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Module 1 CHD > Morphology > Flashcards

Morphology Flashcards

1
Q

Features to describe

A

3 Segments: Atria, Ventricles, Arteries

2 Junctions: AV and VA

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2
Q

Atrial Morphology

A

LA:
Long, tubular hooked appendage with narrow junction to the main atrial compartment

RA:
Triangular appendage with broad junction

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3
Q

Atrial Arrangements

A

Usual (Situs solitus)
Mirror-Image (Situs inversus)
Isomeric left or right

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4
Q

Left Ventricle Morphology

A

MV ALWAYS goes with LV
- not attached to the septum, instead shares fibrous continuity with the aortic valve

Fine apical trabeculation

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5
Q

Right Ventricle Morphology

A

TV ALWAYS goes with RV
- septal leaflet is attached to septum

Moderator band from septum to free wall, joining the anterior papillary muscle

Course apical trabeculation

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6
Q

Biventricular Atrioventricular Connections

A

Concordant (Usual or mirror-image atria)
Discordant (Usual or mirror-image atria)
Ambiguous (Isomeric atria)

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7
Q

Univentricular AV Connection

A

Usually two ventricles, but one dominates and the other lacks direct AV connection

Dominant ventricle may have single or double atrial inlet

Describe the absent AV connection

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8
Q

Absent Ventricle

A

Failed connection of an atrium to the ventricle causes its absence within the first 58 days of development

Seen at 12-14w echo, either absent flow or no crossover

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9
Q

Areas of CHDs

A 
Inflow Tract
Atrial Suptum
AV Junction
Ventricular Septum
VA Junction
Outflow Tract
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10
Q

Atrial Septum

A

Patent Foramen Ovale

  • Tissue flap covers the hole, only shunting if uncovered under certain conditions.
  • Muscle thickens the fibrous layer

ASD (Oval fossa defect)

  • Not enough tissue covering the oval fossa, continuous shunting of blood
  • Fibrous/Muscular fenestrations (like a web)
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11
Q

Conduction

A

AP from SAN propagates through specifically orientated atrial myocardium (not dedicated conduction tissue)

AVN surrounded by fibrous-fatty tissue to isolate it from the ventricles

Penetrating bundle of His carries AP down ventricular septum (splits to R+L bundle)

Purkinje fibres carry AP from apex, rapidly up the ventricles

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12
Q

The AV node

A

Found in the triangle of Koch, its borders are:

  • The Tricuspid valve
  • The Coronary sinus
  • The Eustachian valve *
  • acts in the foetal heart at the IVC, to shunt oxygenated, placental blood from the RA to the LA.
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13
Q

VSD and possible locations

A
  • Failure off descending septum primum and ascending ventricular septum to fully fuse
  • Adjacent to AV or VA junction
  • Underneath/Overridden by a valvular orifice
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14
Q

Morphologic Features of VSD

A
  • 90% involve the membraneous septum

Infundibular VSD: Below the PV

Muscular VSD: Often multiple holes in the muscular septum

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15
Q

Considerations in VSDs

A
  • Margins of the defect
  • Direction of communication (initially from LV to RV, then possibly reversed in pulm.HTN)
  • Relationship of defects to conduction tissue
  • Malalignment of the fused septa
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16
Q

Size in VSDs

A
  • Small holes may close over spontaneously

- Large holes may leak underneath both OFTs and won’t close spontaneously

17
Q

Peri-membraneous VSD

A
  • Most common form of VSD (~80%)

- Partly muscular rim, part of rim is continuous with the membraneous septum

18
Q

Muscular VSD

A
  • Second-most common form of VSD (~17%)
  • Muscle forms the entire border of the defect, conduction system is not nearby
  • Located in inlet, outlet or apical regions
19
Q

Doubly-committed and Juxta-arterial VSD

A
  • Rare (~3%)
  • Hole is underneath the aortic and pulmonary valves
  • AV and PV and normally offset (angle and level) but are adjacent here
20
Q

Normal AV Junction

A
  • Aorta should be in the centre

- TV and MV should surround it like a figure-of-8

21
Q

AVSD

  • Cause
  • Structure
  • AVN
A
  • When AV cushions do not fully separate in development, a large 5-leaflet valve may form
  • May have one common orifice, if superior and inferior bridging leaflets fuse then may have two
  • AVN deviated, sits at AV myocardial border
22
Q

Variation in AVSD shunting

A

Varied by the bridging leaflet attachments:

  • VS: interatrial shunting
  • AS: interventricular shunting
  • Floating bridging leaflets: IA and IV shunting
23
Q

Length of Outlet

A
  • Longer outlet is less efficient

- Risk of OFT obstruction

24
Q

Tetralogy of Fallot

A
  1. Narrowed pulmonary outlet
  2. Large VSD (underneath the RVOFT)
  3. Overriding aorta (supplied by both ventricles)
  4. Hypertrophy of RV
25
Q

Ebstein Malformation

A
  • Failure of TV to delaminate away from the RV wall
  • TV is deep within the ventricle
  • RV volume decreased (essentially absent RV)
26
Q

Bicuspid AV

A
  • One of the most common genetic variations in man
  • sometimes due to congenital lack of 3rd leaflet
  • sometimes due to fusion of 2 of the 3 leaflets
27
Q

Common Arterial Trunk

A
  • Failure of the OFT to divide

- All blood leaves the heart via a common truncus

28
Q

Arterial duct

  • Patent duct
  • Coarctation of the aorta
A
  • In foetus, a duct feeds the pulmonary vessels
  • After birth, pulmonary blood pressure increases, ductal cushions emerge and thicken, duct closes and may remain as a ligament or disappear completely

Patent duct: May stay open, mixing blood

Coarctation: ductal tissue may constrict the aortic arch

29
Q

Double-committed or juxta-arterial VSD

A
  • More rare form of VSD (~3%)

- VSD beneath the AV and PV (they are normally offset in angle and level but are next to each other in this condition)

30
Q

Absent Ventricle
- Imaging

  • Treatment
A
  • Failure of A and V to connect

Imaging
- 12-14w echo

  • flow disturbance (no aorta-pulm cross-over)

Treatment
- Surgery, usually leaving single ventricle heart

31
Q

Absent Left Ventricle (LA inlet and LV outlet missing)

- Blood route

A
  • Enters RA
  • Goes to LA (ASD)
  • LV
  • Goes to RV (VSD)
  • Pulmonary trunk
32
Q

AV Valve Defects

A
  • Imperforate, stenotic, common valve

In VSD
- Valve, chordae or both may overlie the septum

Module 1 CHD (6 decks)

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