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Cardio > Congenital > Flashcards

Congenital Flashcards

1
Q

Relation of Normal PA to Aorta

A

ALS- Anterior,left, Superior; PALS - pulmonary artery is ALS

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2
Q

Mitral pulmonary continuity is seen in

A

TGA

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3
Q

—- has double conus

A

DORV

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4
Q

Ostium secundum is formed in septum

A

Primum;

Ostium primum is at lower end of Septum primum

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5
Q

Limbus is formed by Septum—

A

Secundum.

So will be on RA side

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6
Q

Floor of fossa ovalis is formed by

A

Septum Primum

Remnant of foremen ovale on the right side is called Fossa ovalis

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7
Q

In coarctation resting arm leg gradient >______is considered if more than

A

20 mm Hg at rest

After exercise > 40 mm Hg is abnormal

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8
Q

What percentage of cases both subclavians arise after coarctation

A

3-4%

So BP in all limbs will be equal

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9
Q

Rib notching I coarctation

A

Notching of posterior 1/3 of 3-8th ribs

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10
Q

Indication for coarctation intervention in children is

peak INSTANTANEOUS gradient more than

A

20 mm Hg

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11
Q

Role of balloon angioplasty in coarctation

A
  1. Balloon angioplasty is an alternative to surgical repair for “older infants & young children”(greater than four months) with native discrete coarctation
  2. Stent placement has replaced balloon angioplasty as the procedure of choice in “older children and adults “with native coarctation.
  3. It remains the preferred intervention for all patients with isolated recoarctation regardless of age
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12
Q

Stent placement is not preferred in coarctation if body weight is

A

Less than 25

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13
Q

The features of REcoarctation absent in children

A

Hypertension and Headaches are usually absent

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14
Q

Indications for intervention in re coarctation

A
  1. Hypertension
  2. Instantaneous gradient more than 20
  3. Presence of collaterals
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15
Q

Balloon angioplasty vs Surgery in coarctation risks

A

Aneurysm and re coarctation more with balloon

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16
Q

Indications for Pulmonary valve replacement

A

RF>25% measured by CMR

and 2 or more of

RV volume criteria(3 in no); EF, RVOT aneurysm
or Clinical criteria of exercise intolerance,HF,Syncope,sustained VT

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17
Q

ASD may be closed if PVR is

A

Less than 5 Woods unit

Others the efficacy is uncertain

If Pulmonary artery pressure >2/3 of Systemic pressure should not do

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18
Q

Largest TV leaflet in Ebsteins is

A

ATL

Called ‘SAIL LIKE’

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19
Q

Indications for surgery in Ebsteins

A

Cyanosis- spo2-<90%
RV failure….(to be refined)
Deteriorating exercise capacity
Embolism

REC- RV failure, Embolism, Exercise, Cyanosis

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20
Q

Precautions with Venous P valve for PR

A

Upsize by 3-4 mm

Check for LMCA occlusion with balloon occlusion of RVOT -RAO caudal and lateral views

Deploy proximal part of stent fast to avoid hypotension

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21
Q

Murmur of moderate VSD is evident………..days of birth

A

Within 2-3 days

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22
Q

Katz Wachtel phenomenon is

A

Large biphasic QRS in V2-4.

QRS 50 mm or more

Due to biventricular hypertrophy

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23
Q

Least common type of VSD

A

Supracristal or Doubly committed

AR common

24
Q

Crista Supraventricularis can be considered synonymous with

A

Infundibular or Conus Ventricular Septum

It’s the portion of septum seperating Tricuspid and Pulmonary valves

Supracristal VSD is in this part. Usually the term is reserved for Defects lying immediately below the Pulmonary Valve. Defect in conus septum is also technically supracristal

25
Q

Supracristal septum supports the…..

A

Muscular support to Aortic Valve esp RCC

26
Q

Unlike the ……VSD the supracristal VSD does not lie near……..

A

Peri membranous

Tricuspid Valve

27
Q

VSD closure in children if PAP more than

A

50% of Systemic arterial pressure

28
Q

Double chambered RV is

A

DCRV- A form of septated RV with a proximal and distal chamber ( inlet /outlet)due to hypertrophied or abnormally located muscular bands

A/w VSD, PS, Subaortic Sinus etc

29
Q

Should we close small VSDs

A

Only if history of IE, or Valve prolapse and AR

30
Q

Normal course of LCA in relation to Pulmonary Artery

A

Passes behind the MPA

31
Q

…….color in LCA in PSAX is abnormal and s/o ALCAPA

A

BLUE

32
Q

Classically ALCAPA presents at

A

2-6 wks of age

33
Q

Prominent RCA in a child suspect

A

ALCAPA

34
Q

Incidence of sudden death in adult type ALCAPA

A

80-90% sudden death at a mean age of 35 yrs in adult type( better collateral circulation)

35
Q

In ALCAPA ……is often misdiagnosed as LCA

A

Transverse Sinus of Pericardium

36
Q

Echogenic papillary muscles in a child may suggest

A

ALCAPA

37
Q

RSOV most commonly arises from

A

RCC

38
Q

Reason for LVH +LAD in ALCAPA in older children

A

Due to hypertrophy of basal posterior wall compensating for the scarred and thinned anterolateral wall

39
Q

Incidence of CHD excluding MVP and Bicuspid Aortic Valve

A

0.5-0.8%

BAV-1-2%
MVP-4-6%

40
Q

Most common CHD is

A

VSD

25% of CHD

41
Q

Sizing of VSD

A

In relation to Aortic annulus

<25%- Small
>50% - Large

In between- moderate sized

42
Q

Last portion of Ventricular septum to close during development

A

Peri membranous septum

ie why Perimembranous VSD is most common

43
Q

Other names of Outflow VSD

A

Supracristal
Subpulmonic
Doubly committed subarterial

44
Q

Gasuls VSD develops in………,,type of VSDs

A

Peri membranous VSDs

45
Q

Difference in diastolic flow in a VSD versus RSOV

A

VSD diastolic flow peaks in late diastole

46
Q

Most common congenital cardiac anomaly

A

BAV

Upto 2%

47
Q

Other cardiac anomalies a/w BAV

A

COARCTATION
AORTOPATHY
Asd/Vsd

48
Q

Life expectancy in BAV

A

Same as general population

49
Q

Risk factors for rapid progression of Aortic dilatation in BAV

A

Hypertension
Male sex
Old age
Valve disease

50
Q

Most common type of BAV is

A

Anterior- Posterior (AP) type - fusion of RCC +LCC

Second type is Right-Left type (RL)- fusion of RCC+NCC

RL Type is more associated with Aortopathy

51
Q

Echo probe position for Proximal Ascending Aorta

A

One intercostal space above the PLAX

52
Q

In BAV Aortopathy Most centers recommend intervention when Aortic size is >

A

50-55’mm independent of Valve disease

Can be done at 45-50 if

  1. Undergoing Aortic valve surgery or
  2. Growth > 5mm in 6 months

2013 JACC imaging

53
Q

Spontaneous closure of ASD happens

A

Defects less than 8 mm in younger patients around 90% close

Uptodate 2018

54
Q

Phlebotomy in Eisenmenger only if Hb and PCV is

A

> 20 or > 65

55
Q

Hemoptysis is cause of death in ….% of Eisenmenger patients

A

11-29%

Circulation 2007 Jun 19

Cardio (36 decks)

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