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Applied Cardiovascular IV > ASD, VSD, PDA > Flashcards

ASD, VSD, PDA Flashcards

1
Q

In a pediatric echo the apical and subcostal views are usually ____.

A

Inverted

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2
Q

Majority of pediatric echo labs begin exam in the ____ view to help determine situs of abdominal organs.

A

Subcostal

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3
Q

During a pediatric exam, look for the ____ and ____, if abnormal situs is found, scan for the ____.

A

Liver and stomach; spleen

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4
Q

High right parasternal view: Used to image _____ most often or to check ____ if surgical repair has been completed.

A

SVC; baffles

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5
Q

High ____ parasternal view (aka. ductal or “pants” view): Shows some of ____ and right and left branches.

A

Left; MPA

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6
Q

The ____ view is used most commonly to find a PDA.

A

High left parasternal view

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7
Q

____ ____ is when the chambers connect correctly. Primarily the LA to the LV and the RA to the RV.

A

Atrioventricular concordance

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8
Q

____ ____ is when the chambers are reversed and the LA connects to the RV and the RA connects to the LV.

A

Atrioventricular discordance

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9
Q

____ ____ is the normal connection of the RV to the pulmonary artery and the LV to the aorta.

A

Ventriculoarterial concordance

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10
Q

____ ____ is when the RV is connected to the aorta and the LV is connected to the pulmonary artery.

A

Ventriculoarterial discordance

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11
Q

A ____ is when the ductus between the descending aorta and left PA does not close spontaneously after birth.

A

Patent ductus arteriosus (PDA)

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12
Q

A PDA causes extra blood flow to the ____.

A

Lungs

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13
Q

The ____-to-____ shunt across the PDA can create symptoms of CHF or respiratory problems.

A

Left-to-right

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14
Q

A PDA is the most common extracardiac shunt, comprising __-__% of congenital heart disease.

A

5-10%

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15
Q

What is the murmur associated with a PDA?

A

Continuous “machinery” murmur

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16
Q

Where is a PDA murmur best heard?

A

At the left upper sternal border

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17
Q

Small PDA’s are often ____.

A

Asymptomatic

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18
Q

Moderate to large PDA’s symptoms include: ____, ____, and ____.

A

CHF, Dyspnea, Poor weight gain

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19
Q

For a PDA, within ____ - ____ hours of birth, the smooth muscle of the ductus should contract causing closure.

A

10-15

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20
Q

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 ____ ____.

A

Ligamentum arteriosum

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21
Q

If the PDA does not close, it is usually because the pulmonary vascular resistance is ____ to decrease.

A

Slow

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22
Q

The degree of shunting is related to the ____ diameter of the PDA.

A

Internal

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23
Q

During fetal life, the diameter of the ductus arteriosus is the same as that of the ____.

A

Aorta

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24
Q

While pulmonary resistance is greater than systemic resistance, there is ____-to-____ shunting across the PDA.

A

Right-to-left

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25
Q

As the pulmonary resistance begins to drop, the ____-to-____ flow across the ductus may be quite large.

A

Left-to-right

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26
Q

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.

A

Equal

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27
Q

With a PDA, ____ overload occurs in the LV which may lead to failure.

A

Volume

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28
Q

With a PDA, ____ overload occurs in the RV usually resulting in RVH

A

Pressure

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29
Q

With a right-to-left shunt, what may develop if the PDA is longstanding?

A

PHTN

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30
Q

With a PDA, you may find the main pulmonary artery/pulmonary branch to be ____.

A

Dilated

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31
Q

In a PDA, you may find the bowing of interatrial septum toward ____ atrium.

A

Right

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32
Q

With PDA’s, you need to measure a peak ____ with CW Doppler.

A

Velocity

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33
Q

The highest PDA velocity measured is used to to calculate the ____.

A

PA pressure

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34
Q

What is the formula for PA pressure?

A

PA pressure = systemic BP – 4(V)^2

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35
Q

What medication is given to close a PDA?

A

Indomethacin

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36
Q

What is the non-medication treatment for a PDA

A

Surgical ligation or occluder device in PDA

37
Q

What are the three types of ASD’s?

A

Ostium Secundum – (70%)
Ostium Primum – (20%)
Sinus venosus defects – (10%)

38
Q

Ostium Secundum: Defect in the region of the ____.

A

Fossa ovalis

39
Q

What is the most common ASD?

A

Ostium secundum

40
Q

Ostium ____ defects represent failure of the endocardial cushions to merge.

A

Primum

41
Q

Ostium primum defects are found in the region ____ and ____ to the fossa ovalis.

A

Anterior and inferior

42
Q

What are ostium primum defects associated with?

A

Abnormalities of the AV valves

43
Q

Sinus venosus defects generally occur near the ____/____ junction.

A

SVC/RA

44
Q

Sinus venosus defects are usually associated with an abnormal connection of the ____ to the RA (anomalous pulmonary vein).

A

Right pulmonary vein

45
Q

For an ASD, ____ in the heart determines degree of the flow across the shunt, not the size of the hole.

A

Pressure

46
Q

What is the murmur for an ASD?

A

Soft mid-systolic crescendo-decrescendo ejection murmur

47
Q

Where is an ASD best heard?

