Adult CHD

Question 1

Describe the morphology of the chambers of the heart

Answer 1

• RV = trabeculated endocardium, insertion of chordae into septum, moderator band
• LV = smooth endocardium
• RA = SA nodes broad appendage
• LA = narrow, long appendage

Question 2

Describe features of ASD

Answer 2

• Secundum most common
• primum is considered partial ASVD

Question 3

Describe Secundum ASD

Answer 3

• L-R shunt (RA/RV hypertrophy)
• right heart volume loading (diastole)
• signs: pulmonary flow murmur, fixed, split 2nd heart sound
• consequences: RV failure, tricuspid regurgitation, atrial arrhythmias, pulmonary hypertension Eisenmenger syndrome

Question 4

Describe features of coarctation of aorta

Answer 4

• tends to form after left subclavian artery near the ductus arteriosus
• causes upper body hypertension, berry aneurysms, claudication, accelerated coronary artery disease and renal insufficiency
• rib notching on CXR = collaterals forming due to retrograde pressure gradient from anterior to posterior
• surgical repair = subclavian flap, end-to-end anastomosis or jump graft (older)

Question 5

Describe features of teratology of fallot

Answer 5

1. VSD
2. Overriding aorta
3. RVOT obstruction
4. RVH
   - cynaotic
   - surgery = BT shunt (babies/infants), complete repair (closing VSD, opening pulmonary RV tract to give 2 separate circulations)
   - signs: significant pulmonary regurgitation (RV dilation), arrhythmia (ventricular tachycardia), pulmonary arterial/branch stenosis

Question 6

Describe features of transposition of great arteries

Answer 6

• 2 trunk arteries are switched the wrong way to five a parallel arrangement instead of a cross-cross
• cyanotic
• remnants from foetal circulation can be useful - patent foramen ovale (prostaglandin given in first days of life to keep patent, balloon inflation may be needed subsequently)

Question 7

Describe features of a univentricular heart

Answer 7

• single functioning ventricle because other is smaller and cannot sustain one side of circulation on its own
• reliant on shunts for mixing of blood
• aim of surgery is to create 2 ventricles
• fontan circulation can be created to help

Question 8

Describe Fontan circulation

Answer 8

The vessels are surgically formed to allow venous return straight to the pulmonary vessels (bypasses the heart) and leave the oxygenated blood to go to the single ventricle

• dependent on high systemic venous pressure and low pulmonary vascular resistance so anything that causes an imbalance can be catastrophic (eg. PE, arrhythmia, dehydration, bleeding)

Question 9

What are the possible consequences of ACHD?

Answer 9

• HF
• arrhythmia
• endocarditis
• pulmonary arterial hypertension