Obstructive

Question 1

cutoffs to think about for IAA

Answer 1

LVOT diameter w.r.t. weight

a. If LVOT diameter (in mm) < weight (in kg), survival with a conservative approach is unlikely –> Yasui or Norwood strongly advised
b. If LVOT diameter > baby’s weight (in kg) +2 mm –> survival w/o LVOTO is likely.
c. In between these two numbers is a grey zone, where although survival may be possible, it is likely that significant residual LVOTO will exist.

Question 2

IAA Fetal Assessment of LVOT, what cut-offs

Answer 2

LVOT: >4mm in the third trimester : good prognosis, just need VSD closure and arch repair
Ao valve / pulm valve ratio: if <0.5, possibility of inadequate LVOT

Question 3

Class 1 indications for balloon aortic valvuloplasty (4 total)

Answer 3

PSEG>=50
PSEG >=40+symptoms
Ischemic changes on exercise test
LV dysfunction/critical AS (regardless of PSEG)

Question 4

Class 2 indications for balloon aortic valvuloplasty (2 total)

Answer 4

ECHO mean>50 (nonsedate / lightly sedated)

PSEG > 40 with future pregnancy OR competitive athlete

Question 5

MC types of bicuspid aortic valves and %age

Answer 5

RL 64% really likely
NR 35% not really -> most likely to be stenotic
NL 1% not likely

Question 6

which commisural fusion in BAV is likely to be stenotic

Answer 6

Non-right

Question 7

mitral stenosis cutoffs

Answer 7

Mild: MG:2-5
Mod: MG:5-10
Sev: MG:>10

Question 8

pulmonary stenosis cutoffs

Answer 8

Mild: peak v 2-3m/s
Mod: peak v 3-4m/s
Sev: peak v >4m/s

Question 9

AS cutoffs

Answer 9

Mild: <20 // 2.6-3
Mod: 20-40 // 3-4
Sev: 40 // >4

Question 10

Aortic regurgitations cut-offs

Answer 10

Mild: VC<3, P1/2 >500
Mod: VC3-6, P1/2 200-500
Sev: VC>6, P1/2 <200

Question 11

pericardial effusion cutoffs

Answer 11

Pericardial effusion (adults)
Trivial only in systole
Small <10 mm
Moderate 10-20
Large >20
Very large >25

Question 12

LV systolic function cutoffs

Answer 12

Hyper: >65
Nml: 55-65 (50-55 low nl)
Mild: 40-50
Mod: 30-40
Sev: <30

Question 13

LV diastolic function: what does E/A tell you?
what does a decreased compliance?
normal range?

Answer 13

E/A= Passive/active filling
With decreased compliance -> E gets smaller, A gets bigger –> E/A Decreases with decreased compliance
normal 2-3

Question 14

LV diastolic function: what are the S and D wave
normal relationship?
when is it abnormal?

Answer 14

S and D wave = amplitude of PV S and D wave
Systolic < Diastolic
Systolic predominates in early diastolic dysfunction

Question 15

LV diastolic function: E/e’ what is it?
normal value?
what increases it?
when is it abnormal?

Answer 15

E/e’=flow/filling velocity
normal < 10 (high filling velocity of the LV)
Inc with less filling velocity (denominator goes down)
Important for differentiating pseudonormalization from normal
>10 abnormal

Question 16

difference in numbers for diastolic filling
normal
abnl relaxation
pseudonormalization
restriction

Answer 16

normal: E/A 2-3, E/e’ <10
abnl relaxation: E/A<1
pseudonormalization: E/A back to 2-3, E/e’ >10
restriction: E/A drops back down and E/e’ stays >10

Question 17

DDx: Cyanotic lesions with wet lungs on CXR

Answer 17

DDx: Cyanotic lesions with wet lungs

1) Truncus
2) Transposition
3) TAPVR w/ obstruction

Question 18

Truncus classification:

Answer 18

Collett/Edwards
I - MPA segment (40-60%) (I=MPA)
II - No MPA segment, close proximity of branches (30-40%) (II= brnch PAs)
III - lateral origin of branch Pas (III = on the sides)
IV - branch Pas come off of the duct/descentding aorta, tet/PA/MAPCAS?? (4 = shape of descending aorta)

Question 19

What is Holme’s Heart

Answer 19

DILV
RV anterior and rightward (right handed)
Aorta and PA usually related {S,D,S} = Holmes’ heart (15%)

Question 20

Fetal of severe AS: LV, endocardium, mitral inflow, atrial septum, arch flow, ao valve flow,

Answer 20

LV globular, dysfunctional, EFE, mitral inflow monophasic, atrial septal flow left to right, arch flow BiD or all retrograde, Ao valve high velocity or low (low flow state)

Question 21

Fetal DILV, TGA: what determines need for PGE?

Answer 21

VSD size and ductus flow: if normal, no PGE, if small vsd or any arch reversal –> PGE

Question 22

indications for treatment of fetal CHB

Answer 22

rate < 55, hydrops, heart failure, severe CHD: Terbutaline to augment V rate