CHD Causing Stenosis/Regurgitation Flashcards
Which valvular stenosis is most commonly congenital (other 3 valves most commonly acquired)
PV stenosis
What is a bicuspid AV?
Typically fusion of RCC and LCC, with a resultant “2” cusps
What is the most common CHD found in adulthood?
Bicuspid AV?
Describe the murmur associated with a bicuspid AV
systolic ejection “click” right after S1
- if there is associated AS, we would also hear systolic crescendo decrescendo murmur
Describe the motion of the 2 cusps of a bicuspid AV during the cardiac cycle
“doming” concave during systole
“hammock” convex during diastole
What would we see on M-Mode with a bicuspid AV?
Eccentric closure
Is AI or AS more commonly associated with a bicuspid AV?
AI is more common, but AS can occur
What is associated with bicuspid AV?
CoAo
Dilated Ao
Marfan’s syndrome (connective tissue disorder)
What is membranous subvalvular AS?
Membrane/ridge of tissue in the LVOT, near the AV causing LVOT obstruction
What might we see with subvalvular AS? (think LV and AV)
LVH (increased pressure)
Early systolic closure of AV (m-mode) from pressure changes
Is the AV normal or abnormal with isolated subvalvular AS?
Normal valve opening
What is supravalvular AS?
Narrowed AoR causing stenosis
Is supravalvular AS common?
No
What would a congenital cause of supravalvular AS be? What about acquired?
Congenital - William’s syndrome
Acquired - accumulated fibrous tissue/inflammation (ie. from takayasu arteritis)
Is the AV normal or abnormal with supravalvular AS?
Normal valve opening
Will the continuity equation be accurate when supravalvular or subvalvular AS is present? Why?
No because the AV is normal. The values would be a false representation of the stenosis because the stenosis is NOT caused by the AV itself
What is AV prolapse? (AVP)
Downward displacement of the AV cusps below the AV/sinotubular junction
What is AVP most commonly seen with?
Bicuspid AV
What is associated with AVP?
AoR dilation, MVP, severe MR, perimembranous VSD
What will 100% be seen with AVP?
AI
What is a Cleft MV?
A division in the AMVL
What is most commonly seen with a cleft MV?
Partial AVCD
*also seen with primum ASD
Describe the motion of the AMVL of a cleft MV during diastole
“Doming” during diastole with no stenosis
What results from a Cleft MV?
MR
What is a Parachute MV?
One pap (usually only posteromedial) attaches to both sets of chordae
What does Parachute MV present similar to?
MS
What is a double orifice (outlet) MV
Accessory orifice - like 2 MV’s
What does a double outlet MV cause?
Can be normal or result in MS or MR
What is Cor Triatriatum?
Membrane across the mid LA that disrupts flow
Looks like a 3rd atrium
What kind of MS can occur from Cor Triatriatum?
Supravalvular MS
What does the presentation of Aor Triatriatum mimic?
It mimics MS with turbulence, increased PSV and PPV
80% of those with Cor Triatriatum also have what?
ASD
Is Cor Triatriatum more common in the LA or RA? What is it called when seen in the RA?
LA more common
Cor Triatriatum dexter if in RA
What is Supravalvular MS (Ring)
A membrane or tissue thickening, at the level of the MV annuli causing an LVIT obstruction
What is associated with Supravalvular (Ring) MS?
ASD
VSD
CoAo
Persistent LSVC
Shone Complex
What is MV Prolapse? (MVP)
A prolapsing leaflet (doesn’t coapt properly) resulting in MR
**Usually congenital but doesn’t present until later in life
What is Pulmonary Vein Stenosis? (PVS)
Narrowing of 1 or more PV’s at the entrance to the LA
What does PVS cause?
PHTN (increased pulmonary pressures), resulting in RVH, RV + RA dilation
What would we see on PW with PVS?
Increased S + D waves with flow reversal in between the systolic and diastolic flow
