Congenital

Question 1

What is an LV -> RA shunt called?

Answer 1

Gerbode defect

Question 2

What are the four types of VSD?

Answer 2

Perimembranous (most common)
Supracristal
AV canal
Muscular

Alternative:
Outlet
Membranous
Inlet
Muscular

Question 3

Four VSD closure indications

Answer 3

1. Any symptoms
2. Left heart enlargement (1.5:1 shunt + enlarged LV + LA)
3. PHTN (as long as PASP <50% systemic + PVR <1/3 SVR)
   4) Endocarditis

Question 4

Indications for repairing (stent or surgery) aortic coarctation

Answer 4

CoA peak-to-peak gradient >20mmHg
Significant collateral flow on CTA/MRA
HF or systemic HTN
Stenosis >50%

Question 5

If undergoing bicuspid AVR, at what aortic diameter is aortic replacement also indicated?

Answer 5

4.5cm (2a, lower threshold than non-bicuspid)

Question 6

Lutembacher’s syndrome definition

Answer 6

ASD (secundum > primum) plus MS (congenital or acquired)

Question 7

Taussig-Bing syndrome

Answer 7

DORV + subpulmonic VSD

Question 8

What is Ebstein anomaly?

Answer 8

Congenital malformation characterized by apical displacement of the septal TV leaflet

Question 9

Sinus of Valsalva aneurysms usually arise from _________ and rupture into _______ causing a continuous murmur

Answer 9

right coronary sinus

right ventricle

Question 10

What is scimitar syndrome

Answer 10

RUL + some RLL pulmonary veins anomalous connection to IVC

(a/w R lung hypoplasia)

Question 11

How is “step up” defined on shunt run

Answer 11

SVC -> PA >8%

Question 12

4 types of ASD (in order of most common)

Answer 12

Secundum (80%)
Primum, includes canal (15%)
Sinus venosus (<5%)
Unroofed CS (<1%)

Question 13

ASD ECG findings

Answer 13

Incomplete RBBB
Crochetage (inferior QRS notching)

Question 14

Where do left upper PAPVR drain?

Answer 14

LUPV -> innominate

Question 15

Secundum ASD has normal life expectancy if repaired before age ____

Answer 15

25yo

Question 16

What is a gooseneck deformity?

Answer 16

LVOT elongation due to apical displacement of MV in AV canal defect

Question 17

ECG findings in Down Syndrome w/ AV canal defect

Answer 17

RBBB + LAFB

Question 18

AV canal defects are always associated with what other MV defect?

Answer 18

cleft anterior MV leaflet -> MR

Question 19

Ebstein associations

Answer 19

PFO/ASD (50%)
WPW (20%)
Himalayan P waves

Question 20

What is the “Witches nose” on CXR?

Answer 20

Post-stenotic PA dilation then taper in PS

Question 21

pV and MG criteria for severe PS

Answer 21

pV >4
MG >35

Question 22

Eisenmenger treatment

Answer 22

class I: Bosentan (?class effect for endothelin receptor antagonists)
class IIa: Dual therapy w/ bosentan + PDE5

Question 23

4 components of Tetralogy of Fallot

Answer 23

VSD
RVH
RVOT obstruction
Overriding aorta

A/w anomalous coronaries

Question 24

What are D-TGA and L-TGA

Answer 24

D-TGA is complete transposition:
RA -> RV -> Aorta
LA -> LV -> PA

L-TGA is CC-TGA
RA -> LV -> PA
LA -> RV -> Aorta

(D you die without a surgeon, L you can live without a surgeon)

Question 25

ECG findings in L-TGA

Answer 25

> 75% have some degree of AV block (% risk of CHB ~= age)

inversion of R/L bundles -> septal activation from R to L -> inferior Q waves (lose lateral Q)

Question 26

What are the Mustard/Senning procedures and how are they different?

Answer 26

D-TGA surgery in which an interatrial baffle is created from SVC/IVC to the MV/LV (which is connected to PA)

Senning=pericardial baffle
Mustard=synthetic Dacron baffle