Congenital Heart Disease Flashcards
enlargement vs. dilatation
enlargement is a term used to describe an increase in volume in a chamber that is unrelated to failure of the myocardium
dilatation is when enlargement can be attributable to failure
hemodynamic changes of the valves due to pressure
mostly thickening at the line of closure and edge
hemodynamic changes of the valves due ot flow
generalized thickening of the valve
complex
a single abnormality or group of abnormalities that have a tendency to be associated
includes the effects of the abnormalities on the economy of the heart
categories of congenital heart disease
shunt
obstruction (left and right)
shunt with obstruction
other complexes
types of shunts
atrial septal defect
ventricular septal defect
common AV orifice
patend ductus arteriosus
aortico pulmonary septal defect
total anomalous pulmonary venous drainage
atrial septal defects
fossa ovalis or secundum type - common
ostium primum type
sinus venosus or proximal type of atrial septal defect - uncommon
coronary sinus type of atrial septal defect - rare
secundum type ASD
defect in the fossa ovalis
hemodynamics of secundum type ASD
RA, RV, and PA pressures are normal in childhood and rarely elevated
LA and LV pressrues are normal
R -> L shunt at the atrial level
increased pulmonary flow
secundum type ASD pathologic complex
RA and RV are hypertrophied and dilated
dilatation of tricuspid and pulmonary orifices and pulmonary trunk
primum type ASD
defect in distal to fossa ovalis, close to mitral and tricuspid valves
hemodynamics of primum type ASD
RV and PA pressures are normal or slightly elevated
RA, LA, and LV pressures are normal
L -> R shunt at trial level, slight R -> L
increased pulmonary flow
increased pulmonary vascular resistance and pulmonary hypertension may develop in adult life
pathologic complex of primum type ASD
cleft aortic leaflet of mitral valve
RA and RV hypertrophied and dilated
dilatation of tricuspid and pulmonic orifices
LA and LV are normal
LV hypertrophy present if mitral regurgitation or subaortic stenosis
ventricular septal defect
can occur anywhere in the ventricular septum
predilection for the defect to occur beneath the aortic valve, confluent in part with the membranous septum and extending anteriorly to some extent
most common is called subaortic, in part membranous and in part perimembranous type
hemodynamics of VSD
RV and PA pressures normal if defect is small, increased if large
RA and LA pressures normal or elevated
LV pressure normal
L -> R shunt
increased pulmonary flow
increased pulmonary vascular resistance and pulmonary hypertension may develop causing R -> L shunt and cyanosis if defect is large
pathologic complex of VSD
RA hypertrophied
RV hypertrophied and dilated
LA and LV hypertrophied and dilated
dilatation of pulmonic orifice and pulmoanry trunk
large VSD defect
additional pressure hypertrophy of the RV
patent ductus arteriosus
communication between the aorta and left pulmonary artery distal to isthmus
hemodynamics of PDA
RV and PA pressures normal or elevated
LA and LV pressures normal or elevated
RA pressure normal
L -> R shunt at ductus level
increased pulmonary flow
if pulmonary vascular resistance is high, may have bidirectional shunt at ductus level
pathological complex of PDA
without pulmonary hypertension - LA and LV hypertrophied and dilated
dilatation of PA with pulmonary hypertension
RA and RV hypertrophied and dilated
LA and LV vary
pulmonary hypertension
flow increases beyond the distensibility of the lung vasculature
vasoconstriction of the vascular bed
secondary pathologic changes in the inima or media of the muscular arteries and arterioles of the lungs restricting the pulmonary bed
most common in large VSD, then PDA, and least common in ASD
Eisenmenger complex
the reversal of a left-to-right shunt due to pulmonary hypertension
usually happens at the ventricular level or at the ductal level but not very common at the atrial septal defect level
obstructive lesions without shunts
isolated pulmonary stenosis
isolated aortic stenosis
coarctation of the aorta
isolated pulmonary stenosis
usually consists of a diaphragm-liek structure with an attempted formation of cusps with a central opening, which may be minute or small
uncommonly, the valve is failry well formed, but the cusps are agglutinated at the commissures - the annulus is quite small
