Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiac Imaging > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

Atrial septal defect (ASD) — forms ?

A

Ostium primum defect (ASD1)
Ostium secundum defect (ASD2)
Sinus venosus defect (superior and inferior)
Persistent foramen ovale (PFO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ostium primum defect (ASD1) — facts ?

A

absent fusion of the septum primum with the endocardial cushion
occurs in the 5th week of pregnancy
~20% of all ASD
located just next to the AV-valve plane
often associated with AV-valve anomalies e.g. mitral cleft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ostium secundum defect (ASD2) — facts ?

A

failure of the development of the septum secundum
occurs in the 6th week of pregnancy
~ 70% of all ASD
located in the oval fossa
associated with other congenital anomalies, e.g. ~25% PAPVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sinus venosus defect — facts ?

A

~ 3-10% of all ASD
~93% associated with PAPVR
usually right upper pulmonary vein with superior sinus venosus defect
scimitar syndrome with inferior sinus venosus defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Persistent foramen ovale (PFO) — facts ?

A

normal variant
~25-30%, f>m 2:1
can lead to paradoxical emboli during rise of right atrial pressure (valsalva maneuver)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

atrial septal defect (ASD) — MRI protocol ?

A

Cine-SSFP (2ch, 3ch, 4ch, SA stack, atrial stack, LVOT, RVOT)
PCI (Ao, Pu, ASD Flow)
MRA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Atrial septal defect (ASD) — MRI report ?

A 
LV and RV function including EDV, ESV, SV, EF and RWMAs
ASD type, location, size
Qp:Qs — Pa flow : Ao flow
Pulmonary venous connection
associated findings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Atrial septal defect (ASD) — red flags ?

A

significant RV dilatation or dysfunction
Qp:Qs > 1.8:1
associated abnormalities e.g. PAPVR
pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Atrial septal defect (ASD) — therapy and complications ?

A 
intervention 
surgical closure (sinus venosus defect, some ASD1) 
Complications: residual ASD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Atrial septal defect — therapeutic indications ?

A

Qp:Qs > 1.5:1
ASD size > 10 mm
pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ventricular septal defects (VSD) — forms ?

A

Membranous / perimembranous VSD
Inlet VSD
Outlet VSD (doubly committed)
Muscular VSD (singular, multiple — Swiss cheese)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ventricular septal defects (VSD) — MRI protocol ?

A

Cine-SSFP (2ch, 4ch, LV Stack, RV Stack, LVOT, RVOT, AoV)

PCI (PA Flow, Ao Flow, VSD Flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ventricular septal defect (VSD) — MRI report ?

A

LV and RV function including EDV, ESV, SV, EF and RWMAs
VSD type, location, size
Qp:Qs — Pa Flow : Ao Flow
associated findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ventricular septal defect (VSD) — red flags ?

A

non-restrictive
dilated LV +/- RV
Qp:Qs > 1.8:1
associated valvular dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ventricular septal defect (VSD) — therapy and complications ?

A

Surgical closure
Percutaneous device
Complications: residual VSD, RVOT obstruction, AV-insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ventricular septal defect (VSD) — therapeutic indications ?

A

Qp:Qs > 1,5:1
middle size and large defects (>0,5 cm2/m2 BSA)
pulmonary hypertension
volume overload of the left atrium and left ventricle
absent tendency of spontaneous closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Atrioventricular septal defect (AVSD) — facts ?

A

defect of the atrial septum primum and inlet ventricular septum
presence of a common atrioventricular valve
associated findings: ASD, PDA, aortic coarctation (CoA), anomalous pulmonary venous return (APVR), mitral valve anomalies e.g. parachute MV, double orifice MV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Atrioventricular septal defect (AVSD) — MRI protocol ?

A

Anatomy
Cine-SSFP (2ch, 4ch, LV Stack, RV Stack, LVOT, RVOT)
PCI (PAFlow, AoFlow, VSD-Flow, ASD-Flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Atrioventricular septal defect (AVSD) — MRI report ?

