Septal Defects

Question 1

What are the 4 types of VSD’s?

Answer 1

Perimembranous
Muscular/trabecular
Outlet/supracristal
Inlet

Question 2

When during the cardiac cycle would you hear a VSD mumur?

Answer 2

Entirety of systole (holosystolic)

Question 3

What size of VSD creates flow restriction?

Answer 3

A small VSD (1/3 size of Ao annulus)

Question 4

What is the Qp:Qs ratio for a significant shunt? What is a normal Qp:Qs ratio?

Answer 4

> or = 2:1 (significant)
1:1 (normal)

Question 5

What is “Qp” and “Qs”?

Answer 5

Qp = pulmonary CO
Qs = systemic CO

Question 6

What is the formula for CO?

Answer 6

CO (systemic or pulmonary) = SV x HR

Question 7

What is the CSA formula (for LVOT or RVOT)?

Answer 7

CSA (rvot or lvot) = 0.785 x d^2

d = LVOT or RVOT measurement at mid-systole

Question 8

Would right and left sided pressures be closer to equal with a small or large shunt?

Answer 8

Large

Question 9

Which VSD is the most common? 2nd most common?

Answer 9

Perimembranous (1st)
Muscular/trabecular (2nd)

Question 10

Where would you see a perimembranous VSD?

Answer 10

in LVOT

Question 11

What is associated with a perimembranous VSD?

Answer 11

AI
AV prolapse
VS aneurysm

Question 12

Where would you see a muscular/trabecular VSD?

Answer 12

In the muscular part of the IVS

Question 13

Where would you see an outlet/supracristal VSD?

Answer 13

In RVOT

Question 14

What is associated with an outlet/supracristal VSD?

Answer 14

AI
RCC prolapse

Question 15

Where would you see an inlet VSD?

Answer 15

In posterior portion of the septum

Question 16

What surgical device is used to correct a VSD? What diagnostic value would qualify someone for a repair?

Answer 16

Amplatzer device
Qp:Qs ratio > 1.5:1

Question 17

What happens to the left heart with a small VSD?

Answer 17

Dilated, hyperkinetic LV
Dilated LA

*Dilated chambers = VOLUME OVERLOAD

Question 18

What happens to the RV with a small VSD?

Answer 18

Usually normal with a small VSD

Question 19

What happens to the RV with a large VSD?

Answer 19

Can have volume or pressure overload with a medium - large VSD with PHTN

RA usually normal

Question 20

Large defects can lead to which type of syndrome and why?

Answer 20

Eisenmenger’s (shunt flow reversal to L to R) because of increased right sided pressures greater than the left

Question 21

What are ASD’s associated with?

Answer 21

IAS aneurysm
Systemic thromboembolism

Question 22

When would you hear an ASD murmur?

Answer 22

During systole

Question 23

Would a large or small ASD have implications on the right heart? What would these implications be?

Answer 23

Large

Right sided volume overload and reduced ventricular compliance

Question 24

Where would you see a septum secundum ASD?

Answer 24

mid IAS (mid septal)

Question 25

What is associated with septum secundum ASD?

Answer 25

MVP

Question 26

Where would you see a septum primum ASD?

Answer 26

Close to MV/TV

Question 27

What is associated with septum primum ASD?

Answer 27

Cleft MV

Question 28

Where would you see a sinus venosus ASD?

Answer 28

Near SVC entrance

Question 29

What is associated with sinus venosus ASD?

Answer 29

Anomalous pulmonary drainage

Question 30

Where would you see a coronary sinus ASD?

Answer 30

Inferior IAS

Question 31

What is a common atrium ASD?

Answer 31

Absence of IAS

Question 32

What is a common atrium ASD associated with?

Answer 32

Ellis Van Creveld Syndrome

Question 33

What is the most common ASD? 2nd most common? Least common?

Answer 33

Septum secundum (1st)
Septum primum (2nd)
Coronary sinus (least)

Question 34

What are S&S of an ASD?

Answer 34

SOBOE, orthopnea, JVD, peripheral edema

• usually no symptoms until mid - late adulthood

Question 35

What are the 2 kinds of AVCD’s?

Answer 35

Partial
Complete

Question 36

What is a partial AVCD?

Answer 36

Septum primum ASD

Question 37

What is a complete AVCD?

Answer 37

Septum primum ASD, inlet VSD

Question 38

What syndrome is strongly associated with AVCD’s?

Answer 38

T21