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PTE Masters + A Practical Approach to Transesophageal Echocardiography > Intro to Congenital Heart Disease > Flashcards

Intro to Congenital Heart Disease Flashcards

1
Q

What are the 4 types of ASD’s?

A
  1. Ostium Secundum
  2. Ostium Primum
  3. Sinus Venosus
  4. Coronary Sinus
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2
Q

What is the most common type of ASD?

A

Secundum

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3
Q

What is ASD Secundum associatad with?

A

Mitral Valve Prolapse (MVP)

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4
Q

ASD Secundum is amenable to what therapy?

A

Closure in the cath lab

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5
Q

Where is primum ASD found near?

A

Close to AV Valves

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6
Q

ASD Primum has what leaflet disorders?

A
  1. Cleft AV Valve Leaflets
  2. Cleft Septal Tricuspid Valve Leaflets
  3. Cleft Anterior Mitral Valve Leaflets
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7
Q

ASD Primum associated with what systemic pathology?

A

Trisomy 21

Endocardial Cushion Defect

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8
Q

What are the two types of Sinus Venosus defect?
which is more common?

A

Superior Vena Cavae Sinus Venosus ASD >. Inferior Vena Cavae Sinus Venosus ASD

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9
Q

Superior Sinus Venosus ASD is associated with what syndrome?

A

Anomalous Pulmonary Venous Drainage of the right upper pulmonray vein

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10
Q

Inferior Sinus Venosus VSD is associated with what syndrome?

A

Scimitar syndrome

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11
Q

What is a coronaray sinus ASD associated with?

A

Persistent left superior vena cavae

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12
Q

Primum ASD classified as what type of AV Canal?

A

Partial AV Canal

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13
Q

Primum ASD with restrictive inlet VSD classified as what type of AV Canal?

A

Transitional AV Canal

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14
Q

Primum ASD with non-restrictive inlet VSD classified as what type of AV Canal?

A

Complete AV Canala

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15
Q

What is simetar syndrome?

A
  1. Hypoplastic RLL of the lung
  2. Aorto to Pulmonray Collateral blood flow of RLL
  3. Anomalous pulmonary venous drainage to “Simetar sword” from RLL to IVC
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16
Q

What is a coronary sinus ASD

A

Persistent Left Superior Vena Cava that drains into the Coronary Sinus

Defect is an unroofing of Coronary Sinus allowing higher pressure LA blood to drain into the CS and then drain into the low pressure RA

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17
Q

Where is aa secundum ASD located?

A

Fossa Ovalis

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18
Q

In both of these images, what is the bottom right arrow pointing to?

What is the relevance to this positioning?

A

Crista Terminalis

The crista terminalis is generally a smooth-surfaced, thick portion of heart muscle in a crescent shape at the opening into the right atrial appendage.

Secumdum ASD = Middle

Sinus Venosus ASD = Closer to Crista Terminalis

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19
Q

What type of ASD is present here?

A

Secundum ASD = Located in the Fossa Ovalis

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20
Q

What is seen here?

A

PFO

*NOTE: PFO does not equal ASD*

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21
Q

What is the difference between a PFO and an ASD?

A

Patent foramen ovale (PFO) and is flap-like valve in between left and right atria found in ~ 25 percent of adults that remains open as an intraatrial shunt

ASD = Open communication between the atria after septation (4 types as discussed)

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22
Q

What is the flap seen here?

A

Flap = Septum Primum and is what is a PFO with blood coming under the flap

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23
Q

Due to the location of primum ASD, what is a common sequalae that needs to be addressed emergently?

A

Complete heart block after repair (Due to close proximity to AV Valve (AV nodes)

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24
Q

What exactly is an endocardial cushion defect?

A

Primum ASD + Inlet VSD = Complete AV Canal

Involve AV septum and AV valves

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25
Q

What is seen at the green arrow?

A

Ostium Primum

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26
Q

What is seen in the middle arrow?

A

Complete AV canal

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27
Q

What is seen here?

A

Sinus Venosus ASD

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28
Q

Sinus Venosus VSD associated with?

A

Anomalous Pulmonary Venous Return

Sinus Venosus = Anomalous Pulmonary Venous return

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29
Q

How do you see a sinus venosus defect?

A

Pull back from ME 4 chamber as this is a higher defect

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30
Q

What is the size of a normal coronary sinus?

A

<10 mm

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31
Q

What is seen in a coronary sinus ASD?

A

Dilated coronary sinus >10 mm

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32
Q

How will you investiagate a Coronary Sinus ASD?

A

Left sided IV –> Inject contrast

Coronary sinus bubbles/contrast will light up first before filling RA due to persistent Left SVC

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33
Q

What are the 4 major ways of classifying VSD in terms of location?

A
  1. Relative to Crista Supraventricularis
  2. Relative to RV inflow/outflow
  3. Relationship to the Semilunar Valves
  4. Relationship to the septum
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34
Q

What are the two subclasses of crista supraventricular VSD?

A

Infracristal vs. Supracristal

35
Q

What are the two subclasses of VSD relative to the RV inflow and outflow?

A

Inlet vs. Outlet

36
Q

What are the subclasses of VSD in relationship to semilunara valves?

A

Subaortic and Subpulmonic

37
Q

What are the VSD subclasses in relationship to the septum?