A 
LV and RV function including EDV, ESV, SV, EF and RWMAs
presence of ASD and VSD and size
Qp:Qs — PaFlow:AoFlow
valve stenosis / regurgitation 
associated findings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Atrioventricular septal defect (ASVD) — key issues ?

A

Spectrum of defects: ranges from ASD1 with mitral cleft to complete AVSD
Partial AVSD: AV-valves have separate orifices, usually small VSD
Complete AVSD: common AV-valve and orifice (4-7 leaflets), large VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Atrioventricular septal defect (AVSD) — therapy ?

A

PA banding as staged approach in pulmonary overcirculation
Surgical closure with atrial and ventricular septal patch
Atrioventricular valve repair
PDA ligation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Atrioventricular septal defect (AVSD) — post-OP complications ?

A

Residual ASD and/or VSD
Residual atrioventricular valve insufficiency or stenosis
LV-Outflow obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Atrioventricular septal defect (AVSD) — forms ?

A

Rastelli Type (A-C)
Position of the bridging leaflets (central, ventricular, atrial) — position-dependant atrial/ventricular only shunt or both shunts (central)
Ventricular imbalance with right/left heart hypoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Double chambered right ventricle (DCRV) — facts ?

A

Anomalous muscular sub-pulmonary band dividing the RV-cavity into two different chambers
RV-hypertrophy (may contribute to sub-pulmonary stenosis)
VSD (not always present, often perimembranous, may involve the high or low pressure chamber)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Double chambered right ventricle (DCRV) - MRI protocol ?

A

Anatomical stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, RVOT, LVOT)
PCI (PAFlow, AoFlow)
RV inflow/outflow, VSD-Flow, TV-Flow, coronal stack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Double chambered right ventricle (DCRV) - MRI report ?

A

LV / RV size and function inc. EDV, ESV, SV, EF, RWMA
RV muscular band: location (high/low) and severity of stenosis (may be difficult to assess adequately with MRI)
RVOT or LVOT obstruction
hypertrophy of the proximal / inflow RV chamber
VSD type, size, location, Qp(PAFlow):Qs(AoFlow)
Presence of tricuspid regurgitation (TR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Double chambered right ventricle (DCRV), anomalous muscular bundle - key issues ?

A

usually associated with a VSD, consider spontaneous closure
divides RV into a prestenotic high pressure inflow chamber and a low pressure infundibular outflow chamber
may occur anywhere in the RV from adjacent to the PV down to the apex
best visible on RV inflow/outflow plane, maybe missed on 4ch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Double chambered right ventricle (DCRV), VSD - key issues ?

A

most commonly peri-membranous
may communicate with either proximal or distal chamber
shunts in the proximal chamber can be underestimated because of high-pressure status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Double chambered right ventricle (DCRV) - key issues ?

A

Anomalous muscle bundle
- usually associated with a VSD, consider spontaneous closure
- divides RV into a prestenotic high pressure inflow chamber and a low pressure infundibular outflow chamber
- may occur anywhere in the RV from adjacent to PV down to apex
- best visible on RV inflow/outflow plane, maybe missed on 4ch
VSD
- most commonly peri-membranous
- may communicate with either proximal or distal chamber
- shunts in the proximal chamber can be underestimated because of high-pressure status
RVOT obstruction
- due to progressive hypertrophy of RV and muscle bundles
- may lead to RV failure
Tricuspid regurgitation (TR)
- high tricuspid regurgitation jet velocity can be mistaken as pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Double chambered right ventricle (DCRV) - therapy and complications ?

A

Surgical resection
VSD closure
Post-operative complications: intra-ventricular restenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Patent ductus arteriosus (PDA) - facts and findings ?

A
  • LV / LA dilatation and dysfunction
  • dilated pulmonary veins and ascending aorta in large PDA
  • can lead to pulmonary hypertension
  • right PDA is associated with other congenital anomalies
    associated findings: occasionally aortic coarctation (CoA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Patent ductus arteriosus (PDA) - MRI protocol ?

A

Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT)
PAs, AoArch, PDA stack
PCI (mPAFlow, branchPAFlow, AoFlow, in-plane PAFlow)
pre-/post-PDA aortic flow
MRA, 3D-whole heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Patient ductus arteriosus (PDA) - MRI report ?

