ASD, VSD, PDA Flashcards
In a pediatric echo the apical and subcostal views are usually ____.
Inverted
Majority of pediatric echo labs begin exam in the ____ view to help determine situs of abdominal organs.
Subcostal
During a pediatric exam, look for the ____ and ____, if abnormal situs is found, scan for the ____.
Liver and stomach; spleen
High right parasternal view: Used to image _____ most often or to check ____ if surgical repair has been completed.
SVC; baffles
High ____ parasternal view (aka. ductal or “pants” view): Shows some of ____ and right and left branches.
Left; MPA
The ____ view is used most commonly to find a PDA.
High left parasternal view
____ ____ is when the chambers connect correctly. Primarily the LA to the LV and the RA to the RV.
Atrioventricular concordance
____ ____ is when the chambers are reversed and the LA connects to the RV and the RA connects to the LV.
Atrioventricular discordance
____ ____ is the normal connection of the RV to the pulmonary artery and the LV to the aorta.
Ventriculoarterial concordance
____ ____ is when the RV is connected to the aorta and the LV is connected to the pulmonary artery.
Ventriculoarterial discordance
A ____ is when the ductus between the descending aorta and left PA does not close spontaneously after birth.
Patent ductus arteriosus (PDA)
A PDA causes extra blood flow to the ____.
Lungs
The ____-to-____ shunt across the PDA can create symptoms of CHF or respiratory problems.
Left-to-right
A PDA is the most common extracardiac shunt, comprising __-__% of congenital heart disease.
5-10%
What is the murmur associated with a PDA?
Continuous “machinery” murmur
Where is a PDA murmur best heard?
At the left upper sternal border
Small PDA’s are often ____.
Asymptomatic
Moderate to large PDA’s symptoms include: ____, ____, and ____.
CHF, Dyspnea, Poor weight gain
For a PDA, within ____ - ____ hours of birth, the smooth muscle of the ductus should contract causing closure.
10-15
By 2-3 weeks of age, the newborn should form endothelial tissue which permanently seals off the ductus and leads to the development of the ____ ____.
Ligamentum arteriosum
If the PDA does not close, it is usually because the pulmonary vascular resistance is ____ to decrease.
Slow
The degree of shunting is related to the ____ diameter of the PDA.
Internal
During fetal life, the diameter of the ductus arteriosus is the same as that of the ____.
Aorta
While pulmonary resistance is greater than systemic resistance, there is ____-to-____ shunting across the PDA.
Right-to-left
As the pulmonary resistance begins to drop, the ____-to-____ flow across the ductus may be quite large.
Left-to-right
In patients with large PDAs, the aorta and PA have a wide open connection for blood to flow back and forth creating nearly ____ systolic pressure.
Equal
With a PDA, ____ overload occurs in the LV which may lead to failure.
Volume
With a PDA, ____ overload occurs in the RV usually resulting in RVH
Pressure
With a right-to-left shunt, what may develop if the PDA is longstanding?
PHTN
With a PDA, you may find the main pulmonary artery/pulmonary branch to be ____.
Dilated
In a PDA, you may find the bowing of interatrial septum toward ____ atrium.
Right
With PDA’s, you need to measure a peak ____ with CW Doppler.
Velocity
The highest PDA velocity measured is used to to calculate the ____.
PA pressure
What is the formula for PA pressure?
PA pressure = systemic BP – 4(V)^2
What medication is given to close a PDA?
Indomethacin
What is the non-medication treatment for a PDA
Surgical ligation or occluder device in PDA
What are the three types of ASD’s?
Ostium Secundum – (70%)
Ostium Primum – (20%)
Sinus venosus defects – (10%)
Ostium Secundum: Defect in the region of the ____.
Fossa ovalis
What is the most common ASD?
Ostium secundum
Ostium ____ defects represent failure of the endocardial cushions to merge.
Primum
Ostium primum defects are found in the region ____ and ____ to the fossa ovalis.
Anterior and inferior
What are ostium primum defects associated with?
Abnormalities of the AV valves
Sinus venosus defects generally occur near the ____/____ junction.
SVC/RA
Sinus venosus defects are usually associated with an abnormal connection of the ____ to the RA (anomalous pulmonary vein).
Right pulmonary vein
For an ASD, ____ in the heart determines degree of the flow across the shunt, not the size of the hole.
Pressure
What is the murmur for an ASD?
Soft mid-systolic crescendo-decrescendo ejection murmur
Where is an ASD best heard?
