Congenital

Question 1

What are the7 traditional forms, and the 9 forms of vascular ring anomaly that have been reported by Schorn, scheneider et al

Answer 1

• Type 1, persistent right aortic arch with persistent left ligamentum arteriosum;
• Type 2, persistent right aortic arch with persistent left subclavian artery;
• Type 3, persistent right aortic arch with persistent left ligamentum arteriosum and left subclavian artery;
• Type 4, double aortic arch;
• Type 5, normal left aortic arch with persistent right ligamentum arteriosum;
• Type 6, normal left aortic arch with persistent right subclavian artery;
• Type 7, normal left aortic arch with persistent right ligamentum arteriosum and right subclavian artery

Bellow are the addition by Schorn

• (8) Type 8, right aortic arch with left subclavian branching from the PDA; - (9) Type 9, right sided aortic arch with left-sided brachiocephalic trunk including both carotid arteries and the left subclavian artery referred to as “mirror” image.

Question 2

What is the most common form of vascular ring anomaly ?

Answer 2

Type 1, persistent right aortic arch with persistent left ligamentum arteriosum;

Question 3

What aortic arches contribute to aortic coartation

Answer 3

Juxtapositional -> 6th (PDA one)
Preductal -> 4th

Question 4

4 causes of aortic root dilation?

Answer 4

1) hypertension
2) aortic coarctation
3) Marphan syndrome
4) VSD (adjacent to the aortic valve opening)

Question 5

What are the 3 rastelli classifications and how common are these in humans?

Answer 5

A: chordal attachment to crest of IVS (50-70% cases)
B: chordal attachment past crest of IVS to an anomalous PM on right side ventricular septum (3% rare)
C: no attachments to ventricular septum referred to as free floating leaflet (30%)

Question 6

To be classified as an AVSD you have to have?

Answer 6

• Have an absence of AV septum (ASD + inlet VSD) - the ASD is a primum septal defect
• Common AV valve with a common leaflet
• The mitral and tricuspid will be in the same plane which not right, the tricuspid should be more apical. So if you see this then you have a complete or partial AVSD
• Free floating leaflet with one of three attachements above
• Aorta displaced over the right ventricle (it is not over riding as you have the VSD and the ASD so the aorta kind of falls over the RV – you get a gooseneck appearance on angio and echo

Question 7

what drugs can be given to keep a PDA open or to close it?

Answer 7

Prostaglandin: keeps PDA open
Aspirin/Ibuprofen: can prematurely close PDA