Congenital

Question 1

Relation of Normal PA to Aorta

Answer 1

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

Question 2

Mitral pulmonary continuity is seen in

Answer 2

TGA

Question 3

—- has double conus

Answer 3

DORV

Question 4

Ostium secundum is formed in septum

Answer 4

Primum;

Ostium primum is at lower end of Septum primum

Question 5

Limbus is formed by Septum—

Answer 5

Secundum.

So will be on RA side

Question 6

Floor of fossa ovalis is formed by

Answer 6

Septum Primum

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

Question 7

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

Answer 7

20 mm Hg at rest

After exercise > 40 mm Hg is abnormal

Question 8

What percentage of cases both subclavians arise after coarctation

Answer 8

3-4%

So BP in all limbs will be equal

Question 9

Rib notching I coarctation

Answer 9

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

Question 10

Indication for coarctation intervention in children is

peak INSTANTANEOUS gradient more than

Answer 10

20 mm Hg

Question 11

Role of balloon angioplasty in coarctation

Answer 11

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

Question 12

Stent placement is not preferred in coarctation if body weight is

Answer 12

Less than 25

Question 13

The features of REcoarctation absent in children

Answer 13

Hypertension and Headaches are usually absent

Question 14

Indications for intervention in re coarctation

Answer 14

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

Question 15

Balloon angioplasty vs Surgery in coarctation risks

Answer 15

Aneurysm and re coarctation more with balloon

Question 16

Indications for Pulmonary valve replacement

Answer 16

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

Question 17

ASD may be closed if PVR is

Answer 17

Less than 5 Woods unit

Others the efficacy is uncertain

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

Question 18

Largest TV leaflet in Ebsteins is

Answer 18

ATL

Called ‘SAIL LIKE’

Question 19

Indications for surgery in Ebsteins

Answer 19

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

REC- RV failure, Embolism, Exercise, Cyanosis

Question 20

Precautions with Venous P valve for PR

Answer 20

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

Question 21

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

Answer 21

Within 2-3 days

Question 22

Katz Wachtel phenomenon is

Answer 22

Large biphasic QRS in V2-4.

QRS 50 mm or more

Due to biventricular hypertrophy

Question 23

Least common type of VSD

Answer 23

Supracristal or Doubly committed

AR common

Question 24

Crista Supraventricularis can be considered synonymous with

Answer 24

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

Question 25

Supracristal septum supports the.....

Answer 25

Muscular support to Aortic Valve esp RCC

Question 26

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

Answer 26

Peri membranous | Tricuspid Valve

Question 27

VSD closure in children if PAP more than

Answer 27

50% of Systemic arterial pressure

Question 28

Double chambered RV is

Answer 28

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

Question 29

Should we close small VSDs

Answer 29

Only if history of IE, or Valve prolapse and AR

Question 30

Normal course of LCA in relation to Pulmonary Artery

Answer 30

Passes behind the MPA

Question 31

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

Answer 31

BLUE

Question 32

Classically ALCAPA presents at

Answer 32

2-6 wks of age

Question 33

Prominent RCA in a child suspect

Answer 33

ALCAPA

Question 34

Incidence of sudden death in adult type ALCAPA

Answer 34

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

Question 35

In ALCAPA ......is often misdiagnosed as LCA

Answer 35

Transverse Sinus of Pericardium

Question 36

Echogenic papillary muscles in a child may suggest

Answer 36

ALCAPA

Question 37

RSOV most commonly arises from

Answer 37

RCC

Question 38

Reason for LVH +LAD in ALCAPA in older children

Answer 38

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

Question 39

Incidence of CHD excluding MVP and Bicuspid Aortic Valve

Answer 39

0.5-0.8% BAV-1-2% MVP-4-6%

Question 40

Most common CHD is

Answer 40

VSD | 25% of CHD

Question 41

Sizing of VSD

Answer 41

In relation to Aortic annulus <25%- Small >50% - Large In between- moderate sized

Question 42

Last portion of Ventricular septum to close during development

Answer 42

Peri membranous septum ie why Perimembranous VSD is most common

Question 43

Other names of Outflow VSD

Answer 43

Supracristal Subpulmonic Doubly committed subarterial

Question 44

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

Answer 44

Peri membranous VSDs

Question 45

Difference in diastolic flow in a VSD versus RSOV

Answer 45

VSD diastolic flow peaks in late diastole

Question 46

Most common congenital cardiac anomaly

Answer 46

BAV | Upto 2%

Question 47

Other cardiac anomalies a/w BAV

Answer 47

COARCTATION AORTOPATHY Asd/Vsd

Question 48

Life expectancy in BAV

Answer 48

Same as general population

Question 49

Risk factors for rapid progression of Aortic dilatation in BAV

Answer 49

Hypertension Male sex Old age Valve disease

Question 50

Most common type of BAV is

Answer 50

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

Question 51

Echo probe position for Proximal Ascending Aorta

Answer 51

One intercostal space above the PLAX

Question 52

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

Answer 52

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

Question 53

Spontaneous closure of ASD happens

Answer 53

Defects less than 8 mm in younger patients around 90% close Uptodate 2018

Question 54

Phlebotomy in Eisenmenger only if Hb and PCV is

Answer 54

>20 or > 65

Question 55

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

Answer 55

11-29% Circulation 2007 Jun 19