Sketchy Path: Right-To-Left Shunts

Question 1

What is truncus arteriosus?

Answer 1

Truncus arteriosus is when the aorta and pulmonary artery share a trunk. This leads to mixing of oxygenated and deoxygenated blood. It most commonly occurs with a VSD.

(Think of the purple tree TRUNk with the blue and red halves at the bottom. Also, there’s a weird Link-looking kid that has a V-shaped tunic to symbolize the VSD.)

Question 2

What causes truncus arteriosus?

Answer 2

Failure of the neural crest cells to migrate and form the aorticopulmonary septum

(Think of the “Legend continues this SEPTember” sign and the little demon with the neural crest shield.)

Question 3

On what chromosome can a deletion cause truncus arteriosus?

Answer 3

22q11 (like the demon with 22 and 11 on its helmet)

Question 4

______________ are necessary for survival in transposition of the great vessels.

Answer 4

PDA, VSD, or ASD

Think of the red and blue Pokemon circuits that are totally separate. The current battle is “PDA VS. ASD”… get is?

Question 5

On echo, what is a classic sign of transposition of the great vessels?

Answer 5

Normally, the base of the aorta should be somewhat posterior to the base of the pulmonary artery. If the aorta is anterior, then transposition is likely.

(Think of the Pokemon girl’s red feather IN FRONT OF her blue feather.)

Question 6

___________ is a classic risk factor for TGV.

Answer 6

Diabetes (like the kids throwing candy next to the Pokemon players)

Question 7

TGV results from a defect in _____________.

Answer 7

spiraling (like the spiral Pokemon)

Question 8

Tricuspid atresia often presents with what other defect?

Answer 8

Tricuspid atresia (like the Dragon Ball Z comic with the guy being hurled through the broken window on the cover)

Question 9

What is the tetralogy of Fallot?

Answer 9

• Pulmonic stenosis (sailor girl getting choked by the sorceress)
• RV hypertrophy (other sailor girl with conch shell dangling to her right)
• VSD (sailor girl with V shirt)
• Overriding aorta (girl with red aorta-like ponytail)

Question 10

What x-ray sign is classic for TOF?

Answer 10

Boot-shaped heart (like the giant boots on the water sailor)

Question 11

TOF is also associated with _____________ deletions.

Answer 11

22q11 (like the sailor girl’s shield –same as the truncus demon)

Question 12

TOF presents with what murmur?

Answer 12

Harsh systolic ejection murmur with split S2

Question 13

Describe total anomalous pulmonary venous return.

Answer 13

All of the pulmonary veins return to the right atrium. Thus, there must be an ASD for the child to survive.

(Think of the kid on the Tap VR –get it? –game: he keeps on hitting R, R, R just like how the pulmonary veins return to the right side. The kid on the other side, representing the left heart, doesn’t have the energy to go. Lastly, they have a little ASD window between them.)

Question 14

What valvular problem is common in Ebstein’s anomaly?

Answer 14

Tricuspid regurgitation (like the baby regurgitating on the Dragon Ball Z guy’s trident-hair)