Lesions Flashcards
Four types of VSDs and location
Membranous
Inlet
Muscular
Outlet/ Malalignment
How do you estimate size of a VSD?
< 1/3 of aortic valve = small
1/3 to 100% of aortic valve = moderate
> 100% of aortic valve = large
What is the etiology of pulmonary congestion and FTT in a large unrestrictive VSD
LA hypertension from increased left sided flow
Why are inlet VSDs hard to repair in the neonatal period?
Poor integrity of the AV valves, which need to be incorporated into the repair
What VSD type is associated with aortic valve prolapse?
Outlet and perimembranous VSD. - right aortic cusp
What is an EKG finding in ASDs?
RsR’ in lead I and RV conduction delay
What does a gooseneck abnormality on echo represent?
AVSD
Describe two findings of AVSD on echo
In apical 4 chamber, the tricuspid and mitral valve are on the same plane
Gooseneck abnormality from sprung aorta in the absence of the conal septum
Where is the HIS bundle in AVC?
Displaced posteriorly and inferiorly
What is an EKG finding of AVC?
Northwest axis deviation - inferior in 2, 3 and AVF
Rastelli type C AVSD?
common bridging leaflet
When is a primary prevention ICD indicated for TOF?
LVEF < 35 and NYHA 2/3
How do the locations of anomalous PAs differ between truncus and TOF?
Truncus: Anomalous PA will be same side as arch
TOF: Anomalous PA will be opposite side as arch
Describe the arterial switch procedure
- Lesion
- Indications
- Complications
Describe the Rastelli procedure for TGA
- Indications
- Technique
Used in cases of VSD and LVOTO
No arterial switch
Baffling of the blood from the LV through the VSD to the aorta followed by creation of an RV-PA conduit
Three common associations with ccTGA
1) Tricuspid valve abnormallities (most common)
2) VSD
3) LVOTO
Describe the upper and lower extremity sat gradient in dTGA.
- normally
- conditions for reverse gradient
Normally- no gradient. Sats 75-80.
Reverse gradient- dTGA with pHTN.
What EP finding is commonly associated with ccTGA?
Complete heart block
Describe the difference between physiologic and anatomic repair in ccTGA
Physiologic: VSD closure +/- LVOTO repair. Already phsyiologically “normal” so just addressing associated lesions
Anatomic repair:
- Double switch: Atrial and arterial so that the LV is systemic
- Atrial switch with Rastelli if arterial switch is not possible 2/2 LVOTO
How does an aortic ventricular tunnel present?
Similarly to severe AI with bounding pulses, to-fro murmur except that the aortic valve is competent! Can also see this in a sinus of valsava fistula to the LV
What sinus is most frequently involved in a sinus of valsava aneursym?
right sinus
Describe the pattern of differential cyanosis seen in coarctation with PDA
upper extremities: normal sats
lower extremities: lower sats
What are the extremity saturations in type B IAA with abberant R subclavian
All extremities are desaturated
Most common indication for re-operation in partial AVSD
Mitral regurgitation/ stenosis in the setting of a mitral cleft
What type of AVSD is LVOTO more likely?
Those with two valve orifices such as partial and transitional
Common EKG finding after AVSD repair
Right bundle branch block - can also present with newly split S2
Where is the HIS bundle in perimembranous VSD
Inferior and posterior
Where is the HIS bundle in an inlet VSD
Superior and anterior
Indomethacin vs. Ibuprofen for PDA closure
Theoretically less effect on cerebral blood flow but same rates of intraventricular hemorrhage
What is the gender predilection in Sinus of Valsava aneurysms?
75% male
What sinus is usually involved in a Sinus of Valsava aneurysm?
Right
What additional defects are often seen in Sinus of Valsava aneurysm?
VSD (50% of patients)
Do pulmonary AVMs create high output cardiac failure?
No. Cardiac output is the same when pulmonary AVM present.
What is the PVR often like in a patient with pulmonary AVMs when obtained in the cath lab
Normal. AVM has low PVR but often surrounding tissue is increased, so cancels out
What is the second most common cause of vascular ring?
Right aortic arch with diverticulum of Kommerrell
Balloon angioplasty of unilateral PA stenosis- size balloon?
3-4 x the size of the narrowest portion
% of patients with RV dependent coronary circulation in PA with intact septum
<10%
What structure provides the pulmonary blood flow in PA with intact septum?
Ductus
MPA trunk in PA with intact septum: Present, absent or depends?
Present
When is re-opening the VSD indicated in patients following complete repair of PA/IVS
If RV pressure is > 70%
Truncus arteriosus repair in older children: When is PVR prohibitive?
< 2 years: PVR 8 that decreases to less than that with vasoreactivity testing, can proceed
> 2 years: PHTN is irreversible, palliative procedure only
Where is a fibroma usually located? What is it associated with?
Fibroma = Free wall of the ventricle
Associated with ventricular arrhythmia
What lesion is associated with interrupted aortic arch with intact ventricular septum (type a) ?
AP window
Most common intracardiac tumor in children and infants
Rhabdomyomas
Describe echo qualities of rhabdomyomas:
- Where are they
- Single or numerous
- Color
- Can be anywhere, usually the ventricle
- Numerous
- Bright white on echo
What triad do patients with myxomas usually present with?
- Cardiac obstruction
- Embolization
- Systemic illness
Where are myxomas usually present?
Left atrium, attached to fossa ovalis
The murmur of what lesion increases after a PVC?
Aortic stenosis
Most common lesion found in CCTGA
VSD followed by LVOTO then tricuspid valve dysplasia
What is a Gerbode defect?
