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Applied Cardiovascular IV > Endocardial Cushion Defects > Flashcards

Endocardial Cushion Defects Flashcards

TOF, Truncus Arteriosus, DORV, Transposition

1
Q

Endocardial cushion defects (ECD’s) are also referred to as:

A

Atrioventricular canal defect (AVCD) or
Atrioventricular septal defect (AVSD)

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2
Q

The endocardial cushions make up the IVS, IAS, the ____ leaflet of TV and ____ MV leaflet.

A

Septal; anterior

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3
Q

What are the characteristics of a partial AV canal defect?

A
  • Typically, only the right and left atria are involved
  • Primum ASD
  • Cleft mitral/tricuspid valve
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4
Q

Outlet, or infundibular VSD, may be present with a ____ ASD.

A

Primum

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5
Q

A ____ AV canal defect involves all 4 chambers of the heart and the AV valves.

A

Complete

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6
Q

What are the characteristics of a complete AV canal defect?

A
  • Primum ASD,
  • Inlet VSD,
  • Common atrioventricular valve (most common)
  • MV and TV are merged
  • Transitional Canal Defect consist of two distinct atrioventricular annuli with defects in the atrial and ventricular septa.
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7
Q

Complete AVCDs are further divided into sub-categories according to their ____ within the heart.

A

Attachments

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8
Q

The Three types of complete AVCD’s are:

A

Type A, Type B, and Type C

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9
Q

With Type A complete AVCD’s, chordal attachments to the ____.

A

Crest of the IVS

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10
Q

With Type B complete AVCD’s, chordal attachments to an ____.

A

An anomalous papillary muscle

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11
Q

With Type C complete AVCD’s, there is a ____ with attachments to pap muscles on both sides of IVS.

A

Free-floating leaflet

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12
Q

AVCDs most frequently seen in children with ____.

A

Down Syndrome

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13
Q

If pulmonary vascular resistance increases over systemic resistance, the shunting will reverse __-to-__, which can lead to cyanosis and dyspnea.

A

Right-to-left

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13
Q

If left unrepaired, the increase in pulmonary blood flow will cause progressive obliteration of the ____.

A

Pulmonary arterioles

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14
Q

Complete AVCD’s usually appear within the first few ____ of life.

A

Weeks

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15
Q

What are some signs and symptoms of a complete AVCD?

A
  • Dyspnea
  • Cyanosis
  • Poor appetite and weight gain
  • Possible signs of CHF (edema, ascites)
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16
Q

With a partial AVCD, signs may not appear until patient is __-__ years of age.

A

20 - 30 years

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17
Q

What are some signs and symptoms of a partial AVCD?

A

Arrhythmias, CHF, and Pulmonary HTN

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18
Q

What are some treatment options for an AVCD?

A
  • Digitalis, Diuretics to treat CHF
  • Antibiotic prophylaxis
  • Pulmonary Artery Banding (Palliative)
  • Close ASD
  • Close VSD
  • Reconstruct cleft AV valves
  • Replace MV
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19
Q

Conotruncal defects affect the hearts ___ tract.

A

Outflow

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20
Q

Failure of the conotruncal septation will result in an array of defects, including:

A
  • Tetralogy of Fallot (TET, or TOF)
  • Pulmonary atresia with VSD
  • Double outlet right ventricle (DORV)
  • Truncus arteriosus
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21
Q

With all conotruncal defects, the relationship of the IVS and the great vessels is abnormal with one great vessel overriding the ___, allowing blood to exit from both ventricles.

A

IVS

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22
Q

All ____ defects cause improper circulation of oxygenated and deoxygenated blood.

A

Conotruncal

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23
Q

____ is the most common cyanotic lesion in the adult population.

A

Tetrology of Fallot (TOF)

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24
Q

TOF is comprised of 4 defects:

A
  • Overriding aorta (straddles IVS)
  • VSD
  • Infundibular stenosis (PV) or PS
  • RVH
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25
Q

With TOF, since the ____ is overriding, blood flow from either ventricle can exit out the ____.

