Septal Defects Flashcards
What are the 4 types of VSD’s?
Perimembranous
Muscular/trabecular
Outlet/supracristal
Inlet
When during the cardiac cycle would you hear a VSD mumur?
Entirety of systole (holosystolic)
What size of VSD creates flow restriction?
A small VSD (1/3 size of Ao annulus)
What is the Qp:Qs ratio for a significant shunt? What is a normal Qp:Qs ratio?
> or = 2:1 (significant)
1:1 (normal)
What is “Qp” and “Qs”?
Qp = pulmonary CO
Qs = systemic CO
What is the formula for CO?
CO (systemic or pulmonary) = SV x HR
What is the CSA formula (for LVOT or RVOT)?
CSA (rvot or lvot) = 0.785 x d^2
d = LVOT or RVOT measurement at mid-systole
Would right and left sided pressures be closer to equal with a small or large shunt?
Large
Which VSD is the most common? 2nd most common?
Perimembranous (1st)
Muscular/trabecular (2nd)
Where would you see a perimembranous VSD?
in LVOT
What is associated with a perimembranous VSD?
AI
AV prolapse
VS aneurysm
Where would you see a muscular/trabecular VSD?
In the muscular part of the IVS
Where would you see an outlet/supracristal VSD?
In RVOT
What is associated with an outlet/supracristal VSD?
AI
RCC prolapse
Where would you see an inlet VSD?
In posterior portion of the septum
What surgical device is used to correct a VSD? What diagnostic value would qualify someone for a repair?
Amplatzer device
Qp:Qs ratio > 1.5:1
What happens to the left heart with a small VSD?
Dilated, hyperkinetic LV
Dilated LA
*Dilated chambers = VOLUME OVERLOAD
What happens to the RV with a small VSD?
Usually normal with a small VSD
What happens to the RV with a large VSD?
Can have volume or pressure overload with a medium - large VSD with PHTN
RA usually normal
Large defects can lead to which type of syndrome and why?
Eisenmenger’s (shunt flow reversal to L to R) because of increased right sided pressures greater than the left
What are ASD’s associated with?
IAS aneurysm
Systemic thromboembolism
When would you hear an ASD murmur?
During systole
Would a large or small ASD have implications on the right heart? What would these implications be?
Large
Right sided volume overload and reduced ventricular compliance
Where would you see a septum secundum ASD?
mid IAS (mid septal)
What is associated with septum secundum ASD?
MVP
Where would you see a septum primum ASD?
Close to MV/TV
What is associated with septum primum ASD?
Cleft MV
Where would you see a sinus venosus ASD?
Near SVC entrance
What is associated with sinus venosus ASD?
Anomalous pulmonary drainage
Where would you see a coronary sinus ASD?
Inferior IAS
What is a common atrium ASD?
Absence of IAS
What is a common atrium ASD associated with?
Ellis Van Creveld Syndrome
What is the most common ASD? 2nd most common? Least common?
Septum secundum (1st)
Septum primum (2nd)
Coronary sinus (least)
What are S&S of an ASD?
SOBOE, orthopnea, JVD, peripheral edema
- usually no symptoms until mid - late adulthood
What are the 2 kinds of AVCD’s?
Partial
Complete
What is a partial AVCD?
Septum primum ASD
What is a complete AVCD?
Septum primum ASD, inlet VSD
What syndrome is strongly associated with AVCD’s?
T21
