Cards: Adult Congenital Heart Disease Flashcards
How do you manage a patent foramen oval for stroke prevention?
Patent foramen ovale closure for secondary stroke prevention. The results of three randomized trials demonstrated that, in patients with cryptogenic stroke, percutaneous patent foramen ovale closure reduces the risk for second stroke compared with medical therapy.
If an adult has a patent Foramen ovale but no symptoms or suggestions of stroke, how do you manage it?
There is no indication for patent foramen ovale closure or for antiplatelet therapy in asymptomatic patients.
Should patent Foramen ovales be closed for recurrent strokes or migraines?
Randomized trials do not support patent foramen ovale closure to reduce risk of recurrent stroke or migraine.
What are presenting clinical features of an ASD?
Common presenting features include:
- fatigue
- exertional dyspnea
- atrial fibrillation
- paradoxical embolism
- Abnormalities on the physical examination, including:
- JVD
- parasternal impulse
- systolic pulmonary outflow murmur at left 2nd intercostal space**
- fixed splitting of S2 **
- large shunts may have a diastolic rumble
How should ASDs be managed? When is a procedure performed?
- A small atrial septal defect (pulmonary–to–systemic blood flow ratio [Qp:Qs] <1.5:1) with no associated symptoms or right heart enlargement can be followed clinically.
- Symptoms and right-sided cardiac chamber enlargement are the main indications for atrial septal defect closure.
When should VSD be closed?
- For small ventricular septal defects with a small left-to-right shunt and no left heart enlargement or valve disease, observation is appropriate with periodic clinical evaluation and imaging.
- Closure of a ventricular septal defect is indicated when the pulmonary–to–systemic blood flow ratio (Qp:Qs) is 2.0 or greater, and there is evidence of left ventricular volume overload or a history of endocarditis.
When don’t you close a VSD?
Large ventricular septal defects with right-to-left shunt reversal and pulmonary arterial hypertension (Eisenmenger syndrome) should not be closed as closure will result in clinical deterioration.
When should a PDA be closed?
Closure of a patent ductus arteriosus is indicated for left-sided cardiac chamber enlargement in the absence of severe pulmonary arterial hypertension.
When should a PDA not be closed?
A large patent ductus arteriosus with severe pulmonary arterial hypertension and shunt reversal should be observed as closure may be detrimental.
What is the treatment of choice for pulmonary valve stenosis?
Pulmonary balloon valvuloplasty is the treatment of choice for severe pulmonary valve stenosis.
What is aortic coarctation?
Aortic coarctation is a discrete aortic narrowing, usually located just beyond the left subclavian artery, causing hypertension proximal and reduced blood pressure distal to the aortic narrowing. It can cause a a radial artery–to–femoral artery pulse delay.
When is intervention indicated for coarctation?
Intervention for aortic coarctation is recommended when the coarctation systolic peak (peak-to-peak) pressure gradient is 20 mm Hg or higher or if there is radiologic evidence of severe coarctation with collateral flow.
What should patients with severe residual or unprepared aortic coarctation, aortic stenosis, or a dilated aorta be counseled to avoid?
Patients with severe residual or unrepaired aortic coarctation, aortic stenosis, or a dilated aorta should be counseled to avoid pregnancy, contact sports, and isometric exercise.
When is pulmonary valve replacement indicated for tetralogy of fallot?
Pulmonary valve replacement is recommended in patients with repaired tetralogy of Fallot who have severe pulmonary valve regurgitation with symptoms, decreased exercise tolerance, more than moderate right heart enlargement or dysfunction, or arrhythmias.
What special care do you have to take for IV lines in patients with Eisenminger syndrome?
In patients with Eisenmenger syndrome, meticulous care of intravenous lines with filters to avoid paradoxical air embolism is imperative.
