Congential Heart Disease Flashcards
Aortic Coarctation repair
Sx of systemic upper extremity HTN, drop in BP to LE, DOE
Peak gradient >20mm Hg
OR
<20mm Hg if presence of large collaterals on MRI/CT (echo may underestimate gradient with small passage)
Shunt repair
No repair if PA pressure/systemic pressure >2/3 (vasodilators can be used to bring down PAP to meet goal)
PDA with eisenmengers
reversal of shunt in descending Ao (pink fingers, blue toes) ie differential cyanosis
(pt with unrepair TOF have cyanosis of upper and LE)
(Pt’s with coarcation and anomaloous return of PV do not have cyanosis)
Pulmonary HTN from shunt
most from L->R shunts DISTAL to TV (ie VSD, PDA) morning
Cyanosis/eisenmengers
only with lesions below TV (not ASD, PFO, anamolous return of PV)
Ebstein’s anamaly
Severe TR (holosystolic murmur)
Apical displacement of septal TV leaflet
redundant, elongated sail like anterior leaflet with sail sign (mid systolic click)
TV displacement of 8mm/m^2
ASD/PFO in 50% +- bidirectional shunting, paradoxical emboli, cyanosis on exertion
WPW in 20% (or some sort of SVT)
atrialized RV (tissue properties of RV but is part of atrium)
Regurgitant TV
TOF
Have deg of PS or even PA atresia
(two variations - with pulmonary stenosis or with pulmonary atresia (rare form) - with pulm atria must have VSD and and aorto-pulmonary shunt)
-need to replace the RV->PA conduit
s/p blalock shunt, s/p difinitive repair p/w severe PR, dilated RV
-pulmonary valve replacement
Resting QRS >180 a/w risk of sudden death
RBBB/iRBBB common
Initial palliative TOF repair
1) Waterson shunt - Asc Ao->RPA
2) Potts shunt - Dsc Ao-> LPA
3) Classic Blalock-Taussig shunt - L SC->LPA
4) Modified Blalock-Taussig - R SC-> RPA
Definitive repair
VSD patch repair
Resection of RVOT obstruction, annular patch
No patch if LAD arises from RCA or RCC - need PA->MPA shunt conduit instead
QRS>180ms bad prognosis
Ebstein’s anamaly tx
NYHA III-IV Sx with severe TR -> Class I TV repair/replacement
Sinus Venosus ASD
a/w Ananamalous pulmonary venous return (RUPV) - superior sinus venosus ASD has RUPV->SVC
Needs surgical closure
Primum ASD
Cleft mitral valve VSD Down syndrome (Trisomy 21) PE Fixed split S2 flow murmur (pulmonic flow) MR murmur - systolic best heard near nipple radiating to axilla
Secundum ASD
only ASD that can be device closed
Ebstein’s anomaly
HOLT ORAM (heart hand) sydrome - upper limb abn, missing digits - arm shorter than other
family hx +
Partial Anamolous Pulmon Vein return
unexplained right side vol o/l neg bubble study if no ASD (if no ASD can still cause RH enlargement and pulm HTN) RH enlargement RUPV->SVC/RA RLPV->IVC (scimitar syndrome) LUPV->inominate vein (vertical vein)
Turners (45XO)
Bicupid AV
Ao Coarct