Exam 7

Question 1

Sinus of Valsalva Aneurysm

Answer 1

-Aneurysm of one of the sinuses
-thin dilated area that projects into adjacent cardiac structures often with a fistula
-PSAX shows ‘windsock’ appearance; long mobile sac of tissue extending from sinus
-NCC projects into RA
-LCC projects into LA
-RCC projects into RV

Question 2

Coronary AV Fistula

Answer 2

-Abnormal communication from a coronary artery to coronary sinus or RA
-Rare congenital anomaly
-receiving vessel or chamber dilated
-disturbed color flow in fistula

Question 3

Ebsteins

Answer 3

-One or more TV leaflets displaced into RV
-distance between TV and MV exceeds 1 cm
-TR may be severe
-Atrialized RV adds to RAE appearance
-associated with WPW, ASD, ventricular inversion

Question 4

Dextrocardia

Answer 4

Apex towards the right

Question 5

Situs Inversus

Answer 5

-Organs of the chest and abdomen are arranged in a perfect mirror image reversal of the normal positioning

Question 6

ASD

Answer 6

Secundum, Primum, Sinus Venosus
-Atrial Septal Defect
-color jet across septum into RA
-increased volume leads to RAE, RVD, PSM
-agitated saline injected into venous system briefly crosses from RA to LA to uncover ASD

Question 7

ASD Echo and Doppler Findings

Answer 7

-“T” sign
-RAE, RVD, PSM
-low velocity flow, slightly faster in diastole

Question 8

PAVR

Answer 8

Partial Anomalous Pulmonary Venous Return
- one or more PV drain into RA/SVC/IVC
-may not be ID until adulthood

Question 9

AV Canal Defect

Answer 9

-Abnormal chordal attachment
-Endocardial cushion defect: seen in down syndrome
-consists of large inlet VSD which may extend to atrial septum creating ASD and one large atrioventricular valve

Question 10

PDA

Answer 10

-open ductus from DA to PA
-ductus remains open after birth

Question 11

PDA Echo and Doppler Findings

Answer 11

-color jet in PA
-red jet towards probe in diastole
-LAE, LVE, PVE, PAE
-CW doppler looks like PI
-PW in DA shows holodiastolic flow reversal

Question 12

VSD

Answer 12

Ventricular Septal Defect
-membranous/perimembranous (most common)
-muscular/trabecular
-inlet VSD
-supracristal/outlet

Question 13

VSD Echo and Doppler Findings

Answer 13

-RVE, LAE, LVE
-PISA on the left side
- 5-6 m/s in systole
-color jet across IVS into RV
-high LV systolic pressures result in high velocity flow ~ 5 m/s

Question 14

Coarctation Echo and Doppler Findings

Answer 14

high velocity systolic flow > 1 m/s
-persistent antegrade diastolic flow “sawtooth”
-bicuspid AV

Question 15

Qp Qs

Answer 15

Borderline: 1.5 - < 2
Significant/recurring intervention: > 2

Question 16

Eisenmengers

Answer 16

-significant left to right shunting causes irreversible PHT
-PHT causes right pressures to exceed left pressures, shunt changes R to L
-left heart pushing blood with decreased oxygen saturation to the systemic circulation and signs of cyanosis

Question 17

TGA

Answer 17

Transposition of the Great Arteries
-Aorta originates from RV
-PA originates from LV
-D-transposition: aorta and PA switched back with surgery; oxygenated blood goes to lungs; deoxygenated blood goes to the body

Question 18

Ventricular Inversion

Answer 18

L-trans position: congenitally corrected transposition of the great arteries
RV serves as Systemic ventricle
LV serves as pulmonary vetricle

Question 19

Tetralogy of Fallot

Answer 19

-VSD, PS, RVH, Overriding Aorta

Question 20

Persistent SVC

Answer 20

-SVC drains into coronary sinus
-Agitated saline injected into the arm via IV seen in coronary sinus and then the RA
-Dilated coronary sinus in plax and posterior angulated A4