Congenital Heart Disease 1 (Mayo) Flashcards
Physical exam findings in Secundum ASD
RV heave
PA SEM +/- TV diastolic murmur
FIXED SPLIT S2
ECG w/ RBBB and RAD. CXR with enlarged PA (c/w Ao). Dx?
Secundum ASD
If you are thinking of Secundum ASD and see enlarged LA, what is Dx?
Primum ASD
Main complications of Secundum ASD
Afib (from enlarged RA)
What class indication is cath for Secundum ASD?
III
When do you close Secundum ASD?
If any RV enlargement (shunt calc doesn’t matter!)
If echo shows RV volume overload and no ASD, what do you think of?
Anomalous Pulm veins
Diagnosis of defect in superior atrial septum, posterior to fossa ovalis and anomalous pulmonary veins
Sinus venosus ASD
If RV overload, what do you do?
Find the shunt
Defect of inferior septum, MV cleft and Down’s syndrome
Primum ASD
What is the relation of AV valves in Primum ASD?
On same level
Normally, which valve is apically displaced?
TV
**What type of ASD has RBBB with LAD?
Primum ASD
Name 3 associations with Primum ASD
Sub aortic stenosis
L-SVC
Coarctation
A Primum ASD is synonymous with?
Partial A-V canal
What type of VSD large, or small makes a loud murmur?
Small
With a large defect, what type of murmur might you get?
MV diastolic (like MS)
What type of murmur do you hear with eisenmenger’s?
None
Which VSDs usually close spontaneously?
Muscular and membranous
Which VSDs, even if small, need to be closed to prevent AR?
Supracristal (sub aortic or sub pulmonary)
Which congenital lesion is associated with maternal rubella?
PDA
Physical exam in PDA
Wide pulse pressure
Brisk upstroke
Dynamic LV
machinery murmur
F:M incidence of PDA
3:1
Class I indications to close PDA
If LV enlarged
PAH if net shunt is L–>R
Endocarditis
What syndrome is associated with PS?
Noonan’s
Physical exam in PS
Soft and late P2
A wave on JVP
RV heave
If RV dilated with PS, what to do?
Look for an associated lesion
In what part of systole will click be if PS is severe?
Early (b/c of RVH)
Which R-sided sound decreases with inspiration?
PS click (not murmur)
If CXR shows PA sticking out into lung, Dx?
PS (post stenotic dilatation of PA)
Class I indications for balloon valvotomy in PS
asymptomatic: domed PV/peak grad > 60/mean grad> 40
Sxs: domed PV/peak grad> 50/ mean grad> 30
How and when will complications of ballon valvotomy for PS present?
20y later with arrhythmias, TR, RV enlargement from PR
where in Ao does coarctation usually occur?
just distal to subclavian artery
what dz is commonly associated with Turner’s and bicuspid AV?
Coarctation
CXR findings of coarctation
Figure 3 sign, rib notching
Histopathology of Ao in coarctation
cystic medial necrosis
Class I indications for coarctation repair
P2P gradient >20
if <20, need imaging showing sig coarct with collaterals
why is echo doppler potentially misleading in coarctation?
because the gradient could be lower if good collaterals
How do you decrease mortality in coarctation?
surgery early in life
what f/u is needed after Dacron patch repair of coarctation?
- mandatory yearly imaging (e.g. MR) to r/o aneurysm at repair site
- head imaging to r/o intracranial aneurysm
- tight control of BP, CAD risk
Inferiorly displaced TV and atrialized RV, Dx?
Ebstein’s Anomaly
two lesions associated with Ebstein’s
ASD/PFO, bypass tract
ECG shows RBBB, tall (Himalayan) P waves, prolonged PR, pre-excitation and AF/Afl. Dx?
Ebstein’s
cyanosis, cool periphery, V wave on JVP, subtle RV lift, Loud T1, holosystolic TR murmur that increases with inspiration. Dx?
Ebstein’s
CXR showing globular heart (xmas tree ornament) with small Ao and PA. Dx?
Ebstein’s
5 indications to repair Ebstein’s (valve repair, ASD closure, reduce atrialized component of RV)
decreased exercise capacity/RV dysfunction
Progressive cyanosis or paradoxical embolism
severe TR
bypass tract or arrhythmias nope amenable to catheter-based therapy
cardiothoracic ratio > 60%
Missing tissue in fossa ovalis
Secundum ASD