A

Malalignment

Membranous vs. Muscular

38
Q

What are the “A” types of VSD seen here?

A

A = Outlet (Subpulmonic)

39
Q

What are the “B” types of VSD seen here?

A

B = Membranous (Subaortic)

40
Q

What are the “C” types of VSD seen here?

41
Q

What are the “D” types of VSD seen here?

A

D = Muscular (Trabecular)

42
Q

What is the most common type of VSD?

A

Membranous (Guess this on the exam)

43
Q

What are the other names for Membranous VSD?

A

Para

Peri

Infracristal

Subaortic

44
Q

What are the other names for Conoventricular VSD?

A

Infracristal Subaortic

45
Q

What are the other names for Outlet VSD?

A

Subpulmonic

Supracristal

Conal

Intraconal

Subarterial

46
Q

What are the other names for Inlet VSD?

A

AV Canal Type

47
Q

What are the other names for Muscular VSD?

A

Trabecular

48
Q

What is an inlet VSD associated with?

A

Trisomy 21

Cleft AV valve leaflets

49
Q

What type of VSD is seen with Tetrology of Fallot?

A

Anterior Malalignment VSD that is classified as a membranous vs. conoventricular ASD

*Ask Echo attending*

50
Q

What are the 4 criteria of Tetrology of Fallot?

A
  1. VSD (Anterior Malignment)
  2. Over-riding Aorta causing outflow tract obstruction
  3. Right Ventricular Hypertrophy
  4. Pulmonary Obstruction (Pulmonic Stenosis, Right and Main PA stenosis)
51
Q

What type of VSD is this?

A

Membranous VSD

52
Q

Outlet VSD are associated with what?

A

Prolapse of the Right Coronary Cusp

53
Q

Outlet VSD are:

Anterior or Posterior?

A

Anterior (Will see in ME 5 chamber) near LVOT

54
Q

What are the synonyms for Outlet VSDs?

A

Subpulmonic

Supracristal

Conal

Intraconal

Subarterial

Doubly Committed

Type 1

55
Q

What type of VSD is seen here?

A

Outlet aka Subpulmonic aka Subarterial aka Conal aka Supracristal VSD

56
Q

What is are an inlet VSD associated with?

A

Cleft Anterior Mitral Valve Leaflets

57
Q

Inlet VSD and a Primum ASD make up what?

A

Complete AV Canal

(Primum ASD by itself = Partial AV Canal)

58
Q

Primum ASD with Restrictive Inlet VSD = What?

A

Transitional AV Canal

59
Q

Inlet VSD are associated with what syndrome?

A

Trisomy 21

60
Q

What are the 4 synonyms for Inlet VSDs?

A
  1. AV Canal Type ASD
  2. Endocardial Cushion Defect
  3. AV Septal Defect VSD
  4. Type 3 VSD
61
Q

What is seen here?

A

Complete AV Canal

  1. Inlet VSD shown
  2. Primum ASD shown
62
Q

What primary change in a TOF creates the 4 anatomic/physiological phenomenon?

A

Anterior and Rightward Shifted Septum

Leads to:

  1. Overriding Aorta
  2. VSD
  3. Pulmonary Obstruction
  4. RVH
63
Q

What is seen at A?

A

Membranous VSD

64
Q

What is associated with A?

A

LV septal Aneurysm (TV tissue plugging the hole)

65
Q

What is Scmitar Syndrome associated with?

A

Inferior Sinus Venosus Defect (ASD)

Scmitar vein that drains from the hypoplastic low lower lobe to the IVC

(Vein looks like an Arabian Sword)

66
Q

What type of VSD is associated with AV canal defect?

67
Q

Trisomy 21 is associated with what VSD?

68
Q

Defect in the septum primum results in what type of ASD?

A

Secundum ASD

69
Q

What is Label B?

A

Primum ASD

70
Q

What is Label C?

71
Q

What arch abnormality is seen in 25% of TOF patients?

A

Right aortic arch

72
Q

What type of VSD is seen in TOF patients?

A

Anterior Malalignment VSD

73
Q

Why would a PFO not be repaired for a TOF repair?

A
  1. PFO allows for decompression (pop-off valve for the RV)
  2. Augment LV filling at expense of oxygenation
74
Q

Why is RV failure common after TOF repair?

A
  1. Right Ventriculotomy to address RVOT
  2. Thick RV (Not protected well from cardioplegia)
  3. Bubbles cascade down anterior RCA worsens RV function after bypass
75
Q

Mitral Valve Prolapse is associated with what ASD?

A

Secundum ASD

76
Q

Persistent Left SVC is associated with what ASD?

A

Coronary Sinus ASD

77
Q

Trisomy 21 associated with what ASD?

A

Ostium primum ASD

78
Q

Cleft Anterior Mitral valve leaflet associated with what intercardiac communication(s)?

Name 2

A

Primum ASD

Inlet VSD

79
Q

Anomalous Pulmonaray Venous Return is associated with what ASD?

A

Sinus Venosus ASD

80
Q

What is the most common ASD?

A

Secundum ASD

81
Q

Where are secundum ASD located?

A

Fossa Ovalis

82
Q

Secundum ASD a result from a defect in what?

A

Septum Primum

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