High Yield PTEexam Review part 24 - 26 Flashcards
What is the diagnosis here?
Hypoplastic Left Heart
What is 1
1 = LV
Dx: Hypoplastic Left Heart
Label 2
Hypoplastic Left Heart
2 RA
Label 3
Hypoplastic Left Heart
3 RV
Label 4
Hypoplastic Left Heart
4 Sono Shunt
Label 5
Hypoplastic Left Heart
5 Pulmonic Valve (Neo aortic valve)
What are the two first stage operations that can be performed for hypoplastic left heart?
- BT Shunt
- Sano
For hypoplastic left heart syndrome, the patient will either get a Sano or a BT shunt.
What is the next procedure for the child?
Bidirectional Glenn
Connects the SVC to the RPA (All pulmonary blood flow both Right lung and left lung would come from SVC)
- IVC drains normally into the RA
What are the advantages and disadvantages of a Sano procedure for Hypoplastic Left Heart Syndrome (Vs. BT shunt)?
Sano
- Comes off RV (RV to PA conduit)
- Doesn’t Lower Aortic Diastolic Pressure
- Disadvantage of BT = Lowers Aorto Diastolic BP (Diastolic runoff to the lungs) and flow from Aorta to the Lungs, Lowers Diastolic perfusion pressure of all your organs (Coronary arteries)
You don’t have that problem with Sano
Disadvantage of Sono = Make a ventriculotomy in the RV (single RV) which is their only ventricle. This hole will increase is size as kid grows (RV aneurysm can happen)
What are the advantages and disadvantages of a BT shunt for Hypoplastic Left Heart Syndrome (Vs. Sano)?
BT shunt
Advantage: No ventriculotomy (Unlike the sono)
- Disadvantage = Lowers Aorto Diastolic BP (Diastolic runoff to the lungs) and flow from Aorta to the Lungs, Lowers Diastolic perfusion pressure of all your organs (Coronary arteries)
For hypoplastic left heart syndrome, the patient will either get a Sano or a BT shunt. This is followed by a Bidirectional Glenn. What is the final procedure?
Fontan (Connect the IVC to the Right PA)
(See “e” in the photo)
What echocardiographic aspects do you want to assess before performing Fontan Procedure?
- BT shunt patent
- ASD is wide open (IAS resected)
- Competent Tricuspid Valve
- Competent Pulmonic (Neo-aortic Valve)
- Adequate RV function
What determines the SAO2 in a patient with Hypoplastic Left heart?
3 things
- Deoxygenated blood in single ventricle (Mixed Venous Sat)
- Oxygenated blood from pulmonary veins i.e. Pulmonary venous sat (Left to right shunt through IAS)
- % of Each (Qp/Qs) (PVR / SVR)
What is the function of the reject function of ultrasound?
Eliminates very low level (Amplitude) signals decreasing noise on the 2D image
- When we have very low amplitude signals on 2D grayscale display can be associated with meaningful diagnostic information or meaningless noise
Reject function allows echocardiographer to determine if low amplitude info is displayed or rejected
What are the 5 functions of the ultrasound receiver?
- Amplification
- Compensation
- Compression
- Demodulation
- Rejection (Reject = Threshold = Suppression)
Label 1
left atrial appendage
Label 2
Right Coronary Cusp
Label 3
Left Coronary Cusp
Label 4
Flail P2 scallop of Mitral valve
Which parameter is determine by ultrasound source and medium through which sound travels?
A. Period
B. Wavelength
C. Frequency
D. Amplitude
E. Power
F. Velocity
G. Intensity
B = Wavelength
Which parameter is determine by ultrasound source ONLY through which sound travels?
A. Period
B. Wavelength
C. Frequency
D. Amplitude
E. Power
F. Velocity
G. Intensity
A and C
Period and Frequency
Deals with seconds, so the sound source only
Which parameter is determine by medium ONLY through which sound travels?
A. Period
B. Wavelength
C. Frequency
D. Amplitude
E. Power
F. Velocity
G. Intensity
Velocity = medium only
What are the three parameters of strength of the ultrasound?
What determines strength (Source, Medium, or both)?
- Amplitude
- Power
- Intensity
All determined by sound source
How does stiffness affect velocity of sound?
Directly proportional
Increase stiffness = Increase in velocity