Module 3 : Acyanotic CHD's Flashcards
what are the 5 types of acyanotic CHDs that involve shunting
- ASD
- VSD
- PDA
- atrioventricular septal defects
- CC-TGA
what rest the 3 types of acyanotic CHDs that do not involve shunting (obstructive)
- congenital aortic stenosis
- pulmonary stenosis
- coarctation of the aorta
what two things can ASD lead to
- tricuspid annular dilation > TR
- RA dilation > afib
what are the echo signs of an ASD
- RV volume overload
- paradoxical septal motion
- image from multiple planes
- asses location and size Qp/Qs
what measurement corresponds to a small ASD
<3mm
what measurement corresponds to a moderate ASD
3-6mm
what measurement corresponds to a moderately large ASD
6-8mm
what measurement corresponds to a large ASD
> 8-10mm
what is the most common ASD
secundum
- associated with MVP or pulmonary stenosis
what is the treatment of secundum ASd
- most often closed percutaneously
- amplatazer
where is a secundum ASD located
- most central portion of atrial septum
what is the location of an ostium Primum ASd
- adjacent to AV valves
- associated with inlet VSD, cleft MV, T21
what is the treatment for ostium primum ASD
- percutaneous device closure of the primum ASD not an option
- woven Dacron patch
what is the location fo the coronary sinus ASD
- rare located in the inferior region fo the right atrium adjacent to the coronary sinus
what is the treatment for coronary sinus ASD
- patch closure
what are the associations with coronary sinus ASD
- coronary sinus ASD is almost always associated with connection o the left SVC to the LA
what is the location of sinus venosus ASD
- superior/posterior region of the atrial septum and most often seen adjacent to eh SVC
what are the associations with sinus venosus ASD
- partial anomalous pulmonary venous return
- anomalous drainage of the right upper pulmonary vein to eh SVC/RA junction
with is the treatment of sinus venosus ASD with PAPVR
- surgical correction to restore connection of the RUPV to the LA, then use patch to cover shunt
what is the rate of echo detection with ASDs
- with TEE primum = 100%
how is contrast used to detect ASD/PFO
- shows passage of microbublles into the LA from RA where shunt would be
what is the definition of AVSD
- spectrum of lesions characterized by deficient AV station and a variety of AV vale abnormalities
what are the two main subtypes of AVSD
- complete
- incomplete
what other anomaly is AVSD associated with
T21
what usually occurs after repair of AVSD
- MV and TV regurge
what is complete AVSD characterized
- malformation of endocardial cushion at crux of heart
- primum ASD that is contihous with an inlet VSD
- presence of common AV valve
what is the goal of surgery with complete AVSD
- close any intracardiac shunts
- divide common AV valve into competent MV and TV orfices
what is an incomplete AVSD distinguished by
- absence of an inlet VSD
- comprised of a primum ASD and a cleft in the anterior MV leaflet
what is the goal of surgery in incomplete AVSD
- close interatrial communication
- repair the MV
what is the post op echo procedure for AVSD
- evaluate MV/TV for leaks
- evaluate surgical patches for adhesions and lake
what are the other names for CCTGA
- corrected transposition
- L transposition
- L loop
- L TGA
what is CCTGA characterized by
- L lopping of the ventricles and transposition of the great arteries
- BOTH VENTRICLES AND GREAT ARTERIES SWITHCED
what is the orientation of the great vessel with CCTGA
aorta anterior anterior and the the left of PA
what is the blood flow with CCTGA
- physiologic blood flow is maintain due to double discordance
- ## morphologic RV pumps to aorta morphologic LV pumps to lungs
what are the severity of symptoms dependant on in CCTGA
- degree of TR, VSD and severity of outflow tract obstruction
what are 4 associated lesion with CCTGA
- VSD
- TV anomalies
- pulmonary outflow tract obstruction
- conduction defects
what cor triatriatum
- perforated membrane that partitions the left or right atria into two chambers
what determines the severity with cor triatriatum
- size of hole in the tissue that divides the atrium
- small hole = more symptoms
- large hole = les symptoms
what is cor triatriatum sinister
- divided ledt atrium is characterized by a perforate membrane in the left atrium
- pulmonary veins come together postieorir
what is cor triatriatum dexter
- rare
- perforate membrane in the right atrium
what is partial anomalous pulmonary venous return PAPVR
- one or more but not all of the pulmonary veins are connected to a systemic vein, right atrium, coronary sinus, left innominate vein
what is left sided PAPVR
- pulmonary veins may connect to the coronary sinus and or left innominate vein
what is right sided PAPVr
- pulmonary veins may connect to the right atrium, SVC,IVC
what can a PAPVR be found with
- sinus venosus ASD
what is the echo assessment of PAPVR
- hypertrophy and dilation of the RA nd RV
- dilation of the PA
_ volume overlaid in the right heart
what is a patent ductus arteriosus PDA and what is it caused by
- connection between the descending aorta and origin of he left pulmonary artery
- failure of the ductus arteriosus to close at birth
what is the shunt direction with PDA
- AO blood pressure higher than pulmonary blood pressure so blood flows through a PDA continuously left to right shun t
what is the echo role with PDA
- PSAX level of AO or ascending aorta
- color doppler continous red high jet in main PA
- spectral doppler = low pulmonary artery pressure there iscontinos now form aorta to PA
- LVOT, AV and VTI increased
what is the repair for a PDA
- accomplished with drugs
- surgery or percutaneously
what is a persistent left SVC
- formed by the confluence of the left jugular and subclavian vein and descend inferiorly parallel to the right SVC in most cases
where does the L-SVC common enter
- coronary sinus
what otters anomalies are associated with L-SVC
- any type of ASD
- coronary sinus ASD most common
what is the physiology and symptoms of L-SVC
- LSVC drains into the right atrium through the coronary sinus , physiology normal
- no clinical maifesteion
what is the role of echo with L-SVC
- coronary sinus may be dilates
- IV test = saline into left arm vein will result in pacification of coronary sinus before RA
characteristics of Gerbode VSD
- rare tru left ventricular to right atria shunt
- usually congenital but may be acquired as a complication of endocarditis or surgery
- causes RA enlargement, pulmonary hypertension