A

Aorta; aorta

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26
Q

With TOF, since ____ flow is going out of the pulmonary artery, this reduces the size of the pulmonary artery and valve and increases the size of the aorta

A

Less

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26
Q

The two types of TOF are ___ and ___.

A

Cyanotic and acyanotic

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27
Q

Cyanotic TOF has severe PS with predominant __-to-__ shunt.

A

Right-to-left

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28
Q

Acyanotic TOF has mild PS with predominant __-to-__ shunt

A

Left-to-right

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29
Q

Most important hemodynamic factor in determining the severity of TOF is the severity of the ____.

A

PS

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30
Q

In TOF, what is the order of the blood flow?

A

IVC/SVC > RA/RV > aorta or the pulmonary artery

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31
Q

In TOF, if the PA is of normal size and the pulmonary vascular resistance is lower, there will be more blood going out the ____.

A

PV

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32
Q

In TOF, if there is severe narrowing of the infundibulum, then more blood will go across the VSD and out the ____.

A

Aorta

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33
Q

With TOF, the PLAX view will show an overriding aorta and a ____.

A

VSD

34
Q

With TOF, you need to determine the size of the ____ and ____ to help in determining the surgical course

A

RPA and LPA

35
Q

TOF has a higher likelihood of associated ____ so an assessment of the origins of the coronary arteries must be performed.

A

Coronary artery anomalies

36
Q

What are the signs and symptoms of TOF?

A
  • Exercise intolerance
  • Squatting episodes (the child squats down because this maneuver increases the venous return, stroke volume, and cardiac output)
  • “Tet” spells: episodes of cyanosis, syncope, and hypoxia.
37
Q

Children with TOF exhibit ___ skin during episodes of crying or feeding.

A

Bluish

38
Q

What needs to be done to repair TOF?

A
  • Close the VSD
  • PV replacement (PV redo if valve doesn’t grow adequately with child)

The RVH will lessen as the heart grows with the child

39
Q

____ is when one great vessel coming off of the heart acts as both the pulmonary artery and the aorta.

A

Truncus arteriosus

40
Q

With truncus arteriosus, the ____, ____, and ____ all arise from a common trunk.

A

Coronary arteries, main pulmonary artery, and aortic arch

41
Q

With truncus arteriosus, it is usually the ____ that developed and the ____ will develop out of this trunk.

A

Aorta; pulmonary artery

42
Q

With truncus arteriosus, a large malalignment ____ always present.

A

VSD

43
Q

A truncal valve may have __-__ leaflets and may leak and/or be stenotic.

A

2-6

44
Q

With truncus arteriosus, ____ in aorta and PA is the same.

A

Oxygen saturation

45
Q

With truncus arteriosus, LCA originates from ____ ____ truncus side.

A

Left posterolateral

46
Q

With truncus arteriosus, RCA originates from ____ truncus side.

A

Anterolateral

47
Q

Truncus arteriosus is usually classified into ____ types, based on how the left and right pulmonary arteries originate from the common trunk.

A

4

48
Q

Truncus arteriosus type 1:

A

The MPA arises from the truncal root and then branches to the RPA and LPA (60%)

49
Q

Truncus arteriosus type 2:

A

LPA and RPA arise directly from the posterior portion of the truncal root as separate vessels with separate orifices (20%)

50
Q

Truncus arteriosus type 3:

A

Each pulmonary artery arises directly from the lateral aspects of the truncal root as separate vessels with separate orifices (20%)

51
Q

With truncus arteriosus, the truncal valve may have more than ____ cusps.

A

Three

52
Q

With truncus arteriosus, there is a VSD present __% of the time.

A

100%

53
Q

With truncus arteriosus, you need to find the placement of the ____.

A

Pulmonary arteries

54
Q

To assess the pulmonary arteries, you can use a ____ ____ parasternal short-axis orientation with the transducer angled toward the apex.

