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Lesions Flashcards

1
Q

Four types of VSDs and location

A

Membranous
Inlet
Muscular
Outlet/ Malalignment

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2
Q

How do you estimate size of a VSD?

A

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

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3
Q

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

A

LA hypertension from increased left sided flow

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4
Q

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

A

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

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5
Q

What VSD type is associated with aortic valve prolapse?

A

Outlet and perimembranous VSD. - right aortic cusp

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6
Q

What is an EKG finding in ASDs?

A

RsR’ in lead I and RV conduction delay

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7
Q

What does a gooseneck abnormality on echo represent?

A

AVSD

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8
Q

Describe two findings of AVSD on echo

A

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

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9
Q

Where is the HIS bundle in AVC?

A

Displaced posteriorly and inferiorly

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10
Q

What is an EKG finding of AVC?

A

Northwest axis deviation - inferior in 2, 3 and AVF

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11
Q

Rastelli type C AVSD?

A

common bridging leaflet

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12
Q

When is a primary prevention ICD indicated for TOF?

A

LVEF < 35 and NYHA 2/3

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13
Q

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

A

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

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14
Q

Describe the arterial switch procedure
- Lesion
- Indications
- Complications

A
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15
Q

Describe the Rastelli procedure for TGA
- Indications
- Technique

A

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

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16
Q

Three common associations with ccTGA

A

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

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17
Q

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

A

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

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18
Q

What EP finding is commonly associated with ccTGA?

A

Complete heart block

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19
Q

Describe the difference between physiologic and anatomic repair in ccTGA

A

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

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20
Q

How does an aortic ventricular tunnel present?

A

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

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21
Q

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

A

right sinus

22
Q

Describe the pattern of differential cyanosis seen in coarctation with PDA

A

upper extremities: normal sats
lower extremities: lower sats

23
Q

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

A

All extremities are desaturated

24
Q

Most common indication for re-operation in partial AVSD

A

Mitral regurgitation/ stenosis in the setting of a mitral cleft

25
Q

What type of AVSD is LVOTO more likely?

A

Those with two valve orifices such as partial and transitional

26
Q

Common EKG finding after AVSD repair

A

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

27
Q

Where is the HIS bundle in perimembranous VSD

A

Inferior and posterior

28
Q

Where is the HIS bundle in an inlet VSD

A

Superior and anterior

29
Q

Indomethacin vs. Ibuprofen for PDA closure

A

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

30
Q

What is the gender predilection in Sinus of Valsava aneurysms?

A

75% male

31
Q

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

A

Right

32
Q

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

A

VSD (50% of patients)

33
Q

Do pulmonary AVMs create high output cardiac failure?

A

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

34
Q

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

A

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

35
Q

What is the second most common cause of vascular ring?

A

Right aortic arch with diverticulum of Kommerrell

36
Q

Balloon angioplasty of unilateral PA stenosis- size balloon?

A

3-4 x the size of the narrowest portion

37
Q

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

A

<10%

38
Q

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

A

Ductus

39
Q

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

A

Present

40
Q

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

A

If RV pressure is > 70%

41
Q

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

A

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

42
Q

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

A

Fibroma = Free wall of the ventricle
Associated with ventricular arrhythmia

43
Q

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

A

AP window

44
Q

Most common intracardiac tumor in children and infants

A

Rhabdomyomas

45
Q

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

A
  • Can be anywhere, usually the ventricle
  • Numerous
  • Bright white on echo
46
Q

What triad do patients with myxomas usually present with?

A
  • Cardiac obstruction
  • Embolization
  • Systemic illness
47
Q

Where are myxomas usually present?

A

Left atrium, attached to fossa ovalis

48
Q

The murmur of what lesion increases after a PVC?

A

Aortic stenosis

49
Q

Most common lesion found in CCTGA

A

VSD followed by LVOTO then tricuspid valve dysplasia

50
Q

What is a Gerbode defect?

A

Board Prep (16 decks)

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