Obstructive Flashcards
cutoffs to think about for IAA
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.
IAA Fetal Assessment of LVOT, what cut-offs
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
Class 1 indications for balloon aortic valvuloplasty (4 total)
PSEG>=50
PSEG >=40+symptoms
Ischemic changes on exercise test
LV dysfunction/critical AS (regardless of PSEG)
Class 2 indications for balloon aortic valvuloplasty (2 total)
ECHO mean>50 (nonsedate / lightly sedated)
PSEG > 40 with future pregnancy OR competitive athlete
MC types of bicuspid aortic valves and %age
RL 64% really likely
NR 35% not really -> most likely to be stenotic
NL 1% not likely
which commisural fusion in BAV is likely to be stenotic
Non-right
mitral stenosis cutoffs
Mild: MG:2-5
Mod: MG:5-10
Sev: MG:>10
pulmonary stenosis cutoffs
Mild: peak v 2-3m/s
Mod: peak v 3-4m/s
Sev: peak v >4m/s
AS cutoffs
Mild: <20 // 2.6-3
Mod: 20-40 // 3-4
Sev: 40 // >4
Aortic regurgitations cut-offs
Mild: VC<3, P1/2 >500
Mod: VC3-6, P1/2 200-500
Sev: VC>6, P1/2 <200
pericardial effusion cutoffs
Pericardial effusion (adults) Trivial only in systole Small <10 mm Moderate 10-20 Large >20 Very large >25
LV systolic function cutoffs
Hyper: >65 Nml: 55-65 (50-55 low nl) Mild: 40-50 Mod: 30-40 Sev: <30
LV diastolic function: what does E/A tell you?
what does a decreased compliance?
normal range?
E/A= Passive/active filling
With decreased compliance -> E gets smaller, A gets bigger –> E/A Decreases with decreased compliance
normal 2-3
LV diastolic function: what are the S and D wave
normal relationship?
when is it abnormal?
S and D wave = amplitude of PV S and D wave
Systolic < Diastolic
Systolic predominates in early diastolic dysfunction
LV diastolic function: E/e’ what is it?
normal value?
what increases it?
when is it abnormal?
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
difference in numbers for diastolic filling normal abnl relaxation pseudonormalization restriction
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
DDx: Cyanotic lesions with wet lungs on CXR
DDx: Cyanotic lesions with wet lungs
1) Truncus
2) Transposition
3) TAPVR w/ obstruction
Truncus classification:
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)
What is Holme’s Heart
DILV
RV anterior and rightward (right handed)
Aorta and PA usually related {S,D,S} = Holmes’ heart (15%)
Fetal of severe AS: LV, endocardium, mitral inflow, atrial septum, arch flow, ao valve flow,
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)
Fetal DILV, TGA: what determines need for PGE?
VSD size and ductus flow: if normal, no PGE, if small vsd or any arch reversal –> PGE
indications for treatment of fetal CHB
rate < 55, hydrops, heart failure, severe CHD: Terbutaline to augment V rate
