Module 2: Cardiac Situs and the Segmental Approach Flashcards
what are segments
- the anatomical structures which the cardiovascular system is divided for purpose go evaluation which include the systemic and pulmonary veins, antra, ventricle and great arteries
what are connections
- decreases the anatomical sequence of structures
- venoatrial, atrial-ventricular, ventriclo-arterial
what does concordant mean
- normal sequenctional relationship between the hearts chambers, valve,s and great vessels
what does discordant mean
- refers to an abnormal sequential relationship between chambers, valves, and great vessel
what is commitment
- describes degree of abnormality of flow through valves to ventricles and great vessels
- if more than 50% of a valve overrides a VSD
what is ambiguous
- used when precise identification of a chamber can not be determined
what are inlet/outlet anomalies
- anomalies of structure and flow into the ventricles or out fo the ventricles
what is the segmental approach to CHD
- systemic approach to defining and charcterizing CHDs
what are the 3 steps to the segmental approach
- visceral atrial situs + atrial connections
- orientation of the ventricles + connections
- orientation of the great vessels + connections
what does visceral atrial situs refer to
- position of the atria in relation to the nearby anatomy
what are the three 3 steps to determining visceral atrial situs
- identify which way apex is pointing
- identify atria
- relate to surrounding structures
what are the 3 different cardiac situs
- situs solitus
- situs inversus
- situs ambiguous
what is situs solitus
- morphologic RA is on the right of morphologic LA
what is situs inversus
- morphologic RA is to the left of the morphologic LA
what is situs ambiguous
confident assignment of morphologic left and right atria cannot be made
what does morphologic mean
- has morphologic features of that chamber
what does functional mean
- functional as a different chamber
- LA is functioning as RA due to transposition
what is cardiac position and what are the types
- heart position within chest
- right (dextroposition)
- midline (mesopositon)
- left (levoposition)
what is dextroposition
- most of the heart lies to the right of the sternum
what is mesoposition
- the heart lies directly behind the sternum
what is levoposition
- most of the heart lies to the left of the sternum (NORMAL)
what is cardiac orientation and what are the three types
- apical positon
- right (dextrocardia)
- midline (mesocardia)
- left (levocardia)
what is dextrocardia
- the apex points to the right side fo the body
what is mesocardia
- apex lies under the sternum
what is levocardia
- apex point to the left (normal)
how do we determine dextrocardia
- start with transverse subcostal sweep
- atria and ventricles lie on the left side
- label chest sides
what is the correct term if all organs are mirrored dextro
- dextrocardia situs inversus totalis
what three disorders can patients with dextrocardia be prone to
- endocardial cushion defect
- pulmonary stenosis
- double outlet RV
what does isolated dextrocardia have increased risk of
- ling infection
- sinus infection
- pneumonia
what arrest eh signs and symptoms of dextrocardia
- breathing difficulties
- cyanosis
- fatigue
- failure to thrive in children
what vessels do we evaluate for the venous segment
- hepatic veins
- IVC
- SVC
- coronary sinus
- pulmonary veins
what vessels are interrogated in the vent-atrial connection
- systemic venous return = SVC, IVC
- pulmonary venous return
what are the morphologic features of the RA
- eustachian valve
- venae cavae
- coronary sinus
- chiari network
- RA appendage
what are the morphologic features of the LA
- pulmonary veins
- LA appendage
how can we tell if there is concordant connection between the atria and ventricle
- MV always associated with LV
- TV always associated with RV
- TV more apically attached to the IVS
what are the morphologic features of the RV
- crescent shape
- TV (3 leaflets)
- large apical trabeculations
- multiple small papillary muscles
- moderator band
- septal leaflet apically displaced
what are the morphologic LV
- bullet shapes
- MV (2 leaflets)
- two pap muscle
- fals tendons
- inlet and outlet valves in continuity
what is the crux
- where the atria and ventricles meet at the centre fo the hear
what are the different AV connections
- bi-ventricular = one atria connect to both ventricle
- uni-ventricular = both atria connect to one ventricle
- common = atria connect to both ventricles through a single multi leaflet structure
what can we tell if there is VA concordance
- AV and pV anatomically identical
- Look for fibrous continuity between AV and mV
- look for overriding vessels
what are the 3 main variations of normal VA connections
- transposed connection of the great arteries TGA
- double outlet connection
- single outlet connection
what is TGA
- main PA arises from the LV
- aorta arises from the RV
what is double outlet connection
- both great arteries arise from a single ventricle almost always the RV
what is single outlet connection
- only 1 great artery coming from the ventricle which is overriding or great arteries are fused into a single truncal artery
if there are abnormal VA connections how are the ventricles names
- pulmonary ventricle = whichever ventricle pumps to the PV/PA
- systemic ventricle = ventricle pumps out to the AV/ao
what are the defining features o the pulmonary trunk
- bifurcation to the LPA and RPA
what are the defining features of the aorta
- coronary arteries
- branches brachiocephalic, LCC, LSC
