Heart Disease Flashcards
Type of congestion where there is increased pulmonary vascularity due to increased flow of blood through the lungs
Active congestion
Type of congestion wherein there is increased pulmonary vascularity due to elevated pulmonary venous pressure
Passive congestion
4 types of pulmonary vascularity
Active, passive, decreased due to obstruction through the PA and normal vascularity
Most commonly encountered type of congestion that appears when a systemic to pulmonary, left to right shunt is occurring that is large enough to detect on a chest xray
Active congestion
Rule of thumb in increased pulmonary vascularity
Right descending PA is as large as the trachea diameter and other vessels are increased in diameter
Occurs when there is elevation of the pulmonary venous pressure, from LV abnormalities, mitral valve, RA (cor triatriatum), or obstruction of pulmonary venous return (TAPVR or pulmonary vein stenosis)
Passive congestion
Pulmonary veins enlarge and become ill-defined in passive congestion due to
Fluid leaking into the interstitial tissues of the lungs
Causes of decreased pulmonary vascularity
Obstruction of the right ventricular outflow at the infundibulum, pulmonary valve or main PA
Heart disease with normal blood flow and therefore normal vascularity
Coarctation of the aorta, early cardiomyopathy
CHD that presents with asymmetric pulmonary blood flow
TOF, truncus arteriosus, pulmonic stenosis and postoperative patients
Asymmetric blood flow can be due to
Focal pulmonary arterial stenosis (William syndrome) or underlying lung abnormality (prematurity, congenital diaphragmatic hernia)
A right aortic arch can be seen in what conditions
TOF, truncus arteriosus, double aortic arch and right aortic arch with an aberrant left subclavian artery
Most commonly encountered contour abnormality of the aorta is from what condition
Coarctation of the aorta
Main PA can be concave along with decreased vascularity in what condition
TOF
Main PA can be large due to what conditions
Left to right shunt, poststenotic dilation from pulmonary valvar stenosis, pulmonary valvular insufficiency or pulmonary hypertension
What creates the figure 3 sign of coarctation of aorta
Prestenotic and postenotic dilatation of aorta
How many anterior ribs should be present above the diaphragmatic shadow to say you have a normally aerated chest
6
On lateral radiograph, cardiomegaly can be assessed by tracing a line down the anterior trachea, if the posterior aspect of the heart doesnt extend beyond this line, then what does it say
Normal. No cardiomegaly
If a left to right shunt is large enough, the pulmonary pressures will eventually increase and the shunt will reverse because of pulmonary hypertension, a phenomenon called
Eisenmenger physiology
Most common congenital heart anomaly and can be isolated or associated with more complex CHD
VSD
Most common form of VSD that is most commonly symptomatic
Perimembranous defects
Type of VSD where the membranous and muscular septum fuse
Perimembranous
Type of VSD that are often small, multiple, less hemodynamically significant and tend to close over time
Muscular
Type of VSD that is least common and occur due to an abnormal development of the conus portion of the truncus during cardiac development
Conal VSD
What type of VSD is usually seen in TOF and truncus arteriosus
Conal VSD
A VSD is usually not evident either clinically or radiographically due to
High pulmonary vascular resistance at birth
Radiographic features of VSD
Prominent LV, main PA segment enlargement and LA enlargement, increases vascularity
Cardiac defect most commonly missed in infancy because it is a low-pressure left to right shunt that increases as the pulmonary resistance decreases after birth
ASD
Radiographic features of ASD
Enlarged or prominent right heart border due to RA enlargement, extension of RV into the retrosternal space and increased pulmonary vascularity
Why does LA enlargement do not occur in ASD?
It acts as a passive conduit for the blood shunted from LA to RA
During fetal life, the right ventricular blood flow is shunted away from the developing lungs via the ______ and into the aorta
Ductus arteriosus
Consequence of PDA
Left side of the heart dilates
Cardiac anomalies that are ductal dependent for systemic blood flow
Hypoplastic left heart, interrupted aortic arch
Rare condition that develops when there is incomplete division of the primitive truncus arteriosus and there is absence of a wall between the aorta and PA immediately above the valves
Aortopulmonary window
Rare cause of left to right shunt that can shunt blood from the aorta to the right cardiac chambers, coronary sinus or PA
Coronary artery fistula
Classic and most common CHD resulting in the cyanosis
Transposition of great vessels (D-transposition)
In this condition, systemic veins, pulmonary venous flow and atrioventricular connections are normally connected, but the origin of the PA and aorta are reversed, resulting in ventriculoarterial discordance
Transposition of great vessels
In TOGV, aorta arises from ____ and PA arises from _____
Aorta from RV, PA arises from LV
Presents as oval heart shape with a prominent apex and variable cardiomegaly and a narrow upper mediastinum due to superimposition of the aorta and main pulmonary artery in the AP plane, thymic atrophy
TOGV
Surgical intervention for TOGV to allow free mixing of oxygenated and deoxygenated blood until the definitive repair can be performed
Catheterization and balloon atrial septostomy (Rashkind procedure)
In this condition, the ventricles are also inverted such that the morphologic LV is attached to the RA and the morphologic RV is attached to the left atrium.
