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Echo > simple shunts > Flashcards

simple shunts Flashcards

1
Q

What is the prevalence of ASD’s?

A

ASD’s are not the most common congenital defects; however, they are more prevalent in males than in females. ASD’s account for about 6-10% of all congenital abnormalities and may have a familial link.

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2
Q

What types of ASD’s are there?

A
  • Ostium secundum ASD
  • Ostium Primum ASD
  • Sinus venousus ASD (superior and inferior)
  • Unroofed coronary sinus
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3
Q

What is the cause of an Ostium secundum ASD?

A

Excessive resorption of the septum primum or a deficiency in the growth of the septum secundum

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4
Q

What is the most common ASD

A

Ostium secundum 70%

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5
Q

What is an Ostium secundum ASD associated with?

A

mitral valve prolapse (MVP)

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6
Q

What is an Ostium primum ASD associated with?

A

atrioventricular septal defects, cleft MV/TV and

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7
Q

What is the cause of an Ostium Primum ASD?

A

Failure of the endocardial cushions to close the ostium primum

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8
Q

What is an Ostium Primum ASD also known as?

A

A transitional or partial AVSD (AVC)

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9
Q

What are sinus Venosus ASD’s caused by?

A

Faulty or incomplete resorption of the sinus venosus

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10
Q

What are venosus ASD’s associated with?

A

Associated with partial anomalous pulmonary venous return (PAPVR)

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11
Q

What is an unroofed coronary sinus?

A

Communication between the LA and coronary sinus resulting in LA-RA shunting

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12
Q

What is an unroofed coronary sinus associated with?

A

persistent left SVC, total anomalous pulmonary venous return (TAPVR) and asplenia

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13
Q

What is a common atrium

A

absence of arterial septal tissue

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14
Q

What is a common atrium associated with?

A

cleft MV, PAPVR, persistent left SVC and complex lesions

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15
Q

What are conditions associated with atrial septal defects?

A
  • Ellis Van Creveld Syndrome (common atrium)
  • Lutembacher Syndrome (MV stenosis and primum ASD)
  • Holt-Oram Syndrome
  • PV stenosis
  • Ebstein’s Anomaly of the tricuspid valve
  • PAPVR
  • MVP
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16
Q

Describe the underlying physiology and hemodynamic patterns in most atrial septal defects

A
  • Most ASD’s are marked by predominate left to right shunting of blood, resulting in increased right heart volume and pulmonary flow
  • Slight flow reversal through the shunt may be notable during ventricular systole
  • Children with moderate to large sized ASD’s that are left untreated are at a greater risk to develop pulmonary HNT in their adult life due to the strain put on the right heart from consequential volume overload and increased pulmonary flow.
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17
Q

What are common symptoms and patient history pertaining to larger hemodynamically significant ASD’s are as follows:

A 
o	Fatigue
o	Dyspnea (S.O.B., labored breathing)
o	Recurrent pulmonary infections
o	Slow weight gain
o	Congestive heart failure
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18
Q

What does the cardiac auscultation sound like when an ASD is present?

A
  • Loud S1 and may be slightly split
  • Fixed split of S2 at the upper sternal border
  • Soft ejection murmur at the upper left sternal border
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19
Q

Are there any notable EKG changes when there is an ASD?

A
  • Prolonged PR interval
  • RBBB in V1
  • Right axis deviation
  • Left axis deviation (common with primum ASD’s)
  • PA enlargement
  • RV hypertrophy
  • Atrial fibrillation or flutter (mainly found in adults)
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20
Q

What complications can arise from a severe ASD that is left unrepaired?

A

o CHF
o Pulmonary HNT
o Atrial arrhythmias
o CVA or TIA

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21
Q

How are small ASD defects treated?

A

Most small ASD’s do not require intervention and are simply observed over time unless there is significant risk of CVA due to clotting in the heart or systemic vasculature.
o If a small shunt causes hemodynamic consequence such that the Qp/Qs ratio is <1.5:1 a small closure device may be utilized.

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22
Q

How are Primum and sinus venosus repaired?

A

Surgical repair via Dacron patch, pericardial patch, or primary suture

23
Q

How are secundum defects repaired?

A

First attempted to be closed with a catheter device closure procedure
Surgical procedure necessary if the catheter device closure fails or the septal rims are inadequate for the device to attach to.
Surgical repair may be done robotically with an adequate sized patient (older child or adult

24
Q

How should an ASD be evaluated for?

A
  • When evaluating for an ASD, is important to determine the size and location of the shunt as well as any associated conditions that may be present alongside the shunt.
  • It is important to remember to sweep though and evaluate all parts of the septum in any view it can be visualized.
25
Q

What view is ASD shunting is best observable?

A

from the subcostal four chamber view because the Doppler angle is 0 degrees to the direction of the shunt and will display optimal color filling.

26
Q

What is the prevalence of VSD’s?

