Endocardial Cushion Defects Flashcards
http://emedicine.medscape.com/article/154823-overview
ECDs can be ____ or ____. (Categories of ECDs)
partial, complete
Cause of ECDs
- endocardial cushions don’t grow convex toward IAS, and concave toward IVS
- endocardial cushions don’t grow at all and not in right direction
Complete ECD (AV Canal) involves all 4 ____ in all 4 ____.
valves, chambers
The term ECD and ____ ____ are interchangeable.
AV Canal Defect
Endocardial cushions normally grow ____ toward the interatrial septum.
convex
Endocardial cushions normally grow ____ toward the interventricular septum.
concave
If the endocardial cushions do not grow correctly, there isn’t any ____ to meet the ____ and ____.
tissue, IVS, IAS
ECDs are associated with patients with ____ abnormalities as well.
neurological
EX: Downs Syndrome
The atrial septal defect ____ ____ can also be classified as an endocardial cushion defect.
ostium primum
endocardial cushions help form:
- part of the interatrial septum
- interventricular septum
- medial/septal leaflet of tricuspid valve
- anterior leaflet of the mitral valve
With a complete ECD, there is a large ____ ____ and a large ____ ____.
membranous VSD, primum ASD
With a complete ECD, the ____ & ____ can be merged.
MV, TV
Physical findings of a patient with complete ECD:
cyanotic / blue color around lips and eyes
How would you describe the shunting with a complete ECD?
Shunting at both levels
Swirling of venous and arterial blood
____ ____ is a lesion associated with complete ECD.
Aortic Insufficiency
Other associated defects with complete ECD:
- other septal defects
- cleft mitral valve
- fenestrations in both septum
A Partial ECD is due to the endocaridal cushions partially ____.
fuse
What happens to the right atrium with a partial ECD?
- dilation
- hyperdynamic
- increase in muscle mass
- tricuspid regurge
- eisemnenger’s syndrome
Heart sounds with a complete ECD?
- fixed/split S2 (A2 and P2) (because of the big common ventricle and dilated atria)
With a complete ECD, there is a palpable thrill over the ____, due to a volume overload through that vessel.
pulmonary artery
In extreme cases of ECD, infants suffer from ____ ____ ____.
failure to thrive
Signs and symptoms of infants with complete ECD:
- fatigue
- weakness
- shortness of breath
- dyspnea
- growth retardation
- cyanosis
The volume overload in complete ECD, there is ____ due to increased volume to the pulmonary vascular bed and increased pulmonary vascular resistance.
PHTN
maintaining normal ____ ____ is difficult in patients with complete ECD.
blood pressure
When an infant cannot go directly into surgery to correct a complete ECD, ____ is performed as a palliative measure until the baby is ready to have surgery.
PA banding
PA banding decreases narrows the diameter of the pulmonary artery, thus decreasing the ____ ____.
flow rate
If ECD is not repaired within the first year of life, there is an ____% mortality rate, due to CHF and pulmonary vascular disease.
80%
The primary goal for the surgical repair of ECD:
restore normal blood flow to the system by surgically closing the ASD and VSD with patches
The normal procedure during surgery for the correction of ECD:
- Reconstruct or replace mitral and tricuspid valves
- Make sure LVOT and RVOT are not obstructed
- Close ASD and VSD with patches
- Remove PA band
- Repair any other defects
Factors that need to be addressed before taking an infant into surgery:
- term of pregnancy
- gestational age
- function of lungs
With partial ECD, why do the TV and MV sit lower in the chamber?
Because of the large VSD