Corrected transposition (L-transposition)
Usual coexisiting cardiac defect in corrected transposition that allows systemic to pulmonary shunting
VSD
Characteristic finding on chest xray that suggest corrected transposition in the absence of increased pulmonary vascularity
Border forming ascending aorta on the left side of the heart due to aorta arising from the leftward and posterior RV
Condition in which both arteries arise from the RV and the outlet from the LV is a VSD
Double-outlet right ventricle
Absence of pulmonary stenosis un double outlet RV results in
Large main PA segment, increased vascularity, moderate cardiomegaly
Severe pulmonic stenosis in double-outlet RV results in
Concave PA segment, decreased vascularity with mild cardiomegaly
Present when all the blood returning from the lungs returns to the right side of the heart
TAPVR
Most common type of Anomalous venous site in TAPVR
Supracardiac
Imaging features of TAPVR
Right heart and PA are enlarged, increased blood flow to the lungs
Appearance of obstructive TAPVR
Normal heart size with severe interstitial or alveolar pulmonary edema
Snowman sign in TAPVR only occur when
The vertical vein empties into the brachiocephalic vein
Rare anomaly that presents in early infancy with pulmonary venous obstruction. The pulmonary veins empty into a common confluence separated from the LA by a partial membrane causing obstruction to return of the pulmonary venous flow to the left heart
Cor triatriatum
Name was derived from the appearance of an extra “atrium” posterior to the LA
Cor triatriatum
Defect where there is failure of the primitive truncus to divide correctly into the aorta and PA
Truncus arteriosus
Chest xray presentation of truncus arteriosus
Cardiomegaly and active pulmonary congestion, right arch, concave MPA
Decreased pulmonary vascularity happens when
There is obstruction on the right side of the heart and an intracardiac right to left shunt
Most common cyanotic CHD
TOF
4 components of TOF
Right ventricular hypertrophy, pulmonic stenosis, perimembranous VSD, aorta that overrides the VSD)
What dominates the physiology of TOF
Right ventricular outflow tract obstruction and a large perimembranous VSD
How many percent of patients with TOF has right sided aorta
25%
Imaging findings in TOF
Upwardly displaced cardiac apex caused by right ventricular hypertrophy and concave pulmonary artery shadow
Treatment approach in TOF
Complete surgical repair
Condition where there is complete atresia of the tricuspid valve, allowing no communication of blood from RA to RV, therefore an atrial-level shunt is required, and in 80% of the cases this is a patent foramen ovale. To keep the flow to PA, it is dependent on a ductus arteriosus
Tricuspid atresia without TGA
To keep the ductus to keep the ductus arteriosus open in tricuspid atresia, this procedure is done
Blalock-Taussig shunt or superior cavopulmonary anastomosis (bidirectional Glenn) and eventually a total cavopulmonary anastomosis (Fontan)
Rare condition wherein there is redundant tricuspid valve that balloons into the RV and is adherent to the RV myocardium
Ebstein anomaly
Third most common CHD after VSD and ASD. It is often asymptomatic and the disease is first suspected when a systolic heart murmur is noted
Pulmonic valvar stenosis
Most common cause of pulmonic valvar stenosis
Commissural fusion (90%)
Most common congenital abnormality of the heart because of bicuspid aortic valves
Aortic valvar stenosis
Chest xray features of aortic valvar stenosis
Prominent ascending aortic shadow along the right mediastinum just above the heart, and with age and elongation of the aorta, the transverse segment becomes conspicuous
One of the congenital heart lesions that can present later in life with signs first recognized from a chest xray or a renal ultrasound performed to evaluate hypertension
Coarctation of the aorta
Rib notching in coarctation of the aorta happens when
There are well-developed collaterals, usually not until age 8
Condition wherein there is bounding upper extremity pulses or have upper-extremity hypertension relative to the lower extremities
Coarctation of the aorta
Presence of tardus parvus in the aorta suggests what condition
Coarctation of the aorta
Type of COA that is associated with VSD, ASD and mitral valve abnormalities in many cases
Diffuse type “infantile”
Type of COA with localized narrowing at or just distal to the ductus arteriosus
Juxtaductal
Type of single ventricle heart disease that occurs as a spectrum of underdevelopment of left-sided heart structures (aorta, aortic valve, LV, mitral valve and left atrium)
Hypoplastic left heart syndrome
In this condition, the clinical presentation is severe and out of proportion to the chest xray, which appears relatively normal
Hypoplastic left heart syndrome
Palliative Surgical procedure for hypoplastic left heart syndrome
Norwood procedure
Relationship between the thoracic and abdominal viscera is described in terms of
Situs
Normal configuration of the thoracoabdominal viscera with the cardiac apex
Situs solitus
It is a complete mirror image of the thoracoabdominal viscera
Situs inversus totalis
It is when the apex and the bulk of the heart are to the left
Levocardia
It is when the apex of the heart is to the right and the bulk of the heart in on the right
Dextrocardia
Should be used when the heart is in the center and the laterality of the bulk of the heart is indeterminate
Mesocardia
If there are bilateral eparterial bronchi, bilateral trilobed lungs, bilateral right atria, absence of spleen and a liver that spans the abdomen, what heterotaxy is present
Right atrial isomerism and asplenia
This syndrome typically have hyparterial bronchi, bilateral bilobed lungs, with an asymmetric liver with its bulk on the left or right or in midline, bilateral pulmonary/left atria
Polysplenia syndromes
