ECHO - SImple Congenital Heart Diease Flashcards
TTE evaluation for ASD
see pic
Types of ASD
- Secundum - most common
- Primum associated with cleft in the mitral valve
- Sinus venosus - posterior to the true atrial septum, associated with right sided pulmonary venous return
- Coronary sinus defect - unroofed CS - persistent left sided SVC
Class I indication for ASD secundum closure (AHA)
transcatheter or surgical closure to reduce RV volume and improve exercise tolerance is recommended,
- causing impaired functional capacity (SYMPTOMATIC)
- right atrial and/or RV enlargement, and
- net left-to-right shunt sufficiently large to cause physiological sequelae (e.g., pulmonary–systemic blood flow ratio [Qp:Qs] ‡1.5:1)
- without cyanosis at rest or during exercise,
- provided that systolic PA pressure is less than 50% of systolic systemic pressure and
- pulmonary vascular resistance is less than one third of the systemic vascular resistance
***for primum, sinus venosus defect and coronary sinus defect -> surgical closure as Class I recommendation
***for ASYMPTOMATIC with same parameters, class IIa only
defect in ASD Primum
defect in the AVS- atrioventricular septum
Characteristics of ASD secundum
see pic
associated with Holt-Oram syndrome
Bubble studies for PFO, positive result
bubbles in LA within 3-6 beats for intracardiac shunt
characteristic of Patent Foramen Ovale
see pic
CLASS III recommendation (AHA)
ASD closure should not be performed in adults with:
- PA systolic pressure greater than two thirds systemic, - pulmonary vascular resistance greater than two thirds systemic, and/or
- a net right-to-left shunt
Class I indication for ASD secundum closure (ESC)
- evidence of RV volume overload and
- no PAH (no non-invasive signs of PAP elevation or invasive confirmation of PVR <3 WU in case of such signs) or
- LV disease,
ASD closure is recommended regardless of symptoms. - DEVICE closure is the method of choice
Characteristic of Atrial septal aneurysm
see pic
What is Chiari Network
see pic
known as Partial type of Atrioventricular Septal Defect
see pic
Mechanism of Chiari Network
see pic
Types of AV septal Defect
- Complete
-Partial - Transitional
- Intermediate
Associated Valve disorder with ASD Primum
Cleft Mitral valve
Location of the defect of ASD primum
inferior portion of the atrial septum
type of ASD that is associated with Left Axis Deviation
ASD Primum
ASD type that is hard to detect in TTE
Sinus venosus ASD
location of defect in sinus venosus ASD
superior and posterior aspects of the septum
Mechanism of ASD: unroofed coronary sinus
absence of a portion of the common wall that separates the coronary sinus and the left atrium
Associated anomaly with dilated coronary sinus
- most common
left SVC
can cause dilated coronary sinus
- Elevated right atrial pressure
- Anomalous pulmonary connections to the coronary sinus
T/F? VSD is a left to right shunt at ventricular level causes LEFT heart dilatation.
TRUE
recommendation for ASD intervention
see pic
What is the role of the ECHO in VSD?
- Define location of VSD
- LV and LA size
- Pulmonary pressures
- Aortic Regurgitation
- Tricuspid Regurgitation
Locations of VSD?
- outlet
- membranous
- Inlet
- trabecular or muscular
different VSD terminology
see pic. depends on what terminology you will use
Location of Echo based on standard imaging views
see pic
Location of Echo based on PLAX view
- muscular
- Perimembranous/outlet
Location of Echo based on PSAX view (AV level)
between 9 to 12-1o clock - perimembranous type
- between the tricuspid valve and aortic valve
Location of Echo based on PSAX level (mid LV level)
- Inlet
- Muscular/tracecular
Location of Echo based on 4chamber view
- Inlet
- Muscular/Trabecular
Location of Echo based 5chamber view
- Perimembranous
- muscular/trabecular
type of VSD that is adjacent to TV and AV?
Membranous VSD
type of VSD that is adjacent to the semilunar valves?
Subarterial VSD
aka: outlet or supracristal
What this be?
Pulmonic regurgitation.
check the timing of the flow. this is a diastolic regurgitation
Type of VSD that is remote from the valves
- Muscular VSD
aka: Trabecular
Associated trisomy with Inlet VSD?
trisomy 21
Type of VSd that is usually occurs as part of AV septal defect
- Inlet VSD
type of VSD that is immediately inferior to both AV boths
- Inlet VSD
can you compute RVSP with VSD doppler evaluation?
yes. provided that SBP is obtain and there is no LVOT obstruction
formula:
RVSP = SBP - 4v^2
Indication for VSD interventions
CLASS I Recommendation:
- Left to right shunt with LV enlargement,
- QpQs of >1.5:1
- PVR <1/3 of systemic
- PASP <50% of systemic
Indication for VSD interventions: Class IIa (ESC)
- in patient with no significant L-R shunt but history of repeated episodes of IE
- associated with VSD-associated prolapse of an aortic valve cusp causing progressive AR
- developed PAH and PVR 3-5WU
Follow up for patients with VSD
Patients with more than small residual VSD, valvular lesions, or haemodynamic impairment (LV dysfunction or PAH) should be seen every year, including evaluation in specialized ACHD centres.
In patients with a small VSD (native or residual, normal LV, normal PAP, asymptomatic) and no other lesion, 3-5 year intervals may be reasonable.
After device closure, regular follow-up during the first 2 years and then, depending on the results, every 2-5 years is reasonable.
After surgical closure without residual abnormality, 5-year intervals may be reasonable.
Indication for closure for PDA
- LA and/or LV enlargement
- net L-to-R shunt
- PASP <50% of systemic
- PVR <1/3 of systemic
Indication for VSD interventions: Class IIa (AHA)
- associated with VSD-associated prolapse of an aortic valve cusp causing progressive AR
CLASS IIb
- history of repeated episodes of IE
Echo views for the assessment of PDA
high left PSAX and Suprasternal Notch
what Congenital heart disease is associated with Ebstein’s anomaly?
- ASD or PFO (atrial level shunt)
can you assess/estimate PASP in PDA?
yes
Formula
PASP = SBP-4v^2
What is an Ebstein’s anomaly?
it i a disorder of myocardial development ->valve disorder adn myopathy
characteristic Echo features for Ebstein’s anomaly?
- apical displacement of the the septal leaflet (TV) of >8mm/m^2
- Rotational displacement towards the RVOT
- Anterior leaflet (TV) is large and sail-like
- Atrialized RV
- ASD or PFO in seen in majority of this patient