A

LV and RV function including EDV, ESV, SV, EF and RWMAs
PDA length, diameter, form (conical, window, tubular)
Qp(PAFlow):Qs(AoFlow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Patent ductus arteriosus (PDA) - shunt volume and excess pulmonary blood flow ?

A

Shunt volume = mPAFlow SV - AoFlow SV
Magnitude excess pulmonary blood flow depends on
- diameter and length of PDA
- systemic and pulmonary vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Patent ductus arteriosus (PDA) - therapy and complications ?

A

Occluder device
Coil embolization
Surgical ligation
Complication: residual shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Blalock Taussig Shunt - definition and facts ?

A

Classic: subclavian artery to pulmonary artery
Modified: GoreTex tube from subclavian artery to pulmonary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Blalock-Taussig Shunt - complications and late interventions ?

A

Complications:
- BT-shunt stenosis
- aneurysm formation
- PA dilatation
- pulmonary hypertension if large excess shunting
- subclavian steal syndrome
Late interventions: Blalock-Taussig Stent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Blalock-Taussig Shunt - MRI protocol ?

A

Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT)
Shunt Cines and Shunt Flow
PCI (AoFlow, mPAFlow, PAFlow distal to shunt)
MRA, 3D-whole heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Blalock-Taussig Shunt - MRI report ?

A

LV and RV function including EDV, ESV, SV, EF and RWMAs
BT-shunt patency, dimensions and flow
presence of aneurysm formation
Qp(PAFlow):Qs(AoFlow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Blalock-Taussig Shunt - key issues ?

A
  • palliative Intervention in cyanotic heart disease
  • may be used as a bridge to Glenn- / Fontan-circulation
  • shunts may be small and best seen in MRA (timed to aorta)
  • hemodynamic complication: subclavian steal syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Blalock-Taussig Shunt - alternative shunts ?

A 
Waterstone shunt (ascending aorta to RPA)
Potts shunt (descending aorta to LPA)
Central shunt (ascending aorta to mPA)
Cooley shunt (ascending aorta to RPA, intrapericardial)
42
Q

Aortic valve disease - findings ?

A
  • aortic stenosis (AS) / aortic regurgitation (AR)
  • LV hypertrophy with aortic stenosis (AS)
  • LV dilatation and eccentric hypertrophy with aortic regurgitation (AR)
  • LV dilatation and impaired systolic function in late stage AS or AR
43
Q

Aortic valve disease - associated abnormalities ?

A
  • aortic coarctation (CoA)
  • sub-valvular or supra-valvular stenosis
  • VSD in sub-aortic stenosis
  • Shone complex: parachute MV, MS, bicuspid AV, CoA
44
Q

Aortic valve disease - MRI protocol ?

A

Basic protocol (CHD)
AoV, PAV
Aortic arch
AoFlow, PAFlow

45
Q

Aortic valve disease - MRI report ?

A

LV+RV dimensions, mass and function
AS/AR quantification (Vmax, AVA, RF% etc.)
Aortic dimensions (annulus, SoV, STJ, Ao.asc/arch/desc)
Aneurysm formation
post-OP complications
associated findings

46
Q

Aortic valve disease - therapy ?

A

Aortic valve repair
Aortic valve replacement +/- aortic root/ascending aorta
Ross procedure

47
Q

Ross procedure - definition ?

A
  • replacement of the aortic valve (AV) with patients own pulmonary valve (PV) - autograft
  • implantation of the coronary arteries
  • RV-to-PA homograft conduit
48
Q

Aortic valve repair/replacement - post-operativ complications ?

A
  • valve dysfunction
  • para-valvular regurgitation / leakage
  • pseudo-aneurysm formation
  • para-valvular abscess
49
Q

Ross procedure - complications ?

A
  • aortic insufficiency (AI/AR)
  • aortic autograft / aortic root dilatation / dehiscence
  • RVOT obstruction
  • pulmonary allograft stenosis or regurgitation
  • coronary artery stenosis
50
Q

Aortic valve disease - key issues of cardiac MRI ?

