained venovenous connection, anomlaous connection of R pulm vein to systemic venous (over-infolding of superior rim of the oval fossa)

Question 5

Developmental source of atrial level communications

PFO

Answer 5

floor of oval fossa overlaps but doesn’t fuse. Present in 1/3 of people. It is a tunnel, not a hole. Located anteriorly

Question 6

Lutembacher syndrome, what is it?

Answer 6

Lutembacher syndrome = ASD +MS (seen in rheumatic heart disease)

Question 7

Syndrome of: ASD +MS (seen in rheumatic heart disease)

Answer 7

Lutembacher syndrome = ASD +MS (seen in rheumatic heart disease)

Question 8

Carvallo sign

Answer 8

Carvallo sign = TR murmur increases with inspiration in setting of ASD and Pulm HTN

Question 9

only 2 true atrial septal defects

Answer 9

defects in floor of oval fossa and the vestibular defect

Question 10

Fetal echo signs of a secundum ASD

Answer 10

Absence of flap bowing into LA -> secundum ASD

Question 11

in fetal echo, what does the absence of a flap bowing into the LA signifify

Answer 11

possible ASD

Question 12

fetal echo, what does left to right flow in the atrial leve; signify

Answer 12

L->R flow: l obstruction, mitral valve disease, HLHS, torrential PV flow.

Question 13

PFO size at time of discovery. what size is a significant PFO

Answer 13

<3mm= will close
3-6mm = not likely to be significant

Question 14

what is the only true septal structure? what runs through it?

Answer 14

Anteroinferior Rim separates FO from the CS = true septal structure = Anteroinferior muscular buttress
Tendon of tadaro runs through it = attaches to central fibrous body

Question 15

fetal echo of small 1-2 mm, what size is it, what follow up?

Answer 15

small.
if < 20 weeks, need to follow up
if > 20 weeks, probably gonna be small

Question 16

ICD11, what are the 4 main categories of VSD?

Answer 16

1) perimembranous central
2) trabecular muscular
3) Inlet
4) Outlet

Question 17

If there is loss of apical displacement of TV in a perimembranous VSD in A4C, what does this indicate?

Answer 17

there is inlet extension of the PM VSD (a Muscular inlet retains apical displacement of TV)

Question 18

what kind of fibrous continuity in Juxtaarterial doubly committed -> has fibrous continuity of the Ao and Pulm valves

Answer 18

Juxtaarterial doubly committed -> has fibrous continuity of the Ao and Pulm valves

Question 19

fibrous continuity of the Ao and Pulm valves

Answer 19

Juxtaarterial doubly committed ->fibrous continuity of the Ao and Pulm valves

Question 20

fibrous continuity of TV/MV +/- TV/AoV

Answer 20

perimembranous VSD -> TV/MV +/- TV/AoV

Question 21

fibrous continuity of perimembranous VSD

Answer 21

perimembranous VSD -> TV/MV +/- TV/AoV

Question 22

MC Associated AVSD anomalies and features

Answer 22

• Conotruncus 18% most likely, Tet-Canal usually rastelli C (3 letters in Tet, A,B,C), TOF more common in Trisomy 21

Question 23

pap muscle location in AVSD

Answer 23

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)

Question 24

Overall prevalence of unbalanced AVSD? more common type?

Answer 24

Overall prevalence of unbalanced 10-15%

75% RV dominant

Question 25

Van Praagh: Partial Common AV Canal = Primum atrial septal defect (Van Praagh)

Answer 25

Anderson = AVSD with an atrial level shunt but no ventricular level shunt

Question 26

Van Praagh: Transitional AVSD

Answer 26

Anderson = AV septal defect with small ventricular component

Question 27

Anderson = AV septal defect with small ventricular component

Answer 27

Van Praagh: Transitional

Question 28

Van Praagh: Intermediate Type AVSD

Answer 28

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

Question 29

Anderson = AVSD with common AV junction and separate R and L valvar orifices with potential for shunting at atrial and ventricular levels

Answer 29

Van Praagh: Intermediate Type