Cardiac septation defects Flashcards
ASD, PFO, VSD
Definition of ASD
deficency within the IAS allowing communication between the RA and LA
ostium secundum ASD
-location
- how common ___%
-
centrally located in the IAS (mid portion) in the area of the fossa ovalis
most common form at 70% of all ASD’s
optimally examined in subcostal sagittal and coronal view
PFO’s typically close at full gestational age at ____ weeks?
40 weeks
ostium primum ASD
-loaction
- how common ____%
-
located in lower portion of IAS, confluent with atrioventricular valves
15-20% of all ASD’s
usually classified as an atrioventricular septal defect
optimally examined in AP4 view
Sinus venosus ASD
-location
-how common ____%
Located in the upper posterior portion of the IAS, confluent with the SVC.
5-10% of all ASD’s
best view is bicaval subcostal sagittal view
Unroofed coronary sinus is associated with
complex left-sided congenital heart defects and PLSVC
extremly rare ~2%
Unroofed coronary sinus allows ___ blood into the LA
deoxygenated blood
Which type of ASD is associated with cleft MV
Ostium primum ASD
Which type of ASD is assocciated with PAPVR?
Sinus venosus
allows RUPV to drain into the RA
On two dimensional ecocardiogram what a classic sign of an ASD?
What effects do ASD’s have on the chambers and vessels?
“T” artifact (dropout) true ASD
* RAE
* RVE
* PA dilation
* paradoxial septal motion of the IVS due to vol overload
What type of ASD can be closed in cathlab and what is the most common device?
Secundum ASD becuase it needs a rim to anchor to.
-most common device is Amplatzer
How are sinusus venosus and primum ASD’s closed?
surgically by an open heart procedure with pericardial patch or suture
PFO characteristics
no “T’ artifact
flap in secundum septum
color flow usually directed eccentrically down the IAS
Eisenmenger syndrome
is a long-term complication of an unrepaired heart condition such as VSD’s present at birth that overtime cause high pressures in the lungs (PHTN). These increase pressures damange the small blood vessels.
-life threating cynotic condition
Subcostal sagittal view is also know as the
bicaval view
VSD’s typically close within the first ____ years of life or by the ____ year of life?
first 2 years or by the 10th year
30% closed by age 2
90% closed by age 10
VSD’s are more prevalent in
male vs female?
neither they are equal
What is the most common acyanotic congenital heart disease?
VSD’s
perimembranous VSD
-Locations
-makes up percent of VSD’s
-best seen in
subaortic/infracristal/membranous/outlet alternate names
* occur in the superior portion of the LVOT, adjacent to the septal TV leaflet
* 75-80% of VSD’s, most common
* best seen in PLAX and PSAX
@ 9-12 O’clock in PSAX
can extend into the trabecular, inlet, outlet septum
What are the 3 types of membranous VSD’s?
Outlet/membranous/perimembranous: located in the LVOT
Supracristal/infundibular: located in the RVOT
Inflow/inlet: located in the inflow areas below the (AV) valves
Inlet VSD
-location
-make up percentage of VSD’s
-best seen in
-also called
- inferior to membranous septum between (AV) valves
- makes up 5-8% of all VSD’s
- best seen in AP4, PSAX, Subcostal coronal view
- Also called AV canal -type VSD
Outlet VSD
-Location
-percentage of VSD’s
located between the cusps of both semilunar valves superior to trabecular septum
- directly below the aortic valve on the LV side; shunts to the right side below the PV in the infundibulum on RV side
- 6% of all VSD’s
subpulmonic /supracristal/doubly committed are alternat names
12-3 O’clock
What affect on the aortic valve does outlet VSD have?
aortic valve prolapse
AI
Outlet VSD’s have a higher prevalence in what population?
Asian
Malalignment VSD are associated with what type of VSD?
perimembranous defect with septal malalignment with the great vessels
can cause outflow obstruction
What congenital defects have malalignment VSD’s?
Truncus arteriosus
Tetralogy of Fallot
Double outlet RV
Trabecular VSD’s
-location
-percentage of VSD’s
-additional tip
-Location is muscular or apical
-15-20% of VSD’s
-often come in multiples
from TV attachment to apex
2nd most common type of VSD
VSD surgical procedure
amplatzer device (cathlab)
dacron path (surgical)
depends on size
VSD’s cause volume overload to the ___ chamber
Left ventricle
most times L-R shunt goes out PA (can cause PA dilation) and then returns to the left side
What three flows can you measure a RVSP from?
- PDA
- VSD
- TR jet
How do you measure a RVSP from a TR jet?
If you have a TR PG of 20 mmHg
RAP of 5mmHg
the RVSP= __mmHg
TR PG + RAP= RVSP
20mmHg + 5mmHg = 25mmHg
How do you measure a RVSP from a PDA gradient?
(need to know the systolic BP)
BP 75/35
PDA PG of 50mmHg
systolic BP - PDA PG = RVSP mmHg
75mmHg - 50mmHg = 25mmHg
How do you measure RVSP from a VSD gradient?
(need to know systolic BP)
BP 75/35
VSD PG of 50mmHg
systolic BP - VSD PG = RVSP mmHg
75mmHg - 50mmHg = 25mmHg
In pediatric patients the constant used for the right atrial pressure is?
5mmHg
10mmHg in adults
What is the Gerbode Effect
LV to RA shunt associated with atrioventricular septal defect and post repair
AV Canal repairs
What is a atrioventricular septal defect?
AVSD
failure of the endocardial cushion to form completely resulting in the atria and ventricular septa at the crux of the heart and (AV) valve anomalies.
