Ch. 426 - Acyanotic CHD: Left-to-Right Shunt Lesions

Question 1

MC form of ASD

Answer 1

Ostium secundum defect in the region of the fossa ovalis

Question 2

T/F MC form of ASD is associated with normal AV valves

Answer 2

T

Question 3

Males vs females: ASD

Answer 3

Females

Question 4

T/F A child with an ostium secundum ASD is most often asymptomatic

Answer 4

T

Question 5

Dyspnea on standing relieved when supine

Answer 5

Platypnea

Question 6

Destauration on standing, relieved when supine

Answer 6

Orthodeoxia

Question 7

Symptoms that may occur when R-L shunting occurs through an ASD

Answer 7

Platypnea and orthodeoxia

Question 8

Characteristic finding on auscultation in patients with ASD

Answer 8

Widely split S2 during ALL PHASES of respiration

Question 9

Murmur of ASD is best heard where

Answer 9

Left middle and upper sternal border

Question 10

Murmur of ASD is produced by

Answer 10

Increased flow across the RV outflow tract into the pulmonary artery NOT BY LOW-PRESSURE FLOW ACROSS THE ASD

Question 11

RSR pattern seen in ASD is caused by

Answer 11

Minor right ventricular conduction delay

Question 12

Normal motion of ventricular septum during phases of the cardiac cycle

Answer 12

Moves posteriorly during systole and anteriorly during diastole

Question 13

Motion of ventricular septum during phases of the cardiac cycle in ASD

Answer 13

Septal motion is either flattened or reversed (anterior movement in systole)

Question 14

T/F Secundum ASDs are usually isolated

Answer 14

T

Question 15

Type of ASD associated with Holt-Oram syndrome

Answer 15

Secundum

Question 16

Indications for transcatheter closure or surgical device closure in patients with ASD

Answer 16

Asymptomatic patients with Qp:Qs ratio of at least 2:1 or those with RVE

Question 17

Timing for closure of ASD

Answer 17

After the 1st year and before entry into school

Question 18

ASD repair is preferred during early childhood because

Answer 18

1) Significantly greater surgical mortality and morbidity in adulthood 2) Long-term risk of arrhythmia is greater in adults

Question 19

Procedure of choice for ASD closure

Answer 19

Percutaneous catheter device closure

Question 20

ASD closure is not required in this population of patients

Answer 20

1) Small secundum ASDs 2) Small L-R shunts without RVE

Question 21

T/F Small to moderate sized ASDs detected in term infants may close spontaneously

Answer 21

T

Question 22

Secundum ASDs are well tolerated in childhood and symptoms do not usually appear until ___ year

Answer 22

3rd decade or later

Question 23

T/F IE is common in secundum ASDs

Answer 23

F, extremely rare; antibiotic prophylaxis is NOT recommended

Question 24

T/F Heart size decreases to normal after surgical or device closure of moderate to large ASDs in children

Answer 24

T

Question 25

Late right heart failure and arrhythmias are more frequently encountered in patients who undergo repair after ___ years

Answer 25

20

Question 26

Type of ASD located in the upper part of the atrial spetum in close relation to the entry of the ASD

Answer 26

Sinus venosus ASD

Question 27

Partial anomalous venous return usually involves some or all veins from only 1 lung, more often which side

Answer 27

Right

Question 28

When an associated ASD is present in a PAPVR, the ASD is usually of what type

Answer 28

Sinus venosus

Question 29

Anomalous vein draining into the IVC is visible on chest radiography as a crescentic shadow of vascular density along the right border of the cardiac silhouette

Answer 29

Scimitar syndrome

Question 30

T/F Prognosis is excellent in PAPVR

Answer 30

T

Question 31

ASD located in the lower portion of the atrial septum and overlies the mitral and tricuspid valves

Answer 31

Ostium primum defect

Question 32

Mitral valve defect often associated in ostium primum defect

Answer 32

Cleft in the anterior leaflet

Question 33

AVSD is aka

Answer 33

AV canal defect or endocardial cushion defect

Question 34

AVSD is common in children with what syndrome

Answer 34

Down syndrome

Question 35

L-R shunt across the atrial defect and mitral (or occasionally tricuspid) insufficiency

Answer 35

Ostium primum defect

Question 36

Harsh (occasionally very high pitched) apical HSM murmur that radiates to the left axilla

Answer 36

Mitral insufficiency

Question 37

Surgical interventionf or correction of AVSD must be performed during infancy because

Answer 37

Risk of pulmonary vascular disease developing as early as 6-12 mo of age

Question 38

Palliation with ___ may be done for patients with AVSD in the subset of patients who have other associated lesions that make early corrective surgery too risky

Answer 38

PA banding

Question 39

Prognosis for unrepaired complete AVSD depends on

Answer 39

1) Magnitude of L-R shunt 2) Degree of elevation of pulmonary vascular resistance 3) Severity of AV valve insufficiency

Question 40

MC cardiac malformation

Answer 40

VSD

Question 41

VSD accounts for ___% of CHDs

Answer 41

25

Question 42

MC type of VSD

Answer 42

Membranous

Question 43

Position of a membranous VSD

Answer 43

Posteroinferior position, anterior to the septal leaflet of the tricuspid valve

Question 44

VSD that may impinge on an aortic sinus and cause aortic insufficiency

Answer 44

Supracristal (superior to the crista supraventricularis), just beneath the pulmonary valve

Question 45

Position of muscular VSDs

Answer 45

Midportion or apical region of the ventricular septum

Question 46

Swiss cheese septum is associated with what acyanotic CHD

Answer 46

Multiple muscular VSD

Question 47

Magnitude of L-R shunt in a VSD is determined by

Answer 47

1) Physical size of the VSD 2) Level of pulmonary vascular resistance in relation to SVR

Question 48

Size of a restrictive VSD

Answer 48

Less than 5mm

Question 49

What is meant by a restrictive VSD

Answer 49

RV pressure is normal

Question 50

Size of a nonrestrictive VSD

Answer 50

Large or >10mm

Question 51

Type of VSD wherein the high pressure in the LV drives the shunt L-R and the size of the defect limits the magnitude of the shunt

Answer 51

Restrictive VSD

Question 52

VSD where the direction of shunting and shunt magnitude are determined by the ratio of the pulmonary to systemic vascular resistnce

Answer 52

Nonrestrictive VSD