A

Left upper sternal border

48
Q

The pathophysiology of an ASD in order:

A

Right side volume overload > RAE > RVE > IVS paradoxical overload pattern > change in flow direction (Eisenmenger’s Syndrome)

49
Q

In the case of right-to-left shunting across an ASD, estimation of ____ pressure is critically important

A

RV

50
Q

What is the calculation for RVSP?

A

RVSP = 4(TR vel)^2 + RA pressure

51
Q

A few children with isolated ASDs develop ____ or ____.

A

CHF or cyanosis

52
Q

Whats the best view to view a primum ASD or a secundum ASD?

A

Apical 4 and subcostal views

53
Q

In the ____ view, the SVC can be imaged to show a sinus venosus defect.

A

Subcostal view

54
Q

For an ASD, PW Doppler should be used to trace a ____.

A

Mean gradient

55
Q

The subcostal SAX and parasternal SAX at aortic valve level are good views to use to look for ____.

A

Shunting

56
Q

If flow is left to right, assess ____ heart for dilatation.

A

Right

57
Q

A ratio of __:__ or greater is considered a significant shunt.

A

1.5:1

58
Q

What is the calculation for Qp:Qs>

A

Qp/Qs = SV RVOT / SV LVOT

59
Q

How do you calculate SV RVOT?

A

(CSA RVOT)(VTI RVOT)or
(.785)(RVOT diameter)^2 (RVOT VTI, trace the waveform)

60
Q

How do you calculate SV LVOT?

A

(CSA LVOT) (VTI LVOT)
(.785)(LVOT diameter)^2 (LVOT VTI, trace the waveform)

61
Q

How is a small ASD surgically repaired?

A

Sew the ends together

62
Q

How is a large ASD surgically repaired?

A

A pericardial patch is used to close the ASD

63
Q

How is an PFO/ASD in adults repaired?

A

A PFO/ASD closure device is used via catheter in the cath lab

64
Q

A VSD is communication between right and left ventricles resulting in ____ volume overload.

A

LV

65
Q

What is the most common heart defect through the first 3 decades of life? (20-25% of all CHD)

A

Ventricular Septal Defects - VSD

66
Q

What is the murmur for a VSD?

A

High-pitched, harsh holosystolic murmur

67
Q

Where is a VSD best heard?

A

Lower sternal border

68
Q

The pathophysiology of a VSD in order:

A
  1. Some of the blood from the LV leaks into the RV
  2. Passes through the lungs
  3. Reenters the left ventricle via the pulmonary veins and left atrium.
  4. Volume overload of LV (LVE)
  5. Increased RV pressure and RVE
  6. PHTN
69
Q

What are the 4 types of VSD’s?

A

Perimembranous - (80%)- most common
Muscular – (5-15%)
Inlet – (5-8%)
Outlet (Supracristal) – (5-7%)

70
Q

__-__% of VSDs close in the first year of life

A

75-90%

71
Q

Perimembranous VSD’s are located in the ____ septum region.

A

Membranous

72
Q

____ VSD’s can also be referred to as subaortic, infracristal, and membranous.

A

Perimembranous

73
Q

Perimembranous VSD’s are associated abnormality of the ____.

A

TV

74
Q

An outlet VSD is located above the muscular septum but below the ____.

A

Pulmonary valve

75
Q

____ VSDs are known as supracristal, conal, infundibular, subpulmonary, subarterial, or doubley committed.

A

Outlet

76
Q

Outlet VSD’s are associated with ____ prolapse and ____.

A

Aortic valve prolapse and AI

77
Q

With a VSD, RVOT obstruction is possible, so a complete ____ assessment of the RVOT is critical.

A

Doppler

78
Q

Muscular VSD’s are also referred to as:

A

Trabecular, central, apical, and marginal

79
Q

Muscular VSDs are found anywhere in the septum from the ____ to the ____.

A

TV attachments; apex

80
Q

Occasionally, spontaneous closure of the ____ VSD occurs as the septum grows and forms additional muscle tissue.

A

Muscular

81
Q

A ____ VSD can also be referred to as an AV canal type or posterior VSD.

A

Inlet

82
Q

Inlet VSD’s are located posteriorly and inferiorly beneath the tricuspid valve ____ leaflet.

A

Septal

83
Q

Inlet VSD is often associated with ____.

A

Endocardial cushion defects

84
Q

What are the size classifications for a VSD?

A
  • 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
85
Q

With a VSD, if closure occurs, turbulence will ____ as the defect decreases in size.

A

Increase

86
Q

What are the signs and symptoms for a moderate to large VSD?

A
  • CHF
  • Respiratory distress
  • Dyspnea
  • Irritability
  • Slow weight gain
  • Cyanosis
  • Tachypnea
  • Restlessness
  • Fatigue when feeding
  • Excessive sweating
87
Q

For a VSD, use CW Doppler to check the gradient and measure the ____.

A

Peak velocity

88
Q

Echo protocol for a VSD should also include these four things:

A
  • Calculate Qp:Qs
  • Look for LA and LV enlargement
  • Assess for Pulm HTN
  • Assess for MPA/PA branch dilatation
89
Q

How is a large VSD repaired?

A

VSD will be surgically closed (similar to ASD - pericardial patch)

Applied Cardiovascular IV (6 decks)

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