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Echo 3 > Module 1: Basic Embryology and Septal Defects > Flashcards

Module 1: Basic Embryology and Septal Defects Flashcards

1
Q

when is the heart formed in the fetus

A

3-7 weeks gestation

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2
Q

which organ is the first develop in the fetus

A

heart

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3
Q

at week 3 what structure begins to appear

A
  • the cardiogenic area
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4
Q

where is the fetal heart tup located

A
  • within the pericardium
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5
Q

what is the direction of the blood flow in the endocardial tube

A
  • unidirectional
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6
Q

what must the heart tube do to form the heart

A
  • heart tube must fuse and twist
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7
Q

where is the trunks arteriosis located

A
  • remains near the superior part of the heart
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8
Q

what structures are formed from the trunks arteriosis

A
  • semilunar valves

- aortic root and pulmonary root

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9
Q

what does the looping of the heart form

A
  • forms the 2 atria and 2 ventricle
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10
Q

what is the normal direction of looping

A
  • right wards
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11
Q

what is the abnormal direction of looping and what does it result in

A
  • leftwards

- left transposition of the great arteries

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12
Q

what are the three stages of atrial septal formation

A 
stage one - septum premum 
stage two - foramen secundum 
stage three - secundum septum 
stage four - foramen ovale valve 
stage five - at birth
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13
Q

stage one of atrial septal formation: septum premum - what does the septum premum separate

A
  • divides atrium into right and left halves
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14
Q

stage one of atrial septal formation: septum premum - where is the origin of the septum and where does it travel

A
  • extends downward from roof of common atrium

- towards the endocardial cushions

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15
Q

stage one of atrial septal formation: septum premum - what is the foramen premum

A
  • between the lower margin of the septum primum and the endocardial cushion
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16
Q

stage two of atrial septum formation: foramen secundum - how is the foramen secundum formed

A
  • septum primum grows inferiorly toward the endocardial cushions closing the foramen primum
  • a perforation appears int eh upper portion of the septum primum becoming the foramen secundum
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17
Q

stage three of atrial septum formation: secundum septum: where is the origin of the secundum septum and what does it form

A
  • grows inferiorly to eh right of the septum primum
  • this partially overlaps the foramen secundum
  • forms the foramen ovale
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18
Q

what pressure keeps the flap of the foramen ovale open

A
  • increased right atrial pressure in the fetus
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19
Q

stage four of atrial septum formation: foramen ovale valve - how is the valve formed

A
  • upper septum primum disappears
  • lower part of septum primum becomes the valve for the foramen ovale
  • the septum secundum starts growing superiorly from AV cushions
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20
Q

stage five of atrial septum formation: at birth - how is the foramen ovale shut

A
  • increased systemic vascular resistance + decreased RA pressure
  • the increase in pressure pushes the valve against the septum secundum closing the hole
  • eventually they fuse
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21
Q

what are the 4 locations of interatrial septal defects

A
  1. ostium primum ASD
  2. ostium secundum ASD
  3. patent foramen ovale (fossa ovalis)
  4. sinus venosus ASD
    • superior (SVC), inferior (IVC)
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22
Q

what is the most common type of ASD

A
  • ostium secundum
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23
Q

what are the 4 stages to ventricular septal formation

A

stage one = trabecular IVS
stage two = TO and MO formation
stage three = truncus formation
stage four = membranous septum

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24
Q

stage one of ventricular septal formation : trabecular IVS - how are the RV and LV formed

A
  • the bulbus Cordis becomes the RV

- he Primitive Ventricle becomes the LV

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25
Q

stage one of ventricular septal formation : trabecular IVS - where is the origin of the trabecular IVS (muscular) and are does it travel

A
  • grows from apex to base
  • stops part way between the ventricles
  • this allows blood flow from other ventricles to exit the truncus arteriosus through the inter ventricular foramen
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26
Q

stage two of ventricular septal formation: TO and MO formation - how is the TO and MO formed

A
  • truncus arteriosus and AV cancan move more centrally

- tricuspid and mitral orifices form

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27
Q

stage two of ventricular septal formation: TO and MO formation - how is the rest of the IVS formed

A
  • growth of the inlet portion of the inter ventricular septum
  • fusion of the inlet and trabecular IVS form the IVS
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28
Q

stage three of ventricular septal formation: truncus formation - how are the two great vessels formed from the truncus arteriosis

A
  • truncus arteriosus divides with formation of conotruncal septum to form the proximal aorta and pulmonary artery
  • septum then forms in spiral fashion
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29
Q

hoe is the aortic and pulmonary root form

A
  • conus cordis divides outflow tract into right and left
  • ## two swelling in the truncus arteriosus begin to grow which form a septum
30
Q

