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DMST 367 Echo 3 > Cardiac Situs And The Segmental Approach > Flashcards

Cardiac Situs And The Segmental Approach Flashcards

1
Q

Label these three images in terms of Cardiac position.

A

From left to right

  1. Dextroposition
  2. Mesoposition
  3. Levoposition
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2
Q

Which position is this? And label the image?

A
  1. Apex position

From left to right

  1. Levocardia
  2. Mesocardia
  3. Dextrocardia
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3
Q

What is the difference between the two images?

A

The left is a normal situs and the right is dextrocardia

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4
Q

What does this image demonstrate?

A

Dextrocardia in sub 4CH

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5
Q

Label the images in terms of Visceral Situs?

A
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6
Q

What does this image demonstrate?

A

VSD with overriding Aorta

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7
Q

What are segments? 4

A

The anatomical structures which the cardiovascular structure system is divided for purposes of evaluation which include:
1. Systemic and pulmonary veins
2. Atria
3. Ventricles
4. Great arteries

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8
Q

What does connectives describe?

A

The anatomical sequence of the structures

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9
Q

What does connections include? 3

A
  1. Venous to atria (veno-atrial)
  2. Atria to ventricle
  3. Ventricle to great arteries (ventriculo arterial)
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10
Q

What does concordants describe?

A

Normal Sequential relationship between the hearts chambers, valves, and great vessels

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11
Q

What is a term used for concordant?

A

Appropriate

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12
Q

What does discordant refer to?

A

Abnormal sequential relationship between chambers, valves, great vessels

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13
Q

What does commitment describe?

A

The degree of abnormality of flow through the valves into ventricles and great vessels

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14
Q

What is an example of commitment?

A

A valve which overrides a large VSD is committed to more than one ventricle

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15
Q

Commitment is assigned based on what rule?

A

50% rule

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16
Q

In terms of commitment if more that _____% of a valve overrides a VSD, it is said to be committed

A

50%

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17
Q

What does ambiguous mean?

A

When precise identification of a chamber can not be determined

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18
Q

What are inlet/outlet anomalies? 2

A

Anomalies of structure and flow
1. Into the ventricle (inlet)
2. Out of the ventricle (outlet)

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19
Q

What are things we would see in terms of congenital heart defects in the first 8 weeks of development? 4

A
  1. Looping
  2. Twisting
  3. AV canal formation
  4. Septal formation
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20
Q

What is a segmental approach to CHD?

A

A systematic approach to defining and characterizing congenital heart defects

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21
Q

What does segmental approach to CHD focus on?

A

Focuses on segments of the heart and connections between them

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22
Q

How does segmental approach to CHD differ from old classification system?

A

Differs based on the associated abnormalities

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23
Q

What are three steps for segmental approach of CHD?

A
  1. Visceral atrial situs + atrial connections
  2. Orientation of the ventricles + connections
  3. Orientation of the great vessels + connections
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24
Q

What does cardiac position mean?

A

Where the heart lies within the chest

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25
Q

What is right dextroposition?

A

Most of the heart lies to the right of the sternum

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26
Q

What is midline mesoposition?

A

Heart lies directly behind the sternum

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27
Q

What is left levoposition?

A

Most of the heart lies to the left of the sternum

28
Q

What is normal cardiac position?

A

Left - levoposition
The apex may still point to the left in any of these cases

29
Q

What does Step 1. visceral atrial situs refer to?

A

The position of the atria in relation to the nearby anatomy

30
Q

In terms of step 1. Visceral atrial situs, it is standard to start with what window?

A

Subcostal view

31
Q

What do we look at during step 1. Visceral atrial situs?

A
  1. Identify which way the apex is pointing
  2. Identify atria
  3. Relate to surrounding structures
32
Q

What is cardiac position?

A

The direction the apex points

33
Q

What is right- dextrocardia?

A

Apex points to the right side of the body

34
Q

What is midline mesocardia?

A

Apex lies under the sternum

35
Q

What is Left Levocardia?

A

Apex points to the left

36
Q

What is the normal cardiac orientation?

