Congenital Anomalies Flashcards
secundum asd
located mid IAS, most common
close to fossa ovalis
primum asd
located inferior portion of IAS, associated with mv and av defects
sinus venosus asd
located in superior part of IAS, near entrance of SVC
common atrium asd
absence or near absence of ASD forming a single common atrial chamber
coronary sinus asd
near coronary sinus, inferior portion of IAS
primum asd results from
when the septum primum fails to fuse with the endocardial cushion during separation of atria
sinus venosus asd is associated with
partial anomalous pulmonary venous
for a right to left shunt
the PVR has to be greater than the SVR
also Qp/Qs less than 1
for a left to right shunt
PVR less than SVR
Qp/Qs greater than 1
Qp is…
pulmonic flow
normally right heart output
Qs is…
systemic flow
left heart output
what does the computer need to calculate Qp/Qs ratio
- LVOT diameter (PLAX)
- LVOT VTI (PW)
- RVOT diameter (2-d from PSAX)
- RVOT VTI (PW)
what to look for on echo for an ASD
- view IAS in PSAX apical 4 and 5 and subcostal
- is IAS is aneurysmal
- use color doppler with PRF less than 40
- look for RA enlargement
bubble study
is positive you will see a burst of bubbles cross from right to left within the 3-4 beats after injection, repeated with valsalva
if bubbles are seen in the left heart after 5 beats…
may indicate an intrapulmonary shunt
angel wings closure repair
transcatheter device for asd
2 disk system
amplatzer PFO occluder
patients who have had a cryptogenic stroke from embolus, 2 flat disk are unfolded on each side
perimembranous vsd
between right and non coronary cusp
most common vsd
usually high on septal wall, usually aneurysmal
trabecular or muscular VSD
usually by the paps, low on the septal wall in the muscular part close to the apex
may have a swiss cheese pattern
outlet VSD
between rvot and lvot
associated with AV prolapse
seen in psax, plax sub5
inlet VSD
bordered by mv, and tv
associated with atrioventricular septal defect
inlet vsd in seen in
PSAX (MV & pap level), AP4 and sub4
VSD echo findings
view ivs, plax, psax, ap4 5 3
eval with color doppler
what to look for an VSD
left atrial enlargement
LV enlargement
RVH
AV prolapse
how to calculate RVSP from VSD
what is an atrioventricular septal defect
involves malformation of the endocardial cushions
abnormalities of the MV and TV
occur in children with down syndrome
partial AVSD
septum primum ASD and cleft mitral valve
complete AVSD
septum primum ASD, inlet VSD and common valve
incomplete AVSD
2 separate atrioventricular valve orifices, LV to RA shunt and 3 MV leaflets
eisenmengers syndrome
long standing left to right shunt from vsd, asd, PDA causes pulmonary HTN and eventual shunt reversal into cyanotic right to left shunt
eisenmengers syndrome signs
cyanosis, right heart failure, DOE, TR, PI
eisenmengers syndrome RVSP measures
greater than 120 mmHg
gerbode defect
left to right shunt from LV to RV
may be seen with ASD and PFO
PDA
cyanosis occurs
its a continuous mumur
forces RV to work harder against PVR
PDA echo findings
dilated pulmonary artery
LAE and LVE
reversal of flow in descending aorta
cleft mitral valve leaflet
hole in MV most commonly in anterior leaflet
MR is common
cleft mitral valve leaflet is associated with
primum ASD, VSD , AVSD and MV prolapse, papillary muscle abnormalities
parachute MV
one pap muscle is attached to both chordae
coarctation of aorta
narrowing of descending aorta
distal to narrowing pressures are lower
associated with AS, turners syndrome, VSD, bicuspid aortic valve and PDA
for coarctation of aorta what will you see in the descending aorta
systolic and diastolic velocities will be increased and have a sawtooth appearance in spectral doppler
for coarctation of aorta what will you see in the abdominal aorta
low velocities with monophasic antegrade flow
persistent left SVC
most common thoracic anomaly
noted by a dilated coronary sinus
what is tetralogy of fallot
- pulmonic stenosis
- RVH
- VSD
- overriding aorta
ebsteins anomaly
TV displaced towards the apex
associated with ASD, PFO,VSD,PS, WPW
cor triatriatum
a membrane is present across the mid portion of left atrium
D TGA
aorta attached to RV, PA attached to LV
results in cyanosis
corrected with mustard procedure
L TGA
RV acts as LV
LV acts as RV
truncus arteriosus
aorta and PA fail to separate during fetal development
arise as a single vessel with one valve
TA type 1
single pulmonary trunk and ascending aorta rise from the truncus arteriosus
TA type 2
both pulmonary arteries originate close together from the dorsal wall of the TA
type 3 TA
type 4 TA
blalock taussing shunt corrects
corrects: pulmonary atresia, PS, TOF, hypoplastic left heart, TV atresia
fontan procedure corrects
corrects: TV atresia, single ventricle
Rastelli Procedure corrects
corrects: TOF, Truncus arteriosus, TGA ,pulmonary atresia
ross procedure
removes abnormal aortic valve and replaces with pulmonary valve
mustard procedure corrects
D TGA
baffle
surgically create tunnel or wall within the heart or major blood vessels used to redirect flow of blood
what is a blalock taussing shunt
connects subclavian artery or innomanite to R/L pulmonary artery
what is the mustard procedure
a baffle directs caval blood flow to the LA which pumps blood to the LV
what is the ross procedure
removes abnormal aortic valve and replaces it with an autograft valve
what is the rastelli procedure
connects the RV to the main PA
