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Congenital Flashcards

1
Q

BAV screening

A

First degree relatives

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2
Q

Secundum ASD anatomy

A

Absence of tissue in region of fossa ovalis (center of septum)

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3
Q

Secundum ASD shunt

A

Left to right shunt

RA and RV enlargement

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4
Q

Holt Oram Syndrome

A

Heart-hand syndrome
TBX5 mutation, AD
Associated with secundum ASD

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5
Q

Secundum ASD EKG

A

RAD, RBBB from RV overload

R wave notches in inferior limb leads

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6
Q

Secundum ASD closure indications

A 
Symptoms class I
No symptoms class IIa
No PVD - PASP < 50% systemic, PVR < 1/3 SVR, no R to L shunt on pulse ox
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7
Q

Sinus venous defect

A

Superior portion of septum, posterior to fossa ovalis
A/w anomalous RUPV
L-> R -> RV overload

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8
Q

Sinus venous defect treatment

A

Surgical closure if
impaired functional capacity
R enlargement
No cyanosis or PVD

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9
Q

Primum ASD

A

Partial A-V canal defect, inferior portion of septum
A/w Downs
AV valves abnormal, on same level, MV usually cleft
R enlargement
RBBB and LAD

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10
Q

Primum ASD treatment

A

Surgical closure if
impaired functional capacity
R enlargement
No cyanosis or PVD

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11
Q

Primum ASD associated lesions

A
  • Secundum ASD
  • VSD
  • PS
  • Subaortic stenosis - abnormal MV insertion in LVOT
  • Left SVC
  • Coarctation
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12
Q

Complete AV canal defect

A

Atrial defect above valve, ventricular below
One big AV valve
L->R shunt -> PVD
Huge R sided enlargement
Must be repaired in infancy or Eisenmenger’s develops

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13
Q

Look for anomalous PVs

A

RV volume overload, no ASD

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14
Q

Anomalous PV repair if

A

Qp:Qs > 1.5
Symptoms
RV enlargement

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15
Q

Indication to close VSD

A

LV enlargement

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16
Q

Muscular VSD

A

bordered by myocardium

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17
Q

Perimembranous VSD

A

Beneath commissure between R and posteirior cusps and remote from L cusp

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18
Q

Infundibuluar, outlet supracristal VSD

A
  • Lies beneath commissure between R and L cusps
  • Aortic prolapse
  • Earlier closure to prevent AR
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19
Q

Sub-aortic and sub-pulmonary VSD

A

Should be closed to prevent AR

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20
Q

PDA closure

A
  • LA or LV enlargement with net L to R shunt

- PASP < 50% systemic & PVR < 1/3 systemic

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21
Q

Pulmonary stenosis associated with

A

Noonan’s syndrome

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22
Q

PS severe

A

PG > 65
Peak vel > 4
MG > 35

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23
Q

PS treatment

A

Balloon if mod-severe and HF, cyanosis or exercise intolerance without other reasons
Surgical if ineligible or failed balloon

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24
Q

20 years after Pulm balloon valvotomy complications

A

Arrhythmias
RV enlargement
TR
PR

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25
Indications for coarctation repair
HTN + significant coarctation Arm/leg peak-peak grad >20 or mean doppler systolic > 20 Arm/leg >10 or mean doppler systolic > 10 with collateral flow Arm/leg or doppler > 10 + decreased LV function or AF
26
Ebstein's indications for repair
``` Decreased exercise capacity Cyanosis (risk for stroke) Severe TR Bypass tract Severe RV enlargement with onset of dysfunction ```
27
Holt Oram a/w
Secundum ASD
28
Down syndrome a/w
AV septal defects (partial or complete AV canal)
29
Noonan syndrome a/w
Pulmonary stenosis
30
Turner syndrome a/w
coarctation
31
Phlebotomy for complex CHD indications
Symptomatic hyper viscosity with Hb > 20, Hct > 0.65 Fluids If symptoms and Hit <0.65, suspect iron deficiency
32
Treatment of complex CHD iron deficiency
Ferrous sulfate once daily | Discontinue when Hct rises rapidly
33
Therapy for Eisenmenger's
PH meds ERAs PDE5i Prostacyclin agonists
34
Tetralogy of Fallot
Large sub aortic VSD RVOT obstruction +/- PS Overriding aorta RVH
35
ToF associations
DiGeorge syndrome (low nasal bridge and ears, wide eyes) Right aortic arch Anomalous coronary arteries Secundum ASD
36
ToF simple repair
Close VSD Resect RVOT muscle +/- Pulm valvotomy
37
ToF complex repair
RVOT patch Excision of Pulm valve RV to PA conduit
38
Issues after ToF repair
``` RV dysfunction if late Residual RVOT gradient, VSD Severe PR most common Post-op RBBB Arrhythmias ```
39
Replace PV in ToF
Before irreversible RV dysfunction
40
Shunts for ToF
Cynatoic heart disease with low pulmonary blood flow Improves oxygenation, makes small PAs grow Problems: distortion of PAs, pHTN and LV overload, no heart-lung transplant if lateral thoracotomy
41
Classic Glenn ToF
SVC -> R PA
42
Bidirectional Glenn ToF
SVC -> both PAs
43
Blalock-Taussig ToF
Subclavian -> PA
44
Waterston ToF
Ascending Ao -> R PA
45
Potts ToF
Descending Ao -> L PA
46
dTGA
Morphologic RV on right | Aorta anterior and to the right, from RV
47
L TGA
RV on left Aorta anterior and to left Congenitally corrected transposition, blood going to right places
48
dTGA surgery
Arterial switch | Atrial switch
49
Arterial switch dTGA
Great arteries switched, coronaries reimplanted
50
Mustard dTGA
Baffle from IVC -> SVC -> LV | RV becomes systemic ventricle
51
Mustard dTGA complications
- Eventual RV failure, TR - Atrial arrhythmias - Baffle obstruction, leak (ASD) - beware PPM
52
lTGA associated with
- VSD - PS - Tricuspid / left systemic AV valve regurgitation - Systemic ventricular dysfunction (may be from leaky AV valve) - Conduction abnormalities >75% - Inversion of bundles, absence of septal Q waves, have inferior Q waves - CHB
53
Doublet inlet ventricle
Two AV valves into single ventricle
54
Single inlet ventricle
One AV valve entering ventricle | TV atresia, ASD
55
Common inlet ventricle
One big AV valve entering ventricle
56
Fontan
For single ventricle | Diverts blood from vena cave, RA -> PA
57
BAV surveillance with ascending aortic aneurysm >4.5 cm
Annual
58
BAV surveillance with mild AS, no aneurysm
Every 3-5 years
59
Coarctation surveillance after intervention without symptoms
MRA or CTA every 3-5 years
60
Takayasu arteritis criteria (look for 3+)
``` Age < 40 Claudication Dec brachial artery pulse Subclavian artery or aortic bruit SBP variation > 10 mm Hg between arms Angiographic (CT, MR) evidence of aorta or branch vessel stenosis ```
61
Platypnea Orthodeoxia Syndrome
Dyspnea and hypoxemia when upright Resolves when supine Intracardiac shunt, pulmonary conditions agitated bubble study in supine and upright positions
62
Causes of Playpnea-orthodeoxia
PFO ASD Atrial septal aneurysm with fenestration Pulm - interstitial lung disease, HPS, Pulm AVMs
63
PFO and platpnea orthodeoxia syndrome occur if
``` Distortion of intertribal septum in upright position Post-pneumonectomy, lung transplant Right hemidiaphragm paralysis Kyphoscoliosis Ascending aortic dilatation ```

Cardiology Boards (11 decks)

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