Blonder

Question 1

Discuss PFO. What is it, how to test for it?

Answer 1

Septum made of two pieces, when they come apart there is communication between the 2 atria and that is the PFO. The septum primum but is not sealed shut in 20% of normal subjects, usually sealed within the first few days.

Bubble study shows if blood is flowing from right to left atria, can see bubbles on echo.

Question 2

What is the modality of choice for diagnosis and characterization of the a adult congenital heart disease

Answer 2

echocardiography

Question 3

L vs R sided volume overload

Answer 3

R sided volume overload is well tolerated for years

Question 4

Why does pressure increase when resistance increases?

Answer 4

P = resistance x flow. When SVR goes up, the pressure that the heart must generate also goes up.

Question 5

How do we measure the degree of shunting?

Answer 5

O2 sat

Question 6

What is Eisenmeger’s Syndrome? Sxs?

Answer 6

When a L -> R shunt turns into a R -> L shunt b/c pulm HTN has developed.
Sxs = clubbing, cyanosis & SOB
** once pulm htn develops, Pt will need full heart & lung transplant - high risk of mortality with this, don’t let it go this far!!!

ALL LARGE SHUNTS HAVE SOME R –> L SHUNTING

Question 7

What is ASD? What are some complications of ASD?

Answer 7

second M.C. adult congenital defect (after BAV)

ASD = an open communication between the atria via a defect in the intra-atrial septum. Usually asymptomatic until adulthood, but very large ones can show up in childhood

70% are secundum (usually females, no other defects)
15-20% are primum (lower, assx AV valve defect or VSD)
5-10% are sinus venosus (high, assx w/ anomolous pulm vein insertion, which causes L –> R shunt)

Complications:
o Atrial Arrhythmias → A fib most common (premature atrial beats → A fib)
o Paradoxical Embolus → DVT leading to a stroke
o Cerebral Abscess → if you have an infection and you embolize it across the ASD to your brain
o Right Heart Failure → very common, volume overload → right ventricle starts to fail
o Pulmonary Hypertension>Eisenmenger Syndrome → intima and media scrunch down and increase resistance → pressure goes up → RV failure

Question 8

Clinical Manifestations of ASD

Answer 8

o Most patients with ASD and significant shunt flow (>2:1) will become symptomatic and require surgical repair by age 40 → look for it in 30s – 50s
o Atrial Arrhythmias
o 20% atrial fibrillation or flutter, increases with advancing age
o At risk for embolic events, including stroke, including paradoxical stroke, systemic emboli
o Migraine cephalgia may be associated → but this is not very well supported
o Pulmonary Hypertension and Eisenmenger syndrome, requires >2.5:1 shunt
o Cyanosis
o Usually associated with concomitant Pulmonic Valve Stenosis or Eisenmengers

Question 9

What is scimitar syndrome (triad) under ASD?

Answer 9

1. Partial anomalous venous return
2. Hypoplasia of a lobe of the right lung
3. Thoracic aorta>Pulmonary artery collaterals

Question 10

What does an 8:1 ratio mean? What is cutoff for when surgical repair of ASD is needed

Answer 10

Amt that goes across septum/shunt is 8x greater than amount that goes past LV.
2:1 is the cutoff for needing to close the gap (anything