Left to Right shunt Flashcards
3 types of ASD
secundum defect, primum
defect, and sinus venosus defect.
Only defect that lies inside the fossa ovalis
Ostium Secundum Defect
Most common type of ASD
Ostium Secundum Defect
Anterior to the fossa ovalis
Ostium Primum Defect
this is present 10% of ostium secundum ASD
Anomalous pulmo Venous return
Posterior to the fossa ovalis
Sinus Venosus Defect
physical signs of ASD
Relatively slender body build
precordial bulge
hyperdynamic cardiac impulse
medical management of ASD
diuretic in infants with CHF
preferred method for non surgical closure
catheter delivered closure device
kind of murmur in ASD
systolic ejection murmur at 2nd LICS
most common CHD
VSD
location of perimembranous defects (VSD)
beneath aoritc valve, posterior to the papillary muscles
most common VSD
Perimembranous defects
location of indundibular or conal (outlet) VSSD
beneath pulmonic valve
outlet defect is associated with
aortic insufficiency
location of inlet defect
posterior and inferior to the perimembranous
defect beneath the septal leaflet of the tricuspid valve
location of midmuscular defect
posterior to the septal band
location of apical muscular defect
near the cardiac apex
this may be seen in ECG in those with moderate VSD
Left Ventricular Hypertrophy (QRS widening) and
left atrial hypertrophy (Notching of P wave) may be
seen
this may be seen in ECG in those with large VSD
Biventricular hypertrophy with or without LAH
these serve as markers of specific type of VSD except for trabecular defects
cardiac valves
when does Spontaneous closure of perimembranous and muscular
defect occur
first 6 months
CHF in large defect develops not until
6-8 weeks
This is used to assess pulmonary arteriolar resistance
cardiac catheterization
male to female ration of PDA
1:3
PDA is associated with
Low birth weight and congenital Rubella syndrome
if there is PVOD ___ is present in ECG
RVH
PDA in term infants results from
structural
abnormality of the smooth muscle rather than a
decreased responsiveness of the ductal smooth
muscle to oxygen
standard device used for non surgical closure for small PDA <3mm
gianturco stainless steel coils
Larger ductus are closed by
Amplatzer PDA device
weight requirement for closure using amplatzer
> 6kg
standard procedure for surgical closure of PDA
PDA ligation and division
how is VATS clip ligation performed
3 small ports in the 4th ICS
what syndrome in right isomerism
asplenia
what syndrome in left isomerism
polysplenia
syndromes assctd with partal form of avsd
di george\
ellis van creveld
four types of avsd
partial defect
complete
intermediate
common atrium
there is a distinct and separate mitral and tricuspid annuli in this defect
partial avsd
primum asd and cleft mitral v
partial avsd
partial avsd is symptomatic with the presence of
mitral valve insufficiency
ecg features of partial avsd
prolonged PR interval
P-wave changes indicating L and R atrial enlargement
right atrial enlargement in ECG
peaked P wave (p pulmonale)
left atrial enlargement in ECG
notched P wave ( P mitrale)
standard for diagnosis and categorization of partial or complete AVSD
2d echo
what should you do if you want to determine hemodynamic values in AVSD
cardiac catheterization
Usually done on patients with Down syndrome with
inherent pulmonary hypertension, to determine the
operativity of the defect
CARDIAC CATHETERIZATION AND ANGIOGRAPHY
symptoms of artial avsds are more severe due to
MR in infancy
objectives of surgical repair in partial avsd
closure of interatrial communication
Restoration & preservation of the left
atrioventricular valve
in complete avsd there is presence of
complete heart block:
atrioventricular dissociation
symptoms in complete avsd is a result of
- Large increase in pulmonary blood flow
- Increased pulmonary artery pressure
- Insufficiency of the common atrioventricular valve
in terms of axis deviation in ECG, compare partial to complete avsd
complete avsd has more superior axis deviation
gooseneck deformity is seen in
complete avsd
gooseneck deformity is due to
anterior displacement of LVOT in avsd and produces elongation of LVOT