A

lower temporal and spatial resolution than ultrasound
but more reproducible
alternative especially in poor echo image quality
comprehensive valve assessment necessary

51
Q

Cardiac MRI - comprehensive valve assessment ?

A
  • LV / RV dimensions, mass, fibrosis and function
  • forward and regurgitant flow / fraction
  • mean / peak velocity - will underestimate
  • jet detection, direction and origin
  • valve area by direct planimetry
52
Q

Ross procedure - advantages / disadvantages ?

A

Advantages
- longevity of allograft is superior to bio-prosthesis
- favourable haemodynamics
- no need for anticoagulation
- valve grows as patient grows
Disadvantages
- single valve disease (aortic) treated with a two valve procedure (aortic and pulmonary)

53
Q

Aortic coarctation (CoA) - findings ?

A
  • aortic narrowing in the region of the ligamentum arteriosum, the arch or the isthmus
  • collaterals (e.g. 3rd and 4th intercostal arteries)
  • +/- hypertrophic LV
54
Q

Aortic coarctation (CoA) - associated abnormalities ?

A
  • bicuspid AV and dilated ascending aorta
  • sub-aortic stenosis
  • arch hypoplasia
  • VSD
  • mitral valve abnormalities e.g. parachute mitral valve
55
Q

Aortic coarctation (CoA) - MRI protocol ?

A 
Anatomical stack
Cine-SSFP (2ch, 3ch, 4ch, SA, LVOT, AoV)
Aortic arch
PCI (AoFlow, pre-stenotic Flow, post-stenotic Flow incl. Vmax)
MRA aorta
AoFlow diaphragm ?
56
Q

Aortic coarctation (CoA) - report ?

A 
LV dimensions, mass and function
Aortic dimensions (LVOT, annulus, SoV, STJ, Ao.asc/arch/desc)
Severity of stenosis: 
- minimal dimensions 
- post-stenotic peak flow
- presence and degree of collateral flow
Aneurysm formation
associated findings
57
Q

Aortic coarctation (CoA) - initial therapy ?

A
  • stent
  • end-to-end anastomosis
  • interposition graft
  • patch augmentation
  • bypass graft
  • subclavian flap repair
58
Q

Aortic coarctation (CoA) - postoperative complications ?

A
  • aneurysm
  • restenosis
  • collaterals
59
Q

Aortic coarctation (CoA) - key issues ?

A

Aortic dimensions:
- be aware of caveats of aortic measurements
- diastolic measurements from cine images are preferred
- cardiac phase, orientation and sequence need to be reported
Severity of coarctation:
- peak systolic flow is often underestimated in CMR (echo better)
- diastolic forward flow prolongation is a sign of significant coarctation
Collateral flow:
- a decrease of <10% is expected
- an increase implies collateral flow joining the post-stenotic aorta
- abundant collaterals may reduce the gradient and mask severity
Associated findings:
- ~10% cerebral aneurysms in the circle of Willis (CoW)
- ~70-80% bicuspid aortic valve

60
Q

Aortic coarctation (CoA) - caveats of aortic measurements ?

A

Trans-axial: overestimation due to non-orthogonal plane
Sagittal-oblique: underestimation due to non-central or non-perpendicular plane
Black-blood: overestimation possible due to inclusion of aortic wall
MRA: not cardiac cycle specific / motion artefacts
3D-whole heart: low spatial resolution / motion artefacts

61
Q

Tetralogy of Fallot (ToF) - definition / findings ?

A
  • VSD
  • aortic override
  • RVOT obstruction / pulmonary stenosis
  • RV hypertrophy
62
Q

Tetralogy of Fallot (ToF) - associated anomalies ?

A
  • ASD (Pentalogy of Fallot)
  • muscular VSD, AVSD
  • PDA
  • right sided aortic arch
  • anomalous coronary arteries / pulmonary venous return
63
Q

Tetralogy of Fallot (ToF) - MRI protocol ?

A 
Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT)
PAs, AoArch
PCI (mPAFlow, branchPAFlow, AoFlow)
LGE (2ch, 3ch, 4ch, SA)
MRA,  3D-whole heart
64
Q

Tetralogy of Fallot (ToF) - MRI report ?

