Nomenclature Flashcards
What is the nomenclature approach used for ACHD?
Sequential Segmental Approach
Who proposed the sequential segmental approach?
Praagh in 1960s and revised by Anderson and colleagues
What are the basic building blocks of the SSA?
Atria, Ventricles and the Great Arteries, AV and VA connections
Morphological characteristics of RAA
Blunt triangular appendage
Broad junction to RA
Morphological characteristics of LAA
Tubular
Narrow junction to LA
Morphological characteristics of RA
Pectinate muscles extend from RAA to postero-inferior wall of RA
Morphological characteristics of LA
Smooth posterior wall of LA
What atrial arrangements can you have?
Situs solitus
Situs inversus
Situs ambiguous (Right/Left isomerism = 2 x RA/2xLA)
How are the morphological characteristics in the SAA identified?
Echocardiogram
Morphological characteristics of RV
Coarse apical trabeculations
Muscular infundibulum between TV and PV
Septomarginal trabeculation and moderator band
Morphological characteristics of LV
Fine apical trabeculations
Fibrous continuity valves
Smooth septal surface
Ventricular Patterns
Balanced (Normal)
RV/LV Hypoplasia
Primitive morphological ventricle
How can you determine which is the primary ventricles in hypo-plastic RV/LV?
Based on morphological characteristics of large ventricle
Small ventricle in front and above –> large ventricle is LV
Small ventricle behind and below –> large ventricle is RV
What is a primitive morphological ventricle?
Very rare
Mixed morphological characteristics of LV and RV
Ventricular Arrangements
Normal Ventricular inversion (mirror image)
In what order do we undergo SSA?
Atria
Ventricles
AV
VA
AV Connection Analysis
Mode
Type
AV Connection Mode analysis
Details on AV valves, Chordae, papillary muscles and annuli
AV Connection Type
Which atrium is connected or not to the ventricle:
Biventricular and Univentricular Types
Biventricular AV Connection Types
Concordant (Atrial Situs solitus/inversus)
Discordant (RA to LV; LA to RV)
Ambiguous (In atrial isomerism = situs ambiguous)
Univentricular AV Connection Types
Double Inlet (Both atria >50% connected to LV) Absent AV connection (Usually RA not connected to RV) If remnants of TV tissue, it is biventricular or double inlet with imperforate valve
Modes of AV Connection
2 perforate valves 1 perforate and 1 imperforate valve Common AV valve Straddling Over-riding
Types of common AV Valve
Balanced AVSD (equally above both ventricles) Unbalanced AVSD (Greater part above one ventricle)
Straddling AV Connection
Of left, right or both AV valves
Concerns tension apparatus of the valves (one or more chordae/papillary muscles attached to the myocardium in the wrong ventricle)
Over-riding AV Connection
AV valves is over-riding the other ventricle that has the other AV orifice
Biventricular type of AV connection if over-riding <50%
Univentricular (double inlet) type of AV connection if over-riding>50%
VA Connection Mode analysis
Details on arterial valves and annuli
VA type analysis
Which ventricle is connected or not to which great artery
Types of VA Connection
Concordant (normal ventricular pattern or ventricular inversion)
Discordant (Normal ventricular pattern/ventricular inversion)
Double outlet (both great arteries connected to one ventricles - usually RV)
Single outlet VA connection
What are the types of single outlet VA connection?
Common arterial trunk (truncus arteriosus)
Single outlet aorta (pulmonary atresia)
Single outlet aorta (Absent pulmonary trunk and arteries)
Modes of VA Connection
2 perforate valves
1 perforate and 1 imperforate valve
Over-riding (Bother arteries > 50% above RV: Double outlet VA connection)