Step four of ventricular septum formation: membraneous septum

A
  • once truncus arteriosus divides, the membranous IVS forms to complete the right heart and left heart separation sequence
31
Q

what are the 4 typical locations of VSD and which is most common

A
  • membraneous MOST COMMON
  • inlet VSD
  • muscular VSD
  • outlet VSD
32
Q

what are the 2 sub locations of outlet VSDs and what is there location

A
  • supracristal = above crista supraventricularis ridge (seen close to PV in SAX)
  • infracristal = below crista supraventricularis ridge (seen directly anterior to AO valve in SAX)
33
Q

what type of CHD is a VSD

A
  • acyanotic

- not bad enough to cause serious hypoxia

34
Q

which way is the blood shunted with a VSD

A
  • left heart to right heart
35
Q

what is the tool used to assess any shunt

A
  • Qp/Qs
36
Q

where and what views would we see a perimembraneous VSD

A
  • PLAX,
  • PSAX at AO valve 9-12 O’clock
  • AP 5
  • subcostal 5
37
Q

where and what views would we see a muscular/trabecular VSD

A
  • PLAX
  • PSAX (LV-pap level & apex)
  • AP 4 &5
  • subcostal 4 & 5
  • SAX views
38
Q

where and what views would we see a outlet VSD

A
  • PLAX
  • PSAX (ao valve 12-3 o’clock)
  • subcostal 5
  • SAX of AO
39
Q

where and what views would we see an inlet VSD

A
  • PSAX (MV and LV at pap level)
  • AP 4
  • subcostal 4
40
Q

what is Qp

A
  • volume of blood going to lungs
41
Q

what si Qs

A
  • volume of blood going to aorta
42
Q

how is Qp calculated

A
  • from pulmonary arterial stoke volume

- RVOT diameter and VTI of RVOT flow

43
Q

how is Qs calculated

A
  • LVOT diameter and VTI of LVOT
44
Q

what is the normal Qp/Qs

A

1:1

45
Q

what Qp/Qs indicated a hemodynamically significant shunt

A
  • ratio greater than 1.5:1
46
Q

what Qp/Qs corresponds to a small shunt and what is the treatment

A
  • 1 - 1.5: 1

- none or septal occlude device

47
Q

what Qp/Qs corresponds to a moderate shunt and what is the treatment

A
  • 1.5-2.0: 1

- septal occluder device or septal patch

48
Q

what Qp/Qs corresponds to a large shunt and what is the treatment

A
  • > 2.0:1

- foetal patch

49
Q

what is the flow through the heart with an ASD

A
  • flow enters RA from the LA through the ASD
  • flow to the lungs through the TV and RVOT flow in increased
  • flow entering the LA through the pulmonary veins is increased
50
Q

what is flow through the heart with a VSD

A
  • flow from the LV enters the RV through the VSD
  • RVOT flow in increased
  • flow to the lungs is increased
  • flow to the pulmonary veins and MV is increased
  • may lead to the dilation of RV and LA
51
Q

how to calculate Qp

A 
- measure RVOT diameter 
   \+ during systole, <5mm from pulmonary annulus, inner to inner
- CSA = 0.785 x d^2
- trace RVOT VTI 
- Qp = CSA x VTI
52
Q

how to calculate Qs

A 
- measure LVOT diameter 
  \+ during systole 
  \+ < 5mm from annulus 
- CSA = 0.785 x d^2
- trave LVOT VTI
- Qs = CSA x VTI
53
Q

what rules is changed when obtaining a Qp and Qs with a PDA

A
  • Qp derived from LVOT

- Qs derived from RVOT

54
Q

what is the flow through the heart with PDA flow

A
  • flow shunts from descending ao to the pulmonary artery
  • flow to the lungs is increased
  • flow the pulmonary veins, LA, MV, LV, LVOT increased
  • entire left heart has increased volume
55
Q

how to calculate RVSP in presence of VSD

A

RVSP = BP systolic - 4 x (Vmax VSD)^2

56
Q

what is eisenmengers syndrome

A
  • shunt direction is switched to right to left

- caused by large shunt with high volume to lungs causing lung damage increasing pulmonary resisitncae

57
Q

what are 6 complications of eisenmengers syndrome

A
  • CHF
  • early death
  • brain abscess
  • SBE
  • pulmonary infarction
  • pregnancy contraindicated
58
Q

how do we report intracardiac shunts

A
  • segmental approach to describe VSD
59
Q

what are the 2 function of the endocardial cushions

A
  • divide AV canal into 2 atrioventricular orifices

- assist in closure of ostium primum portion of IAS and membranous portion of IVS

60
Q

what are the different endocardial cushions

A
  • 2 medial

- 2 lateral

61
Q

what do the 2 medial endocardial cushions form

A
  • septal leaflet of tricuspid valve

- anterior leaflet of mitral valve and portion of inflow perimembranous IVS

62
Q

what do the 2 lateral endocardial cushions form

A
  • anterior and posterior TV leaflets

- posterior leaflet of mitral valve

63
Q

how many sets of aortic arches are formed in the fetus

A

6

64
Q

which aortic arch develops into the adult aorta

A

4th

65
Q

what two structures are the other aortic arches formed

A
  • carotid artery

- ductus arteriosus

66
Q

how are the AV valves formed

A
  • from portion of the AV canal
  • connective tissue
  • endocardial lateral cushions
67
Q

how are the semilunar valves formed

A
  • from truncus arteriosus

- swelling of tissue forms vessels/valves

68
Q

what is the normal route of oxygenated blood to the fetal heart

A
  • umbilical vein > DV > IVC > RA

- eustacian valve directs most of the blood through foramen ovale

69
Q

what ar ether 2 possible paths of oxygenated flow one blood reaches the fetal heart

A

1) RA > LA > … LA > LV > AO

2) RA > TV > RV > PA > ductus arteriosus > AO

70
Q

what six events happen at birth in the fetal heart

A
  • umbilical vein closes
  • ducts arteriosus closes - becomes ligamnetum arteriosum
  • foramen ovale closes - become fossa ovalis
  • RV and pulmonary artery walls decrease in thickness (pressure decreases)
  • LV walls increase in thickness (pressure increase)
  • ductus venosus closes - becomes ligamentum venosum

Echo 3 (4 decks)

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