Neonatal Cardiology Flashcards
TAPSE stands for?
Tricuspid Annular Plane Systolic Excursion
Closely correlates to right ventricular ejection fraction
Apex of heart is fixed in location during contraction, while tricuspid annulus is displaced to the right and inferiorly in systole
Displacement of annulus = marker for RVEF
Motion of right ventricle and left ventricle during contraction?
RV contracts from apex to base
LV contracts in a cylindrical squeeze fashion
Geometric shapes of the right and left ventricle?
Left ventricle (cylinder) and right ventricle (encases the left ventricle- crescentic shape on parasternal short axis)
Like a “ball and socket” = LV and RV
Normal ejection fraction for a neonate?
Ejection fraction: 55-75%
True/False. If there is pulmonary valve stenosis, you can still trust your measured RVSP to be a surrogate for your mean pulmonary artery pressure.
False.
What is considered to be an elevated pulmonary pressure?
Mean Pulmonary Artery Pressure > 25mmHg.
Ballpark of RSVP as a fraction of systemic pressures based on location of inter-ventricular septum on parasternal short axis view
Rounded septum bowing into RV ~ RVSP <1/2 systemic pressure
Flattened septum ~ RVSP > 1/2 systemic pressure
Displacement/bowing of the inter-ventricular septum into the LV~ RVSP supra-systemic
What is the gold standard of measuring severity of pulmonary hypertension?
Cardiac catheterization
What equation is used to calculate the RVSP based on echo measurements of tricuspid jet?
Bernoulli equation:
RVSP= 4 (velocity across tricuspid annulus)^2 + RAP
True or False. A small PFO with a left to right shunt needs to be followed up post-discharge.
False. Only needs follow up if shunting right to left across PFO or is identified as an ASD.
When would you consider correction of an ASD?
If large ASD in an asymptomatic shunting L>R, may close by 2-5 years of age with follow up one year after closure.
Earlier ASD closure if you have pulmonary disease that puts you at higher risk for developing pulmonary hypertension (BPD, chronic ventilator dependence, diaphragmatic hernia).
Implications of a left SVC?
Normal variant, don’t panic; in case UVC is not entering the thorax on the right side of the heart, can do an echo to rule this out
Complete vs Limited echo?
Complete- evaluation for pulmonary hypertension, to evaluate cardiac structure function; can take up to an hour and cost ~$1000s
Limited- have a specific question; persistence of PDA or other shunts? Can take up to 15min and cost $100s
CCHD has low sensitivity for detection of what types of cardiac lesions?
Partially obstructive or structural but acyanotic heart lesions (double outlet right ventricle, interrupted aortic arch, partial coarctation, Ebstein anomaly)