A

LV+RV dimensions, mass and function
RVOT obstruction: subvalvular / valvular / supravalvular
mPA and bPA obstruction and flows
pulmonary regurgitation volume + fraction
presence and severity of tricuspid regurgitation
residual shunting (ASD, VSD, APCs) Qp:Qs
relation to coronaries
aortic root and ascAo dimensions
AV regurgitation
associated findings

65
Q

Tetralogy of Fallot (ToF) - initial therapy ?

A

palliative Blalock-Taussig shunt or RVOT stent - if cyanosed ++
definitive repair: VSD patch, RVOT patch, conduit

66
Q

Tetralogy of Fallot (ToF) - late interventions ?

A
  • pulmonary valve replacement (allograft, bio-prosthesis)
  • redo conduit
  • pulmonary artery stent
67
Q

Tetralogy of Fallot (ToF) - postoperative complications ?

A
  • RVOT +/- PA stenosis
  • pulmonary and tricuspid valve regurgitation
  • RV dilatation and dysfunction, LV dysfunction
  • myocardial fibrosis / scarring
  • residual VSD / ASD
  • aortic root and ascending aorta dilatation
  • aortic regurgitation
68
Q

Tetralogy of Fallot (ToF) - key issues ?

A

Pulmonary regurgitation / insufficiency
- common after repair of ToF
- may be tolerated without symptoms
- RF% typically 35-45%
Unilateral branch-PA stenosis
- compare LPA and RPA-Flow
Regurgitant fraction (RF%) may exceed 50% if:
- RV is unusually large and compliant
- mPA and/or bPA are large and compliant
- elevated pulmonary vascular resistance
Late diastolic antegrade flow in mPA
- indicates restrictive RV
Timing of PV-replacement remains controversial:
- allograft replacement may function for ~15-20 years
- preOP RV-EDVI > 160-170 ml/m2 and RV-ESVI > 82-85 ml/m2 fail to recover to normal range after operation
Percutaneous Intervention of RVOT / branch-PA obstruction:
- consider 3D-whole heart to identify close relation to coronaries

69
Q

Pulmonary atresia - findings ?

A 
Underdeveloped RVOT and pulmonary valve
- membranous pulmonary valve (PV)
- hypoplastic pulmonary arteries (PAs)
- atretic PAs and MAPCAs (major aorto-pulmonary collateral arteries)
VSD / PDA
Pulmonary collaterals
RV / RA dilatation and hypertrophy
70
Q

Pulmonary atresia - associated anomalies ?

A
  • PFO / ASD
  • tricuspid atresia / stenosis
  • dTGA, ccTGA
71
Q

Pulmonary atresia - MRI protocol ?

A 
Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT, PAs)
PCI (mPAFlow, branchPAFlow)
MRA PAs + MRA Ao 
3D-whole heart
72
Q

Pulmonary atresia - MRI report ?

A

LV+RV dimensions, mass and function
PA stenosis / hypoplasia - extent and severity
MAPCAs (major aorto-pulmonary collateral arteries)
pulmonary regurgitation volume + fraction
presence and severity of VSD, PDA and/or ASD
associated findings also depending on initial interventions

73
Q

Pulmonary atresia - initial interventions ?

A

Radiofrequency perforation of the membranous pulmonary valve
Blalock-Taussig Shunt
Definitive repair:
- PV valvulotomy or conduit if suitable right ventricle (RV)
- atrial septostomy and Glenn -> Fontan, if RV small or coronaries depend on RV

74
Q

Pulmonary atresia - late interventions ?

A 
PV valvuloplasty 
PV replacement
TV repair / replacement
Conduit replacement
MAPCA stenting, occlusion, unifocalization
75
Q

Pulmonary atresia - complications ?

A

Dependant on special procedure
BT-shunt complications
ToF, single ventricle physiology and operations

76
Q

Pulmonary atresia - key issues ?

