Ch. 426 - Acyanotic CHD: Left-to-Right Shunt Lesions Flashcards
MC form of ASD
Ostium secundum defect in the region of the fossa ovalis
T/F MC form of ASD is associated with normal AV valves
T
Males vs females: ASD
Females
T/F A child with an ostium secundum ASD is most often asymptomatic
T
Dyspnea on standing relieved when supine
Platypnea
Destauration on standing, relieved when supine
Orthodeoxia
Symptoms that may occur when R-L shunting occurs through an ASD
Platypnea and orthodeoxia
Characteristic finding on auscultation in patients with ASD
Widely split S2 during ALL PHASES of respiration
Murmur of ASD is best heard where
Left middle and upper sternal border
Murmur of ASD is produced by
Increased flow across the RV outflow tract into the pulmonary artery NOT BY LOW-PRESSURE FLOW ACROSS THE ASD
RSR pattern seen in ASD is caused by
Minor right ventricular conduction delay
Normal motion of ventricular septum during phases of the cardiac cycle
Moves posteriorly during systole and anteriorly during diastole
Motion of ventricular septum during phases of the cardiac cycle in ASD
Septal motion is either flattened or reversed (anterior movement in systole)
T/F Secundum ASDs are usually isolated
T
Type of ASD associated with Holt-Oram syndrome
Secundum
Indications for transcatheter closure or surgical device closure in patients with ASD
Asymptomatic patients with Qp:Qs ratio of at least 2:1 or those with RVE
Timing for closure of ASD
After the 1st year and before entry into school
ASD repair is preferred during early childhood because
1) Significantly greater surgical mortality and morbidity in adulthood 2) Long-term risk of arrhythmia is greater in adults
Procedure of choice for ASD closure
Percutaneous catheter device closure
ASD closure is not required in this population of patients
1) Small secundum ASDs 2) Small L-R shunts without RVE
T/F Small to moderate sized ASDs detected in term infants may close spontaneously
T
Secundum ASDs are well tolerated in childhood and symptoms do not usually appear until ___ year
3rd decade or later
T/F IE is common in secundum ASDs
F, extremely rare; antibiotic prophylaxis is NOT recommended
T/F Heart size decreases to normal after surgical or device closure of moderate to large ASDs in children
T
Late right heart failure and arrhythmias are more frequently encountered in patients who undergo repair after ___ years
20
Type of ASD located in the upper part of the atrial spetum in close relation to the entry of the ASD
Sinus venosus ASD
Partial anomalous venous return usually involves some or all veins from only 1 lung, more often which side
Right
When an associated ASD is present in a PAPVR, the ASD is usually of what type
Sinus venosus
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
Scimitar syndrome
T/F Prognosis is excellent in PAPVR
T
ASD located in the lower portion of the atrial septum and overlies the mitral and tricuspid valves
Ostium primum defect
Mitral valve defect often associated in ostium primum defect
Cleft in the anterior leaflet
AVSD is aka
AV canal defect or endocardial cushion defect
AVSD is common in children with what syndrome
Down syndrome
L-R shunt across the atrial defect and mitral (or occasionally tricuspid) insufficiency
Ostium primum defect
Harsh (occasionally very high pitched) apical HSM murmur that radiates to the left axilla
Mitral insufficiency
Surgical interventionf or correction of AVSD must be performed during infancy because
Risk of pulmonary vascular disease developing as early as 6-12 mo of age
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
PA banding
Prognosis for unrepaired complete AVSD depends on
1) Magnitude of L-R shunt 2) Degree of elevation of pulmonary vascular resistance 3) Severity of AV valve insufficiency
MC cardiac malformation
VSD
VSD accounts for ___% of CHDs
25
MC type of VSD
Membranous
Position of a membranous VSD
Posteroinferior position, anterior to the septal leaflet of the tricuspid valve
VSD that may impinge on an aortic sinus and cause aortic insufficiency
Supracristal (superior to the crista supraventricularis), just beneath the pulmonary valve
Position of muscular VSDs
Midportion or apical region of the ventricular septum
Swiss cheese septum is associated with what acyanotic CHD
Multiple muscular VSD
Magnitude of L-R shunt in a VSD is determined by
1) Physical size of the VSD 2) Level of pulmonary vascular resistance in relation to SVR
Size of a restrictive VSD
Less than 5mm
What is meant by a restrictive VSD
RV pressure is normal
Size of a nonrestrictive VSD
Large or >10mm
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
Restrictive VSD
VSD where the direction of shunting and shunt magnitude are determined by the ratio of the pulmonary to systemic vascular resistnce
Nonrestrictive VSD