A

High right

55
Q

For the surgical repair of a truncus arteriosus, the ____ needs to be closed.

A

VSD

56
Q

For the surgical repair of a truncus arteriosus, you need to excise the ____ from the truncus and place a valved conduit from the RV to the PA.

A

Pulmonary arteries

57
Q

Double Outlet Right Ventricle (DORV), is where the two great vessels both of which arise from the morphologic ____.

A

RV

58
Q

With DOVR, a ____ must always be present so the blood can get from the LV to the aorta..

A

VSD

59
Q

With DORV, there is no ____ continuity between either AV valve and either semilunar valve.

A

Fibrous

60
Q

DORV is often associated with ____ and ____.

A

PS and MV abnormalities (parachute MV, cleft MV straddling MV, supramitral ring)

61
Q

Severity of DORV is determined by the type of ____ and the presence or absence of PS.

A

VSD

62
Q

A more moderate or severe form of DORV will cause ____ in the patient.

A

Cyanosis

63
Q

With DORV, blood flow from the left and right ventricles mixes at the ____ level and exits via both great vessels.

A

Ventricular

64
Q

With DORV, the degree of mixing and the relative volumes going to each great vessel depend on the ____ of the VSD and the great vessels.

A

Position

65
Q

The diagnosis of DORV is usually apparent from the ____ view.

A

Subcostal

66
Q

What are the 3 goals to repairing DORV?

A
  • Establish left ventricle to aorta continuity
  • Establish right ventricle to pulmonary artery continuity
  • Repair associated defects (VSD repair)
67
Q

What are the two types of transposition?

A

D-transposition and L-transposition

68
Q

What type of transposition includes atrioventricular concordance with ventriculoarterial discordance (A.K.A. complete transposition).

A

D-transposition (DTGV)

69
Q

What type of transposition includes atrioventricular discordance and ventriculoarterial discordance (A.K.A. congenitally corrected).

A

L-transposition (LTGV)

70
Q

In the PSAX, if the aorta is ____ to the pulmonary artery, the diagnosis is transposition of the great vessel (TGV).

A

Anterior

71
Q

With DTGV, there is ____ wrong connection.

A

One

72
Q

With ____, the correct atrium is connected to the correct ventricle, but the wrong great vessel is attached to each ventricle.

A

DTGV

73
Q

What is the circulation of blood for D-transposition?

A
  • Circulation is as follows: RA ~ RV ~ aorta ~ body ~ RA again.
  • Pulmonary veins ~LA ~ LV ~ pulmonary artery ~ lungs ~ LA again.
74
Q

DTGV has ____ independent parallel circuits.

A

2

75
Q

Life is dependent on some intermixing of those two circuits which occurs through a ____.

A

Shunt - PFO, PDA, or VSD

76
Q

What drug is used to keep a shunt open?

A

Prostaglandin

77
Q

In DTGA, the aorta originates from the RV, carrying ____ blood to the body.

A

Desaturated

78
Q

In DTGA, the PA originates from the LV, delivering ____ blood to the lungs

A

Oxygenated

79
Q

In DTGA, the aorta is ____ and to the right of the PA.

A

Anterior

80
Q

In LTGA, the anatomic RV will be displaced posterior and leftward, becoming the ____ ventricle.

A

Arterial

81
Q

In LTGA, the anatomic LV will be displaced anterior and rightward, becoming the ____ ventricle.

A

Venous

82
Q

What is the circulation of blood for L-transposition?

A
  • Pulmonary veins ~ LA ~ TV ~ RV ~ AO ~ body
  • SVC/IVC ~RA ~ MV ~ LV ~ PA ~ lungs
83
Q

In LTGV, despite the displacement of the ventricles, the PA arises from the ____ ventricle and the AO arises from the ____ ventricle as they should.

A

Venous; arterial

Applied Cardiovascular IV (6 decks)

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