Congenital Disease Flashcards
ASD echo
RV enlargement
TR, pHTN
Color flow for shunt
Looks at PVs
Secundum ASD
Most common
Central / fossa ovalis
Device closure
Associated with Holt-Oram
Primum ASD
AV septum / inlet to ventricle
Portion of septum between septal TV leaflet and anterior MV leaflet
Primum ASD echo
Cleft mitral valve anterior leaflet, MR
LVOT obstruction (enlongated outflow tract, accessory chordal tissue)
VSD
LAD on EKG
Sinus venous ASD
Abnormal communication between SVC, pulmonary vein and LA
Anomolous PVs in most
Big right heart
Unroofed coronary sinus
Absence of portion of common wall between CS and LA
A/W persistent left SVC
PFO
Potential opening between RA and LA
Does not cause RV volume overload
Atrial septal aneurysm
Redundant and mobile atrial septum flap
Phasic excursion of 10 mm from midline or total of 15 mm during cardiac cycle
A/w PFO or multiple fenestrations
Chiari network
Meshwork connecting edge of IVC and coronary sinus with Crista terminalis
A/W PFO and ASA
VSD
Left to right shunt
Causes left heart dilatation
Types of VSD
Outlet / sub arterial
Membranous
Inlet
Muscular
Outlet / sub arterial VSD
Located in outlet septum
Under PV and AV
AR due to prolapse of AV cusps
Membranous VSD
Between TV and AV
Most common
TV may become aneurysmal
AR
Inlet VSD
At inlet to ventricle (AV septal defect)
Immediately below both AV valves
Trisomy 21
Muscular VSD
Muscular portion of septum
Children
Not near valves, close with device
Apical 4, parasternal views
VSD in PLAX
Right below AV = membranous or subarterial
Further out = muscular
VSD in RV inflow/outflow SAX
9-12:00 = membranous 12-3 = subarterial
VSD in LV SAX
9-11 = inlet 11-2 = muscular
VSD apical 4
Base of septum = inlet
Rest of septum = muscular
VSD in apical 5
Base of septum = membranous
Rest of septum = muscular
RVSP using VSD velocity
RVSP = SBP - 4 (VSD vel^2)
PDA characteristics
Communication between descending thoracic aorta and PA
Left heart enlargement
PDA echo
High left parasternal or SSN Color and CW doppler across PDA LV enlargement Holodiastolic flow reversal in abdominal aorta pHTN
PASP in PDA
PASP = SBP - 4 (PDAv^2)
Ebstein’s anomaly
Exaggerated apical displacement of TV septal leaflet
Atiralized RV, RV dysfunction
ASD / PFO
Accessory pathway
Rotational displacement of TV towards RVOT
Sail like and large anterior TV leaflet
Indexed apical displacement of TV septal leaflet in Ebstein’s
> 8 mm/m2
Tetralogy of Fallot
Displacement of part of ventricular septum -> RVOT obstruction Secondary RV hypertrophy VSD Associated aortic override
ToF associated with
Right aortic arch
Secundum ASD
Anomalous coronary arteries
Problems after ToF repair
PR due to patch in RVOT
PS
Residual VSD
AR
Coarctation aorta PW doppler
Later upstroke in systole
Persistent flow in diastole
Coarctation echo
Dilated ascending aorta
BAV
Abnormal aorta PW doppler
d-loop TGA
RV is on right side
l-loop TGA
Morphologic RV with TV is on left side
Congenitally-corrected TGA echo
RV with coarse trabeculation, septoparietxal muscle bundle, TV chordal insertions into RV
TV apical compared to MV
Cardiac crux
Meeting between AV septum and septal portion of MV and TV
Inflow portion of LV and RV
Corrected TGA a/w
Systemic TR Decreased ventricular function VSD, PS, RV dysfunction Dextrocardia, mesocardia CHB
Heart on fire
Anomalous RCA from pulmonary artery
Blalock-Taussig shunt
Subclavian artery transected, connected to pulmonary artery
Surgical shunts
For cyanotic patients with low pulmonary blood flow
Echo in Blalock-Taussig Shunt
High velocity signal, continuous flow in diastole
Classic Glenn Shunt
SVC to PA connection
Low velocity flow (venous)
Bidirectional Glenn shunt
SVC to both PAs
Problems with shunts
PA distortion
pHTN, LV volume overload with large shunts
Baffles
Typically for transposition
Atrial switch baffle (mustard, senning)
IVC / SVC -> LV -> lungs
-> Pulmonary venous baffle -> RV -> body
Atrial switch echo
Redirection of PV blood to morphologic RV to body
LV connected to PA
Rastelli shunt
When VSD present
LV -> aorta
RV -> pa conduit
Arterial switch
Transect both great vessels, redirects them
Reimplants coronary arteries
ToF most common post op problem
PR
l-TGA correction problems
Systemic TR
Systemic RV dysfunction
CHB
d-TGA corrected problems
RV dysfunction
Arrhythmias
Baffle problems
Arterial switch problems
Valve and vessel (CA) problems
Rastelli problems
Subaortic stenosis
Conduit obstruction
Big RV DDx
ASD or PV shunt
TR and PR
RV myopathy
Systemic RV
VSD leads to enlargement of
LV
ASD leads to enlargement of
RV / RA
Best view for ASD
Subcostal 4-chamber
Trisomy 21 a/w
AV septal defect
ToF
Best view for sub pulmonary VSD
Parasternal short axis
Large VSD physiology effect
Equalization of right and left ventricular pressures
Elevated PA pressure
Left atrial and ventricular volume overload
Most common type of subaortic stenosis
Discrete membrane
VSD associated with coarctation
Perimembranous VSD
Aortic arch interruption most common in
DiGeorge syndrome
Type A interruption of aortic arch
Distal to origin of left subclavian
Type B interruption of aortic arch
Between left common carotid and left subclavian artery
Type C interruption of aortic arch
Between right innominate and left common carotid arteries
Muscular VSD spontaneous closure rate in childhood
80-90%
Direction of atrial shunting determined by
Compliance of ventricles
Most common site of coarctation
Opposite insertion site of ductus arteriosus
Noonan syndrome
Short stature, triangular face, webbed neck
PV stenosis
HCM
ASDs
Most common cyanotic CHD
ToF
Truncus arteriosus
Large VSD
Overriding great vessel
Single great vessel giving rise to aorta and PA
A/w DiGeorge syndrome
Tricuspid valve atresia
Must have atrial shunt to decompress RA
25% have transposition
Single ventricle lesion; lateral Fontan connects IVC to PA
Hypoplastic left heart syndrome
Two atria. single ventricle, single AV valve
Ductal dependent
CO maintained by circumventing left heart
Pulmonary atresia with intact ventricular septum
RV hypoplasia
Needs to repair as single ventricle
Pulmonary atresia with VSD
Severe form of ToF
Total anomalous pulmonary venous return
PVs converge in midline, posterior and superior to LA
See pulmonary venous confluence
TGA most commonly a/w
VSD