A

Pulmonary atresia vs ToF with pulmonary atresia
- PAs in ToF are usually normal in size with normal arborisation
- systemic to pulmonary collaterals are less developed in ToF
Complete surgical repair if
- central PAs are present
- sufficient PA blood supply to the lungs
- a single PA is normal in size and reaches all lung segments
Complete surgical repair is contraindicated if
- intact ventricular septum and hypoplastic right ventricle
- hypoplastic or absent central PAs
- inadequate peripheral arborisation of PAs
Palliative procedures
- Blalock-Taussig Shunt
- Waterstone Shunt
MAPCAs
- are best visualised on an aortic MRA
- strict removal of air bubbles if MRA performed
- consider CT to visualise small MAPCAs

77
Q

Dextro-transposition of the great arteries (dTGA) - findings ?

A
  • VA discordance (morphological RV to aorta, LV to mPA)

- parallel great arteries

78
Q

Dextro-transposition of the great arteries (dTGA) - associated anomalies ?

A
  • VSD / pulmonary stenosis
  • LVOT obstruction sub-pulmonary stenosis
  • PDA / ASD
  • aortic coarctation (CoA)
  • coronary origin anomalies
79
Q

Dextro-transposition of the great arteries (dTGA) - common therapies ?

A
  • arterial switch
  • Rastelli (if associated with VSD, RVOT obstruction or PS)
  • atrial switch - historical (Senning / Mustard)
80
Q

Arterial switch - early interventions ?

A
  • switch of aortic and pulmonary root
  • anterior positioning of distal mPA / bPAs (LeCompte manoeuvre)
  • translocation of coronaries from aorta to neo-aortic root
81
Q

Arterial switch - late interventions ?

A
  • AV replacement
  • aortic root replacement
  • RVOT enlargement
  • PA stenting
  • PDA closure
82
Q

Arterial switch - postoperative complications ?

A
  • RVOT obstruction / mPA and bPA stenosis
  • LVOT obstruction
  • neo-aortic root dilatation
  • neo-aortic valve regurgitation
  • neo-pulmonary valve regurgitation
  • coronary artery stenosis
  • systemic RV dysfunction
83
Q

Arterial switch - MRI protocol ?

A 
Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT, PAs)
PCI (mPAFlow, AoFlow, branchPAFlow)
3D-whole heart
MRA PAs
stress +/- rest perfusion 
LGE
84
Q

Arterial switch - MRI report ?

A

LV+RV dimensions, mass and function
RVOT / LVOT obstruction
mPA and bPA patency and flows
PR and AR volume + fraction
aortic dimensions
coronary arteries origin, proximal course and flow
myocardial ischaemia and / or scar tissue

85
Q

Arterial switch - key issues ?

A

Arterial switch procedure:
- operation of choice in dTGA
- usually performed in the first two weeks of life
- favourable long term outcome
Most progressive postoperative complications:
- neo-aortic regurgitation
- neo pulmonary stenosis
- coronary obstruction
MRI sequences in case of coronary obstruction
- 3D whole heart to assess coronary origin, prod. course and patency
- stress perfusion to assess ischaemia
- LGE to assess myocardial scar

86
Q

Rastelli - early and late interventions ?

A 
Early interventions:
- conduit RV-mPA
- intraventricular baffle: VSD closure, redirection of left ventricular outflow to anterior aortic valve
Late interventions:
- re-operation conduit
- VSD closure device
87
Q

Rastelli - postoperative complications ?

A
  • conduit or conduit valve stenosis / obstruction
  • LVOT obstruction
  • residual VSD
  • residual ASD
  • branch PA stenosis
88
Q

Rastelli - MRI protocol ?

A 
Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT, PAs)
PCI (mPAFlow, AoFlow, branchPAFlow)
Conduit cross-cuts
3D-whole heart
coronal cine stack
89
Q

Rastelli - MRI report ?

A

LV+RV dimensions, mass and function
conduit patency and proximity to sternum
LVOT obstruction
mPA and bPA patency and flows
residual ASD / VSD, Qp(mPAFlow):Qs(AoFlow)
aortic dimensions
coronary arteries origin, proximal course and likelihood of compression in case of intervention

90
Q

Rastelli - key issues ?