A

VSD’s are the most common type of congenital abnormality and are slightly more common in females than in males.

27
Q

How is the membranous septum formed?

A

formed by the spiral septum during development of the pulmonary artery and aorta from the truncus arteriosus.

28
Q

Where is the membranous septum

A

It a relatively small structure that begins below the attachment points of the RCC and NCC and spans until it meets the inlet and outlet components of the muscular septum.

29
Q

What types of VSD’s are there?

A
  • inlet VSD
  • Outlet VSD
  • Membranous VSD
  • Muscular VSD
  • Malaligned VSD
30
Q

what are children with moderate to large sized ASD’s that are left untreated at greater for and why?

A

pulmonary HNT in their adult life due to the strain put on the right heart from consequential volume overload and increased pulmonary flow.

31
Q

What is the most common VSD

A

Membranous 75-80%

32
Q

Which type of VSD has an increased risk for developing AI?

A

Membranous - subaortic

33
Q

What VSD is commonly associated with AVSD’s?

A

Inlet (often require surgical closure)

34
Q

What are patients with an outlet VSD at greater risk for?

A

developing AI

35
Q

Which type of VSD has an increased prevalence in the Asian population?

A

Outlet

36
Q

What is a malaligned VSD generally associated with?

A

ToF and Truncus arteriosus

37
Q

What is a Patent ductus arteriosus?

A

The ductus arteriosus is the connection between the Pulmonary artery and the aorta that allows for shunting of oxygenated blood in fetal circulation for the purpose of bypassing the lungs. A patent ductus arteriosus is persistence of the fetal pulmonary artery to aortic vessel connection after birth.

38
Q

What is the most common extra cardiac shunt?

A

PDA

39
Q

Which shunts is more common in high altitudes?

A

PDA

40
Q

Which shunt has a high incidence in premature babies?

A

PDA

41
Q

What are other defects associated with a PDA?

A
  • Interrupted aortic arch
  • Coarctation of the aorta
  • Pulmonary or aortic atresia
  • d-TGA
  • VSD
  • AVSD
42
Q

What is the most common birth defect?

A

Congenital heart defect

43
Q

What is the most commonly missed shunt?

A

ASD in the presence of complex lesions

44
Q

How should a PDA be evaluated for on an echo? How does a PDA present on an echo?

A
  • PSAX at level of the PA bifurcation
  • Suprasternal notch
  • High left parasternal
45
Q

What is an atrioventricular septal defect?

A

the failure of the endocardial cushion to develop correctly. The degree of malformation is dependent on the degree of failure of the cushion to form all of its counter structures. AVSD’s are typically the most severe form of simple shunting and cannot be left untreated, as they are hemodynamically compromising.

46
Q

What are some other names for an AVSD?

A
  • Atrioventricular canal defect
  • AV canal Defect (AVC)
  • Endocardial cushion defect
47
Q

How common are AVSD’s

A
  • AVSD’s account for 4-5% of all CHD’s
  • 40% of children born with Down’s syndrome have complete AVSD’s
  • AVSD’s are slightly more predominate in the female population
48
Q

Describe the types of AVSD’s that can exist

A 
Complete AVSD
      Primum ASD
       Inlet VSD
       Common AV valve 
Partial AVSD
	Primum ASD
	Cleft MV/TV
49
Q

How many leaflets does the common valve in a complete AVSD typically have?

A

5

50
Q

Describe the defective embryology of a complete AVSD and what happens when they fail to form.

A
  • Typically, the endocardial cushions develop within 4-8 weeks of conception- at this time the IAS and the IVS form the AV region and primitive orifices of the AV valves.
  • When the endocardial cushions fail to form, a common AV valve with bridging leaflet forms
  • AV valves are at the same level versus straddling or overriding AV valves are at two separate levels.
51
Q

Describe the anatomic locations of a partial AVSD’s

A

• Partial AV canal has primum ASD or inlet VSD and the AV valve is divided into two orifices

52
Q

Describe the anatomic locations of a complete AVSD’s

A

• Complete AV canal has communication at both atrial and ventricular levels, classified according to bridging leaflet attachment
o Type A: attached to papillary muscles
o Type B: Attached to papillary muscle in RV
o Type C: Known attachment to the IVS

53
Q

How is an AVSD treated?

A 
•	Treat for CHF symptoms 
	       Digoxin and Lasix 
•	Surgical
              PA banding (rarely used)
              Surgical repair 
	VSD and ASD repair 
	Separation and reconstruction of the common AV valve 
	Single ventricle palliation (Fontan)
54
Q

How is the hemodynamics of someone with an AVSD affected?

A

• Potential for blood flow between any of the four chambers
o Flow dependent on relative resistances of the pulmonary and systemic systems, chamber pressures, and chamber compliance
• The common valve can have a common orifice or R and L orifice

Echo (2 decks)

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