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PTE Masters + A Practical Approach to Transesophageal Echocardiography > High yield PTEexam review part 36 - 38 > Flashcards

High yield PTEexam review part 36 - 38 Flashcards

1
Q

For a watchman procedure, how is the septum usually crossed?

A
  1. Inferiorly

and

  1. Posterioly
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2
Q

What is the release criteria for a Watchman?

A
  1. Position - Device distal to LAA
  2. Anchor - Fixation anchors and is engaged or stable
  3. Size - Device is compressed 8-20% of original size (said another way 80-92% of original size)
  4. Seal - Ensure all lobes are distal to the device
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3
Q

To place a watchman, what is the width of the LAA ostium have to be between?

A

17 and 31 mm

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4
Q

To place a watchman, what is the length of the LAA ostium have to be between?

A

Equal to or greaater than the ostium width

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5
Q

What are the pragmatic ways in which you measure the LAA ostium at different angles (4 of the them)?

Include angle measurements and where to measure

A

0 degrees - Measure from coronary artery marker to a ppint 2 cm from tip of “limbus”

45 degrees - Measure from top of LV annulus to a ppint 2 cm from tip of “limbus”

90 degrees - Measure from top of LV annulus to a ppint 2 cm from tip of “limbus”

135 degrees - Measure from top of LV annulus to a ppint 2 cm from tip of “limbus”

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6
Q

What vena contracta measurement is seen in the narrowest cross sectional area of the LAA after watchman?

(What vena contracta is normal)

A

<5 mm is ok

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7
Q

Label 1 - 4

A

1 Aorta

2 RPA

3 RUPV

4 IVC

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8
Q

When does Pressure Recovery occur?

A

Elevated peak instantaneous pressure gradient derived from echo (higher than the peak-to-peak gradient obtained by cath)

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9
Q

What 3 risk factors exist for Pressure Recovery?

A
  1. Small Aortic Root
  2. Small aortic valve
  3. Mechanical valve
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10
Q

Draw the peak to peak vs. instantaneous pressure measurements comparing TEE vs. Cath

A

See image

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11
Q

What does the backing material do to bandwidth?

A

increases bandwidth

(Creates wider range of frequencies)

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12
Q

What does the backing material do to spatial pulse length?

A

Decreases SPL

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13
Q

How does backing material affect axial resolution?

A

Improves axial resolution

Remember, lower numerical vaalue for axial resolution (1/2 SPL)

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14
Q

How does the backing material affect Q factor?

A

Decreases Q factor

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15
Q

What is the formula for Q factor?

A

Resonant Frequency* / *Bandwidth

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16
Q

What two heart conditions are found in Lutembacher Syndrome?

A

1. Mitral Stenosis

2. ASD

Lutembacher syndrome is defined as a combination of mitral stenosis and a left-to-right shunt at the atrial level. Typically, the left-to-right shunt is an atrial septal defect (ASD) of the ostium secundum variety. Both these defects, ASD and mitral stenosis, can be either congenital or acquired

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17
Q

What is the cosine of 0 degrees?

A

1

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18
Q

What is the cosine of 10 degrees?

A

-0.8

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19
Q

What is the cosine of 20 degrees?

A

0.94

(Underestimates by 6%)

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20
Q

What is the cosine of 60 degrees?

A

0.5

We are measuring 50% of the true velocity

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21
Q

A.I. due to normal leaflet (cusp) motion with dilation of the sinuses of Valsalva and the sinotubular junction is best classified as what A.I. morphology?

A

Type 1b

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22
Q

What is Type 1a Aortic Regurgitation Morphology?

A

Normal Leaflet Motion

Sinotubular Junction Enlargement & Dilation of Ascending Aorta

1A = (Ascending Aorta)

“A = A”

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23
Q

What is Type 1b Aortic Regurgitation Morphology?

A

Dilation of the Sinuses of Valsalva and Sinotubular Junction

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24
Q

What is Type 1c Aortic Regurgitation Morphology?

A

Dilation of the Annulus (Ventriculoarterial Junction)

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25
Q

Type 1d Aortic Regurgitation Morphology

A

Perforation

“Dog bite a hold in the cusp”

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26
Q

What is Type II A.I. Morphology?

A

Tyle II Cusp Prolapse

(Excessive Leaflet motion)

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27
Q

What is Type III A.I. Morphology?

A

Cusp Restriction

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28
Q

What type of VSD is seen with RCC prolapse?

A

Membranous VSD and Outlet VSD

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29
Q

What are 3 syndromes associated with myxomas?

A
  1. LAMB Syndrome
  2. NAME Syndrome
  3. Carney Complex
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30
Q

LAMB syndrome is associated with myxoma.

How did LAMB syndrome acquire it’s name?

(List the associations with the acronym)

A

Lentigines (Liver spots)

Atrial Myxoma

Blue Nevi (Blue pigmented spots)

31
Q

NAME syndrome is associated with myxoma.

How did NAME syndrome acquire it’s name?

(List the associations with the acronym)

A

Nevi

Atrial Myxoma

Myxoid Neurofibroma

Ephelides (Freckle like skin markings)

32
Q

What is the most common primary cardiac tumor >15 years?

33
Q

What is the most common primary cardiac tumor <15 years?

A

Rhabdomyoma

34
Q

Rhabdomyomas are benign or malignant?

35
Q

Frequency of rhabdomyoma found in locations of the heart?

A

Both ventricles = Equivalent

36
Q

rhabdomyoma are associated with what syndrome?

