Heart Disease Flashcards by Butch Josef Abuel

Type of congestion where there is increased pulmonary vascularity due to increased flow of blood through the lungs

Active congestion

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Type of congestion wherein there is increased pulmonary vascularity due to elevated pulmonary venous pressure

Passive congestion

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4 types of pulmonary vascularity

Active, passive, decreased due to obstruction through the PA and normal vascularity

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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

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Rule of thumb in increased pulmonary vascularity

Right descending PA is as large as the trachea diameter and other vessels are increased in diameter

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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

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Pulmonary veins enlarge and become ill-defined in passive congestion due to

Fluid leaking into the interstitial tissues of the lungs

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Causes of decreased pulmonary vascularity

Obstruction of the right ventricular outflow at the infundibulum, pulmonary valve or main PA

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2 Heart disease with normal blood flow and therefore normal vascularity

Coarctation of the aorta,

early cardiomyopathy

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4 CHD that presents with asymmetric pulmonary blood flow

TOF,
tuncus arteriosus,
pulmonic stenosis and
postoperative patients

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Asymmetric blood flow can be due to (2)

Focal pulmonary arterial stenosis (William syndrome) or

underlying lung abnormality (prematurity, congenital diaphragmatic hernia)

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A right aortic arch can be seen in what 4 conditions

TOF,
truncus arteriosus,
double aortic arch and
right aortic arch with an aberrant left subclavian artery

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Most commonly encountered contour abnormality of the aorta is from what condition

Coarctation of the aorta

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Main PA can be concave along with decreased vascularity in what condition

TOF

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Main PA can be large due to what 4 conditions

Left to right shunt,
poststenotic dilation from pulmonary valvar stenosis,
pulmonary valvular insufficiency or
pulmonary hypertension

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What creates the figure 3 sign of coarctation of aorta

Prestenotic and postenotic dilatation of aorta

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How many anterior ribs should be present above the diaphragmatic shadow to say you have a normally aerated chest

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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

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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

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Most common congenital heart anomaly and can be isolated or associated with more complex CHD

VSD

bicuspid aortic valve?

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Most common form of VSD that is most commonly symptomatic

Perimembranous defects

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Type of VSD where the membranous and muscular septum fuse

Perimembranous

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Type of VSD that are often small, multiple, less hemodynamically significant and tend to close over time

Muscular

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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 / high membranous septal defect

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What type of VSD is usually seen in TOF and truncus arteriosus

Conal VSD / high membranous septal defect

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

2 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 cyanosis with increase pulmonary vasculature

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, infundibular 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 Pulmonic stenosis?

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 lungs and a liver that spans the abdomen, what heterotaxy is present

Right atrial isomerism and asplenia

This syndrome typically have hyparterial bronchi, bilobed lungs, with an asymmetric liver with its bulk on the left or right

Polysplenia syndromes