Left upper sternal border
The pathophysiology of an ASD in order:
Right side volume overload > RAE > RVE > IVS paradoxical overload pattern > change in flow direction (Eisenmenger’s Syndrome)
In the case of right-to-left shunting across an ASD, estimation of ____ pressure is critically important
RV
What is the calculation for RVSP?
RVSP = 4(TR vel)^2 + RA pressure
A few children with isolated ASDs develop ____ or ____.
CHF or cyanosis
Whats the best view to view a primum ASD or a secundum ASD?
Apical 4 and subcostal views
In the ____ view, the SVC can be imaged to show a sinus venosus defect.
Subcostal view
For an ASD, PW Doppler should be used to trace a ____.
Mean gradient
The subcostal SAX and parasternal SAX at aortic valve level are good views to use to look for ____.
Shunting
If flow is left to right, assess ____ heart for dilatation.
Right
A ratio of __:__ or greater is considered a significant shunt.
1.5:1
What is the calculation for Qp:Qs>
Qp/Qs = SV RVOT / SV LVOT
How do you calculate SV RVOT?
(CSA RVOT)(VTI RVOT)or
(.785)(RVOT diameter)^2 (RVOT VTI, trace the waveform)
How do you calculate SV LVOT?
(CSA LVOT) (VTI LVOT)
(.785)(LVOT diameter)^2 (LVOT VTI, trace the waveform)
How is a small ASD surgically repaired?
Sew the ends together
How is a large ASD surgically repaired?
A pericardial patch is used to close the ASD
How is an PFO/ASD in adults repaired?
A PFO/ASD closure device is used via catheter in the cath lab
A VSD is communication between right and left ventricles resulting in ____ volume overload.
LV
What is the most common heart defect through the first 3 decades of life? (20-25% of all CHD)
Ventricular Septal Defects - VSD
What is the murmur for a VSD?
High-pitched, harsh holosystolic murmur
Where is a VSD best heard?
Lower sternal border
The pathophysiology of a VSD in order:
- Some of the blood from the LV leaks into the RV
- Passes through the lungs
- Reenters the left ventricle via the pulmonary veins and left atrium.
- Volume overload of LV (LVE)
- Increased RV pressure and RVE
- PHTN
What are the 4 types of VSD’s?
Perimembranous - (80%)- most common
Muscular – (5-15%)
Inlet – (5-8%)
Outlet (Supracristal) – (5-7%)
__-__% of VSDs close in the first year of life
75-90%
Perimembranous VSD’s are located in the ____ septum region.
Membranous
____ VSD’s can also be referred to as subaortic, infracristal, and membranous.
Perimembranous
Perimembranous VSD’s are associated abnormality of the ____.
TV
An outlet VSD is located above the muscular septum but below the ____.
Pulmonary valve
____ VSDs are known as supracristal, conal, infundibular, subpulmonary, subarterial, or doubley committed.
Outlet
Outlet VSD’s are associated with ____ prolapse and ____.
Aortic valve prolapse and AI
With a VSD, RVOT obstruction is possible, so a complete ____ assessment of the RVOT is critical.
Doppler
Muscular VSD’s are also referred to as:
Trabecular, central, apical, and marginal
Muscular VSDs are found anywhere in the septum from the ____ to the ____.
TV attachments; apex
Occasionally, spontaneous closure of the ____ VSD occurs as the septum grows and forms additional muscle tissue.
Muscular
A ____ VSD can also be referred to as an AV canal type or posterior VSD.
Inlet
Inlet VSD’s are located posteriorly and inferiorly beneath the tricuspid valve ____ leaflet.
Septal
Inlet VSD is often associated with ____.
Endocardial cushion defects
What are the size classifications for a VSD?
- Small (restrictive): (< .5cm2) , less than 50% of aortic orifice
- Moderate: (.5 to 1.0 cm2) , 50% to 100% of aortic orifice
- Large (unrestrictive): (> 1.0 cm2), greater than 100% of aortic orifice
With a VSD, if closure occurs, turbulence will ____ as the defect decreases in size.
Increase
What are the signs and symptoms for a moderate to large VSD?
- CHF
- Respiratory distress
- Dyspnea
- Irritability
- Slow weight gain
- Cyanosis
- Tachypnea
- Restlessness
- Fatigue when feeding
- Excessive sweating
For a VSD, use CW Doppler to check the gradient and measure the ____.
Peak velocity
Echo protocol for a VSD should also include these four things:
- Calculate Qp:Qs
- Look for LA and LV enlargement
- Assess for Pulm HTN
- Assess for MPA/PA branch dilatation
How is a large VSD repaired?
VSD will be surgically closed (similar to ASD - pericardial patch)
