CHD of the Right Heart Flashcards
What is pulmonary stenosis? (PS)
Narrowing of the OV causing obstruction to RVOT flow
Is congenital or acquired PS more common?
Congenital, most often in pediatric pt’s and rarely seen in adults
If acquired, typically from carcinoid syndrome
What does PS do to the RV and RA?
RVH (increased pressures)
RA dilation
What is most commonly associated with PS?
Maternal rubella
Clubbed fingers
Turner’s
Noonan’s
Polycythemia Vera
*Peripheral PAS associated w/ William’s
*Infundibular PAS associated w/TOF
What are S+S of PS?
SOB
SOBOE
Chest pain
Syncope
Fatigue
What US finding is most commonly seen with PS? (Hint: septal defect)
VSD
What happens to the PV leaflets with PS?
Thickened
Doming in systole
If the PS jet is eccentric, what can happen to the MPA?
Dilation
What is an M-Mode finding with PS?
Increased A - wave
What is Pulmonary Atresia?
Absence of PV opening
With Pulmonary Atresia, how does the PA get blood?
Ductus arteriosus
*Must remain open after birth! Or have associated defects
What is associated with Pulmonary Atresia?
VSD with overriding Ao
What is Tricuspid Atresia?
Absence of TV opening
What associated defects must be present for survival with Tricuspid Atresia?
VSD AND PFO
- once PDA closes, no deoxygenated blood can reach the PA without a VSD and PFO
What happens to the heart chambers with Tricuspid Atresia?
Hypoplastic RV
Biatrial enlargement with PFO (R to L or bi-directional)
What is Ebstein Anomaly?
When the TV originates very inferior, toward the apex
Are the TV annuli inferior or in their normal position with Ebstein’s?
Normal
What is the normal measurement (in mm and mm/m^2) of distance between the TV and MV
20 mm
8 mm/m^2
What happens to the heart chambers with Ebstein’s?
Very large RA ++++
Small RV
Small, ‘D’ shaped LV
What does Ebstein’s cause?
Severe TR
What is associated with Ebstein’s?
Secundum ASD (most common), R to L shunt
30% have WPW
What is Eisenmenger’s Syndrome
Occurs when there is a shunt between the L and R side. Normal shunt flow is from R to L, but if the right pressures exceed the L, the shunt direction reverses
What does Eisenmenger’s cause?
Cyanosis and right heart failure
What defect does Eisenmenger’s usually occur with?
VSD (most common)
ASD, PDA, AVCD
What is a Persistent Left SVC (PLSVC)
Blood from left UE drains directly into the coronary sinus through the brachiocephalic vein
What would we most commonly see on US with PLSVC? What if we used contrast?
Dilated coronary sinus
If saline contrast is injected into the left arm, and the coronary sinus fills BEFORE the RA, PLSVC is present
What is an Aortopulmonary Window? (AoPW)
A direct connection between the AscAo and MPA (L to R shunt, unless Eisenmenger’s is present)
What does an Aortopulmonary Window do to the descending aorta?
Diastolic flow reversal
What murmur is heard with diastolic flow reversal in the Desc Ao from an AoPW?
Continuous murmur
What are S+S of AoPW?
Respiratory infection
Tachypnea
Tachycardia
What can occur as a result of AoPW?
CHF
PHTN
What is a Patent Ductus Arteriosus? (PDA)
When DA doesnt close after birth and blood continues to shunt from the descending Ao to the PA
What does a PDA cause?
Cyanosis, especially in the lower extremities
LVVO, dilated LV and LA
May see diastolic flow reversal in desc Ao
