Lesions

Question 1

Four types of VSDs and location

Answer 1

Membranous
Inlet
Muscular
Outlet/ Malalignment

Question 2

How do you estimate size of a VSD?

Answer 2

< 1/3 of aortic valve = small
1/3 to 100% of aortic valve = moderate
> 100% of aortic valve = large

Question 3

What is the etiology of pulmonary congestion and FTT in a large unrestrictive VSD

Answer 3

LA hypertension from increased left sided flow

Question 4

Why are inlet VSDs hard to repair in the neonatal period?

Answer 4

Poor integrity of the AV valves, which need to be incorporated into the repair

Question 5

What VSD type is associated with aortic valve prolapse?

Answer 5

Outlet and perimembranous VSD. - right aortic cusp

Question 6

What is an EKG finding in ASDs?

Answer 6

RsR’ in lead I and RV conduction delay

Question 7

What does a gooseneck abnormality on echo represent?

Answer 7

AVSD

Question 8

Describe two findings of AVSD on echo

Answer 8

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

Question 9

Where is the HIS bundle in AVC?

Answer 9

Displaced posteriorly and inferiorly

Question 10

What is an EKG finding of AVC?

Answer 10

Northwest axis deviation - inferior in 2, 3 and AVF

Question 11

Rastelli type C AVSD?

Answer 11

common bridging leaflet

Question 12

When is a primary prevention ICD indicated for TOF?

Answer 12

LVEF < 35 and NYHA 2/3

Question 13

How do the locations of anomalous PAs differ between truncus and TOF?

Answer 13

Truncus: Anomalous PA will be same side as arch
TOF: Anomalous PA will be opposite side as arch

Question 14

Describe the arterial switch procedure
- Lesion
- Indications
- Complications

Question 15

Describe the Rastelli procedure for TGA
- Indications
- Technique

Answer 15

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

Question 16

Three common associations with ccTGA

Answer 16

1) Tricuspid valve abnormallities (most common)
2) VSD
3) LVOTO

Question 17

Describe the upper and lower extremity sat gradient in dTGA.
- normally
- conditions for reverse gradient

Answer 17

Normally- no gradient. Sats 75-80.
Reverse gradient- dTGA with pHTN.

Question 18

What EP finding is commonly associated with ccTGA?

Answer 18

Complete heart block

Question 19

Describe the difference between physiologic and anatomic repair in ccTGA

Answer 19

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

Question 20

How does an aortic ventricular tunnel present?

Answer 20

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

Question 21

What sinus is most frequently involved in a sinus of valsava aneursym?

Answer 21

right sinus

Question 22

Describe the pattern of differential cyanosis seen in coarctation with PDA

Answer 22

upper extremities: normal sats
lower extremities: lower sats

Question 23

What are the extremity saturations in type B IAA with abberant R subclavian

Answer 23

All extremities are desaturated

Question 24

Most common indication for re-operation in partial AVSD

Answer 24

Mitral regurgitation/ stenosis in the setting of a mitral cleft

Question 25

What type of AVSD is LVOTO more likely?

Answer 25

Those with two valve orifices such as partial and transitional

Question 26

Common EKG finding after AVSD repair

Answer 26

Right bundle branch block - can also present with newly split S2

Question 27

Where is the HIS bundle in perimembranous VSD

Answer 27

Inferior and posterior

Question 28

Where is the HIS bundle in an inlet VSD

Answer 28

Superior and anterior

Question 29

Indomethacin vs. Ibuprofen for PDA closure

Answer 29

Theoretically less effect on cerebral blood flow but same rates of intraventricular hemorrhage

Question 30

What is the gender predilection in Sinus of Valsava aneurysms?

Answer 30

75% male

Question 31

What sinus is usually involved in a Sinus of Valsava aneurysm?

Answer 31

Right

Question 32

What additional defects are often seen in Sinus of Valsava aneurysm?

Answer 32

VSD (50% of patients)

Question 33

Do pulmonary AVMs create high output cardiac failure?

Answer 33

No. Cardiac output is the same when pulmonary AVM present.

Question 34

What is the PVR often like in a patient with pulmonary AVMs when obtained in the cath lab

Answer 34

Normal. AVM has low PVR but often surrounding tissue is increased, so cancels out

Question 35

What is the second most common cause of vascular ring?

Answer 35

Right aortic arch with diverticulum of Kommerrell

Question 36

Balloon angioplasty of unilateral PA stenosis- size balloon?

Answer 36

3-4 x the size of the narrowest portion

Question 37

% of patients with RV dependent coronary circulation in PA with intact septum

Answer 37

<10%

Question 38

What structure provides the pulmonary blood flow in PA with intact septum?

Answer 38

Ductus

Question 39

MPA trunk in PA with intact septum: Present, absent or depends?

Answer 39

Present

Question 40

When is re-opening the VSD indicated in patients following complete repair of PA/IVS

Answer 40

If RV pressure is > 70%

Question 41

Truncus arteriosus repair in older children: When is PVR prohibitive?

Answer 41

< 2 years: PVR 8 that decreases to less than that with vasoreactivity testing, can proceed > 2 years: PHTN is irreversible, palliative procedure only

Question 42

Where is a fibroma usually located? What is it associated with?

Answer 42

Fibroma = Free wall of the ventricle Associated with ventricular arrhythmia

Question 43

What lesion is associated with interrupted aortic arch with intact ventricular septum (type a) ?

Answer 43

AP window

Question 44

Most common intracardiac tumor in children and infants

Answer 44

Rhabdomyomas

Question 45

Describe echo qualities of rhabdomyomas: - Where are they - Single or numerous - Color

Answer 45

- Can be anywhere, usually the ventricle - Numerous - Bright white on echo

Question 46

What triad do patients with myxomas usually present with?

Answer 46

- Cardiac obstruction - Embolization - Systemic illness

Question 47

Where are myxomas usually present?

Answer 47

Left atrium, attached to fossa ovalis

Question 48

The murmur of what lesion increases after a PVC?

Answer 48

Aortic stenosis

Question 49

Most common lesion found in CCTGA

Answer 49

VSD followed by LVOTO then tricuspid valve dysplasia

Question 50

What is a Gerbode defect?