Congenital Heart Disease Flashcards
Atrial Septal Defects:
types
associations
secundum 75% @ fossa ovalis primum 15-20% cleft MV sinus venous 5-10% near svc/ivc coronary sinus <1% anomalous venous return
ASD sig features as adult
RV enlargement due to excessive pul flow
rv failure with pul infarctions, arrhythmias, pul htn
ASD ecg
secundum: right axis deviation
primum: left axis deviation
surg vs device for asd
too large for device septum primum coronary sinus primum defect contrindicated if severe pul htn
asd prophylaxis
not indicated for isolated asd
indicated for 6 mths after surgery for asd
congenital hd offspring
maternal and paternal
4-10% offspring
general population incidence: 6/1000
fetal echo @22 wks
Gerbodie defect
AV canal repair- late complication of lv to la fistulae
differential of PDA on echo:
aortopulmonary collaterals
coronary av fistula
ruptured sinus vasalva
indication for PDA closure:
lae
lvh
endoarteritis
contraindicated if pul art hypertension
subaortic stenosis
may recur post removal
associated: vsd, aortic insufficiency
surg if grad >50mmHg/ 30 mmHg mean
supravalvular aortic stenosis:
associated:
Williams syndrome, coronary obstruction, aortic hypoplasia,
renal art stenosis
peripheral pul art stenosis
Aortopathies:
Marfans
Loeys-dietz
Beale’s syndrome- ulnar deviation of fingers
Ehlors’ Danlos
coarctation associations:
bicuspid aov subaortic stenosis,vsd aortic arch mitral valve circle of willis cerebral aneurysm
coarctation intervention:
> 20 mmhg
look for rib notching on cxr
pulmonary valve stenosis:
Noonan’s syndrome
intervention if: grad >60mmHg/ 40mmHg mean
if regurg may need replacement
tetralogy of fallot
sub pul stenosis, rvh, vsd, overiding aorta
blalock taussig: sub artery to pul art
waterston cooley - pul art to ao (ruined pul art)
associated cardiac defects with tetralogy of fallot
pul art anomalies asd secundum (pentology of fallot) av canal defect right ao arch, cor anomalies 22q 11 deletion (degeorge syndrome)
d transposition of great arteries
aorta connected to rv, pul art connected to lv
pda permits mixing oxygenated blood-
raskin procedure- create asd
procedure: mustard- vena cava flow tubed to “la”
newer: switch ao/pa,
post Rastelli complication
rv to pa- with asd
conduit obstruction
branch pul stenosis
L transposition great arteries
aorta on left, congenital corrected
rv systemic and may fail eventually
watch for complete heart block
Ebstein anolmaly
apical displacement of tricuspid valve
“atrialization” of rv
asd/pfo 50%
25% wpw
single ventricle
tri, mitral atresia, double inlet lv, hypoplastic lv
surgery to commit single ventricle to systemic circ and seperate pul inflow:
bidirect Glenn- svc to pul art, ivc to pul art
Fontan: ivc to pul art
Risk factors for fetal congenital heart disease
Dm, moderate etoh, rubella,maternal hx cong defect, anti convulsive, lithium, warfarin,
Trisomy 13
Inslet vsd, hypoplastic left heart
Trisomy 21 primum asd, inlet vsd, tetralogy
Trisomy 18 inslet vsd, hypoplastic left heart