A

usually performed at age 1-2years with BT-shunt in the meantime
allows for correction of a combination of congenital defects:
- dTGA / double outlet right ventricle and
- VSD and
- RVOT obstruction, pulmonary atresia, (sub-)pulmonary stenosis
maintains systemic left ventricle
- at the cost of possible LVOT obstruction and inevitable conduit interventions (surgical or percutaneous)
obstruction of RV-PA conduit
- the conduit runs very anteriorly mostly directly beyond the sternum and therefore is prone to obstruction

91
Q

Mustard / Senning - initial interventions ?

A

Systemic venous baffle: directing systemic venous blood to MV
Pulmonary venous baffle: directing pulmonary venous blood to TV

92
Q

Mustard / Senning - late interventions ?

A
  • Baffle dilatation / stenting
  • closure devices
  • surgical baffle revision
  • Pacemaker
93
Q

Mustard / Senning - postoperative complications ?

A
  • systemic and pulmonary venous baffle obstruction
  • systemic and pulmonary venous baffle leak
  • systemic RV dysfunction
  • tricuspid regurgitation
  • sub-pulmonary obstruction
94
Q

Mustard / Senning - MRI protocol ?

A 
Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT, PAs)
Baffle cine stacks in axial and SA plane
PCI (mPAFlow, AoFlow)
3D-whole heart, MRA PAs
coronal cine stack
95
Q

Mustard / Senning - MRI report ?

A

LV+RV dimensions, mass and function
Baffle obstruction
Baffle leak / shunt, Qp(mPAFlow):Qs(AoFlow)
Presence (and severity) of RVOT obstruction
Presence (and severity) of TR

96
Q

Mustard / Senning - key issues ?

A

Systemic venous baffle stenosis
- in 5-15% of patients, SVC>IVC
- SVC channel patency required for transvenous pacing
- IVC baffle stenosis less-well tolerated as SVC baffle stenosis
-> alternative blood drainage through azygos veins system
-> elevated venous pressure on the liver
Pulmonary venous baffle stenosis
- physiological similar to mitral stenosis in a normal heart
- consider stenosis in patients with pulmonary hypertension
Systemic right ventricle
- MRI allows routine follow up and change in function
- in RV dilatation with severe systemic TR -> valve replacement
- in TR due to systemic RV failure and annular dilatation -> no options
if baffle stenosis consider
- 3D whole heart, MRA, transaxial flow to assess flow reversal in azygous veins system if SVC baffle limb is stenosed

97
Q

Congenitally corrected transposition of the great arteries (ccTGA) - findings ?

A
  • L-TGA: AV and VA discordance
  • Systemic RV
  • Parallel great arteries
98
Q

Congenitally corrected transposition of the great arteries (ccTGA) - associated anomalies ?

A
  • VSD
  • Ebstein-like malformation of the TV
  • (sub-)pulmonary stenosis
  • aortic coarctation (CoA)
  • abnormal situs
99
Q

Congenitally corrected transposition of the great arteries (ccTGA) - MRI protocol ?

A 
Anatomy stack
Cine-SSFP (2ch, 4ch, LV+RV stacks, LVOT, RVOT, PAs)
PCI (mPAFlow, AoFlow, branchPAFlow)
3D-whole heart
Coronal stack
TRFlow
101
Q

Congenitally corrected transposition of the great arteries (ccTGA) - MRI report ?

A

LV+RV dimensions, mass and function
Presence type, size and location of VSD, jet velocity Qp:Qs
Presence (and severity) of TR ?
Presence (and severity) of (sub-)pulmonary stenosis
Associated diagnosis

101
Q

Congenitally corrected transposition of the great arteries (ccTGA) - interventions ?

A

depends on associated findings

102
Q

Congenitally corrected transposition of the great arteries (ccTGA) - key issues ?

A

ccTGA
- usually associated with other congenital anomalies
- most common associated anomaly: perimembranous VSD
- prognosis depends on associated anomalies
- may present late in life
Coronary arteries
- mirror image location
Systemic right ventricle
- multiple coarse trabeculations including moderator band
- best visible of RV stack (or LV stack)
- prone to dysfunction
- AV valve goes with ventricle: TV with RV, MV with LV

Cardiac Imaging (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions