High yield PTEexam review part 36 - 38 Flashcards by Tim Montrief

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

Inferiorly

and

Posterioly

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What is the release criteria for a Watchman?

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

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

17 and 31 mm

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

Equal to or greaater than the ostium width

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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

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

(What vena contracta is normal)

<5 mm is ok

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Label 1 - 4

1 Aorta

2 RPA

3 RUPV

4 IVC

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When does Pressure Recovery occur?

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

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What 3 risk factors exist for Pressure Recovery?

Small Aortic Root
Small aortic valve
Mechanical valve

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

See image

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What does the backing material do to bandwidth?

increases bandwidth

(Creates wider range of frequencies)

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What does the backing material do to spatial pulse length?

Decreases SPL

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How does backing material affect axial resolution?

Improves axial resolution

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

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How does the backing material affect Q factor?

Decreases Q factor

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What is the formula for Q factor?

Resonant Frequency* / *Bandwidth

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What two heart conditions are found in Lutembacher Syndrome?

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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What is the cosine of 0 degrees?

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What is the cosine of 10 degrees?

-0.8

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What is the cosine of 20 degrees?

0.94

(Underestimates by 6%)

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What is the cosine of 60 degrees?

0.5

We are measuring 50% of the true velocity

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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?

Type 1b

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What is Type 1a Aortic Regurgitation Morphology?

Normal Leaflet Motion

Sinotubular Junction Enlargement & Dilation of Ascending Aorta

1A = (Ascending Aorta)

“A = A”

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What is Type 1b Aortic Regurgitation Morphology?

Dilation of the Sinuses of Valsalva and Sinotubular Junction

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What is Type 1c Aortic Regurgitation Morphology?

Dilation of the Annulus (Ventriculoarterial Junction)

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Type 1d Aortic Regurgitation Morphology

**Perforation** "Dog bite a hold in the cusp"

What is Type II A.I. Morphology?

Tyle II Cusp Prolapse | (Excessive Leaflet motion)

What is Type III A.I. Morphology?

Cusp Restriction

What type of VSD is seen with RCC prolapse?

Membranous VSD and Outlet VSD

What are 3 syndromes associated with myxomas?

1. LAMB Syndrome 2. NAME Syndrome 3. Carney Complex

**LAMB** syndrome is associated with myxoma. *_How did LAMB syndrome acquire it's name?_* (List the associations with the acronym)

**L**entigines (Liver spots) **A**trial **M**yxoma **B**lue Nevi (Blue pigmented spots)

NAME syndrome is associated with myxoma. How did NAME syndrome acquire it's name? (List the associations with the acronym)

**N**evi **A**trial Myxoma **M**yxoid Neurofibroma **E**phelides (Freckle like skin markings)

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

Myxoma

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

Rhabdomyoma

Rhabdomyomas are benign or malignant?

Benign

Frequency of rhabdomyoma found in locations of the heart?

Both ventricles = Equivalent

rhabdomyoma are associated with what syndrome?

Tuberous Sclerosis

Are rhabdomyoma usually problematic as patients are older?

No, they usually regress

Which property is most responsible for *_reflection_* of ultraasound?

Acoustic Impedence

Is bicuspid aortic valve more common in men or women?

**Men** | (4:1 male to female ratio)

What 3 syndromes are associated with bicuspid aortic valves?

1. Turner Syndrome 2. Shone Complex 3. Kabuki Syndrome

How common is a bicuspid aortic valve?

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

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

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

What occurs on the left side with bicuspid aortic valves

**Left sided obstructive syndrome** | (Low flow = Low grow)

What type of VSD is seen with Bicuspid Aortic Valves?

**Posterior Malalignment VSDs** (Septum shifted posteriorly and leftward)

What 4 congenital heart defects is Down Syndrome Associated with?

1. AV canal defect 2. VSD 3. ASD 4. TOF

What can occur with turner syndrome of the left heart?

Hypoplastic Left heart

What 4 cardiovascular abnormalities are seen with DiGeorge Syndrome?

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

What 2 anatomical cardiovascular abnormalities are seen with Williams syndrome?

**1. Supravalcular Aortic stenosis** **2. Peripheral Pulmonic Stenosis** (Also sudden death with anesthesia)

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

1. Pulmonic Stenosis 2. ASD 3. HOCM

What 5 congenital heart defects are seen with Kabuki syndrome?

**1. Coarctation of the Aorta** **2. ASD** Left Sided Stenotic vessels **3. Aortic Stenosis** **4. Mitral Stenosis** **5. Hypoplastic Left Heart Syndrome**

Kabuki syndrome is from what genetic etiology?

**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.

Alagille Syndrome has what 3 cardiac abnormalities?

1. Peripheral Pulmonic Stenosis 2. Pulmonic Stenosis 3. Tetralogy of Fallot

What cardiac anomalies are seen with Barlow's Syndrome?

Myxomatous Mitral Valve with bileaflet prolapse

Shone Complex has 7 cardiac anomalies. Name them

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

Wha is the formula for LVSP?

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

What is the formula for EROA for MR?

2πr² \* Velocity_Aliasing / Velocity _{MR peak}

What is the formula for MR regurgitant volume?

**EROA \* (VTI_MR)** EROA = 2πr² \* Velocity_Aliasing / Velocity_{MR peak}

What is the formula for RVSP?

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

Label 1