A

Tuberous Sclerosis

37
Q

Are rhabdomyoma usually problematic as patients are older?

A

No, they usually regress

38
Q

Which property is most responsible for reflection of ultraasound?

A

Acoustic Impedence

39
Q

Is bicuspid aortic valve more common in men or women?

A

Men

(4:1 male to female ratio)

40
Q

What 3 syndromes are associated with bicuspid aortic valves?

A
  1. Turner Syndrome
  2. Shone Complex
  3. Kabuki Syndrome
41
Q

How common is a bicuspid aortic valve?

A

VERY COMMON

BAV is the most common cause of heart disease present at birth and affects approximately 1.3%-3% of adults

43
Q

What two other abnormal cardiovascular findings are associated with Bicuspid Aortic Valves?

A
  1. Coarctataion of Aorta (Turner syndrome)
  2. Patent Ductus Arteriosus
44
Q

What occurs on the left side with bicuspid aortic valves

A

Left sided obstructive syndrome

(Low flow = Low grow)

45
Q

What type of VSD is seen with Bicuspid Aortic Valves?

A

Posterior Malalignment VSDs

(Septum shifted posteriorly and leftward)

46
Q

What 4 congenital heart defects is Down Syndrome Associated with?

A
  1. AV canal defect
  2. VSD
  3. ASD
  4. TOF
47
Q

What can occur with turner syndrome of the left heart?

A

Hypoplastic Left heart

48
Q

What 4 cardiovascular abnormalities are seen with DiGeorge Syndrome?

A
  1. Conotruncal Defects
  2. Interrupted Aortic Arch
  3. Truncus Arteriosus
  4. TOF
49
Q

What 2 anatomical cardiovascular abnormalities are seen with Williams syndrome?

A

1. Supravalcular Aortic stenosis

2. Peripheral Pulmonic Stenosis

(Also sudden death with anesthesia)

50
Q

What are 3 congenital heart anatomical abnormalities that are seen with Noonan syndrome?

A
  1. Pulmonic Stenosis
  2. ASD
  3. HOCM
51
Q

What 5 congenital heart defects are seen with Kabuki syndrome?

A

1. Coarctation of the Aorta

2. ASD

Left Sided Stenotic vessels

3. Aortic Stenosis

4. Mitral Stenosis

5. Hypoplastic Left Heart Syndrome

52
Q

Kabuki syndrome is from what genetic etiology?

A

KMT2D

KDM6A

The KMT2D and KDM6A genes belong to a family of genes called chromatin-modifying enzymes. Specifically, these genes code for a histone methyltransferase (KMT2D) and a histone demethylase (KDM6A), and play a part in the regulation of gene expression.

53
Q

Alagille Syndrome has what 3 cardiac abnormalities?

A
  1. Peripheral Pulmonic Stenosis
  2. Pulmonic Stenosis
  3. Tetralogy of Fallot
54
Q

What cardiac anomalies are seen with Barlow’s Syndrome?

A

Myxomatous Mitral Valve with bileaflet prolapse

55
Q

Shone Complex has 7 cardiac anomalies.

Name them

A
  1. Coarctation of the Aorta
  2. Bicuspid Aortic Valve
  3. Aortic Stenosis
  4. Hypoplastic Left heart syndrome
  5. Parachute Mitral Valve (1 papillary muscle)
  6. Supravalvular Mitral Ring
  7. Subaortic Stenosis
56
Q

Wha is the formula for LVSP?

A

LVSP = SBP + Gradient across Aortic Valve (Vmax2 AV)

57
Q

What is the formula for EROA for MR?

A

2πr2 * VelocityAliasing / Velocity MR peak

58
Q

What is the formula for MR regurgitant volume?

A

EROA * (VTIMR)

EROA = 2πr2 * VelocityAliasing / Velocity MR peak

59
Q

What is the formula for RVSP?

A

Change in Pressure (Delta P) = 4V2 + RAP (or CVP)

60
Q

Label 1

A

Middle Cardiac Vein

61
Q

Label 2

A

Coronary Sinus

62
Q

What is the valve to the coronary sinus?

A

Thebesian Valve

63
Q

What is a cone procedure for?

A

Ebstein Anomaly

64
Q

What is a Ross Procedure for?

A

Aortic stenosis or Bicuspid Aortic Valve

65
Q

What is a Warden Procedure for?

A

Sinus Venosus ASD with anomalous pulmonary vein

66
Q

What is a Jatene procedure?

A

d-TGA

(Done initially but part of double switch for L-TGA)

67
Q

What is a Rastelli procedure done for?

A

Double Outlet RV with Pulmonic Stenosis

68
Q

What is a Fontan procedure?

A

Hypoplastic Left Heart Syndrome

“Final” 3rd operation

69
Q

What is a Glenn Procedure?

A

2nd operation for hypoplastic left heart syndrome

70
Q

What is a Norwood procedure?

A

1st procedure for hypoplastic left heart syndrome

71
Q

What is a Kawashima procedure for?

A

Hypoplastic left hearat with interrupted IVC

72
Q

What is a Mustard Procedure for?

A
  1. D-TGA operataion done initially
  2. Still part of double switch for L-TGA
73
Q

How do you calculate the LVEDP using echo?

A

Bernoulli (Use it!)

Delta P = 4 (V)2
AoDP - LVEDP = 4 (VAI late)2

PTE Masters + A Practical Approach to Transesophageal Echocardiography (55 decks)

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