Adult congenital heart disease Flashcards
What happens in undercirculation?
Low saturations, blue baby
What happens in over circulation?
Pulmonary vascular disease , unrestricted blood flow and they may need a band
In shunt lesions which chamber of the heart gets bigger?
The one receiving blood in diastole
What is the morphology of the right ventricle?
- Trabeculated endocardium
- Insertion of chordae to IVS
- Moderator band
What is the morphology of the left ventricle?
- Smooth endocardium
* Ellipsoid cavity
What is the most common atrial septal defect?
Secundum
What are the atrial septal defects?
•Secundum
•primum
(•sinus venosus and coronary sinus defects)
What is the shunt in an isolated secundum atrial septal defect?
Left to right
What would you find on examination in a patient with an secundum atrial septal defect?
- Pulmonary flow murmur
* Fixed, split second heart sound
What could a secundum atrial septal defect lead to?
- right ventricular failure
- Tricuspid regurgitation (due to increased size of heart)
- Atrial arrhythmias (due to fibrotic changes)
- Pulmonary hypertension
- Eisenmenger syndrome
What is the shunt in a ventricular septal defect?
Left to right
What would be found on examination in a patient with a ventricular septal defect?
- Occasionally no murmur
* Pansystolic murmur
What may a ventricular septal defect lead to?
- LV failure
- Aortic valve regurgitation
- RV outflow tract obstruction
- Arrhythmia
- Pulmonary hypertension
- Eisenmenger syndrome
What is a juxta-ductal position of a coarctation of the aorta?
After the left subclavian artery
What are the sings of coarctation of the aorta?
- upper body hypertension (can be different in the side of limbs)
- rib notching may be present on a chest x ray
What is the cause of rib notching in the coarctation of the aorta?
Retrograde flow from high pressure anterior intercostal arteries to low pressure posterior
What is the cause of rib notching in the coarctation of the aorta?
Retrograde flow from high pressure anterior intercostal arteries to low pressure posterior
What are the surgical interventions for coarctation of the aorta?
Via thoracotomy:
•Subclavian flap
•End to end
•Jump graft
What are the components of tetralogy of fallot?
- Ventricular septal defect
- Overiding aorta
- right ventricular outflow tract obstruction
- Right ventricular hypertrophy
What are the components of tetralogy of fallot?
- Ventricular septal defect
- Overiding aorta
- right ventricular outflow tract obstruction
- Right ventricular hypertrophy
What are the options for the operative surgeries for tetralogy of fallot?
- BT shunt (will need a full repair later on)
- complete repair- pulmonary artery and right ventricle enlarged using a patch, muscular obstruction removed, VSD closed
What should you look out for with a repaired tetralogy of fallot?
- Significant pulmonary regurgitation
- Arrhythmia (particularly ventricular tachycardia)
- Pulmonary arterial/branch PA stenoses
Describe foetal circulation
- In utero oxygenation is by the maternal placenta
- Pulmonary circulation is minimal and at high resistance
- Oxygenated blood returns to the right atrium via the inferior vena cava
- It then bypasses the right ventricle and pulmonary artery via the foramen ovale
- Of the blood that is pumped to the pulmonary artery via the right ventricle, most passes to the aorta via the ductus arteriosus
What is the surgical treatment of the transposition of the great arteries?
- Atrial switch
* Arterial switch
What is a univentricular heart?
• on functional ventricle reliant on shunts for mixing of the blue and red blood
What are the treatment options for univentricular heart?
- first aim of surgery should be to create two functioning ventricles
- If not feasible then a Fontan circulations will be created
What is Fontan circulation?
- The single functional ventricle is used to support the systemic circulation
- the IV and the SVC are directly plumbed into the pulmonary arteries bypassing the heart so the blue blood does not enter the heart
What are the issues with Fontana circulation?
- Pulmonary circulation is dependent on high systemic venous pressure and low pulmonary vascular resistance
- Anything that causes an imbalance can cause catastrophic haemodynamic compromise (PE, arrhythmia, dehydration, bleeding)
What are the common issues in adult congenital heart disease?
- Heart failure
- Arrhythmia
- Endocarditis
- Pulmonary arterial hypertension