A

Left levocardia

37
Q

What is the process to determine dextrocardia? 4

A
  1. Start with a transverse subcoastal sweep
  2. Determine visceral situs
  3. PLAX
  4. Label RT chest for the reading physician
38
Q

How many people are afflicted with Dextrocardia?

A

1:12000 people

39
Q

If all organs are mirrored the correct term is what?

A

Dextrocardia situs inversus totalis

40
Q

Individuals with Dextrocardia may be prone to what? 4

A
  1. Esophageal, bronchial, cardio pulmonary disorders
  2. Endocardial cushion defect
  3. Pulmonary stenosis
  4. Double outlet RV
41
Q

What is a situs solitus (normal) visceral situs?

A
  1. LT sided: Stomach, spleen, pancreas
  2. RT sided: Liver, cecum, appendix
42
Q

What is a situs inversus visceral situs?

A

Mirror image of normal

43
Q

What is situs ambiguous?

A
  1. Inconsistent organ placement
  2. Duplication/absence of organs
44
Q

What is atrial situs solitus (normal)?

A

Morphologic RA is on the RT of the morphologic LA

45
Q

What is Atrial situs inversus?

A

Morphologic RA is to the LT of the morphologic LA

46
Q

What is atrial situs ambiguous?

A

Confident assignment of morphologic left and right atria cannot be made

47
Q

What does morphologic mean?

A

Has morphologic features of that chamber

48
Q

What are some morphologic RA features that are defining? 5

A
  1. Eustachian valve
  2. Venae cave
  3. Coronary sinus
  4. Chiari network
  5. RA appendage
49
Q

What are some definitive morphologic LA structures? 2

A
  1. Pulmonary veins
  2. LA appendage
50
Q

What do we use to evaluate with venous segments position? 5

A
  1. Hepatic veins
  2. IVC
  3. SVC
  4. Coronary sinus
  5. Pulmonary veins
51
Q

What are some identifiable features of veno-atrial connections? 2

A
  1. Systemic venous return (SVC/IVC)
  2. Pulmonary venous return (Pulmonary veins)
52
Q

What are morphologic RV features? 7

A
  1. Crescent shaped
  2. TV (3 leaflets)
  3. Large apical trabeculations
  4. Multiple small papillary muscles
  5. Moderator band
  6. Septal leaflet apically displaced
  7. Infundibulum
53
Q

What features define the morphologic LV? 5

A
  1. Bullet shaped
  2. MV (2 leaflets)
  3. Two papillary muscles
  4. May have false tendons
  5. Inlet and outlet valves in continuity
54
Q

What is the crux?

A

Where the atria and the ventricles meet at the center of the heart

55
Q

What is a bi-ventricular?

A

One atrium connected to both ventricles

56
Q

What is uni-ventricular?

A

Both atria connect to one ventricle

57
Q

What is common curx?

A

Atria connect to ventricles through a single multi-leaflet structure

58
Q

What are some things we look for in terms of Ventriculo- arterial concordance? 4

A
  1. AV and PV anatomically identical
  2. Look for fibrous continuity between AV and MV
  3. Look for overriding vessels
  4. Assess spatial relational of AV/PV in SAX
59
Q

In terms of ventricular-arterial connections, what are 3 main variations from normal?

A
  1. Transposed connection
  2. Double outlet connection
  3. Single outlet connection
60
Q

What is a transposition of the great arteries in terms of ventricular arterial connections?

A
  1. Main PA arises from the LV
  2. Aorta arises from the RV
61
Q

In terms of Ventriculo-arterial connections, what is double outlet connections?

A

Both the great arteries arise from a single ventricle (almost always the RV)

62
Q

In terms of ventriculo-arterial connections, what is a single outlet connection? 2

A
  1. Only 1 overriding great artery (aorta) coming from the ventricle
  2. Great arteries are fused into a single truncal artery with branches from the ventricle
63
Q

What are some defining features of the pulmonary trunk?

A

Bifurcations to the branch PAs in the
1. LPA
2. RPA

64
Q

What are defining features in the Aorta?

A
  1. Coronary arteries
  2. Branches (innominate a, LCC, LSC)
65
Q
A

DMST 367 Echo 3 (27 decks)

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