Structural Heart Defects Flashcards
Four characteristics of tetralogy of fallot
- Ventricular Septal Defect
- Pulmonary Stenosis
- Hypertrophy of RV
- Overriding Aorta
Pathophysiology of tetralogy of ballot
- Stenosis of RV outflow leads to Rv being higher pressure than left
- Blue blood passes from RV to LV
Symptom of patients with tetralogy of ballot
Patients are BLUE
How is tetralogy of fallot repaired
Black-Taussig Shunt - 1944
When is surgical intervention of tetralogy of fallot done
Before the age of two years
Side-effect of tetralogy of fallot surgery
Pulmonary valve regurgitation in adults life - redo surgery
What is seen in an ECG in tetralogy of ballot
- WRS duration - 142 msec
Symptoms of tetralogy of Fallot
None
Echo every pulmonary regurgitation
What is ventricular dental defect
Abnormal connection between two ventricles
How common are VSDs
20% of all congenital heart defects
Pathophysiology of VSDs
- High pressure LV
- Low pressure RV
- Blood flows from high pressure chamber to low pressure chamber
- Increased blood flow through the lungs
What is the large VSD physiology
1, Breathless, poor feeding, failure to thrive
2. Require fixing in infancy
What can large VSD lead to
Eisenmengers Syndrome
Surgical procedure to fix VSD
PA band, complete repair
Does minor VSD need intervention
No, it’s asymptomatic
Clinical signs of large VSD
- Small breathless skinny baby
- Increased respiratory rate
- tachycardia
- Big heart on CXR
- Murmur varies in intensity
Clinical signs of small VSD
- Loud systolic murmur
- Thrill (buzzing sensation)
- Well Grown
- Normal HR
- Normal Heart Size
What is Eisenmengers Syndrome
- High pressure pulmonary blood flow
- Damages pulmonary vasculature
- Reisstance to blood flow through lungs increase
- Rv pressure increases
- Shunt direction reverses
PATIENT IS BLUE
What is an atrial septal defect
Abnormal connection between the two atria
How common are atrial septal defects
Common
When do ASDs present
Adulthood
ASD pathophysiology
Slightly higher pressure in the LA than the RA
Shunt is left to right
Therefore not BLUE patient
Increased flow into right heart + lungs
Large ASD physiology
- Significant increased flow through the night heart and lungs in childhood
- Right Heart dilation
Signs of Large ASD
Chest infections
Intervention for ASD
Right heart should be closed
Is right heart dilation seen in small ASD
No
Intervention for minor ASD
None, leave alone
What happens to the shunt in small ASDs as age increases
Shunt increases in gradient size
ASD clinical signs
- Pulmonary flow murmur
- Fixed split second heart sound (delayed closure of PV because more blood has to get out)
- Big pulmonary arteries on CXR
- Big heart on CXR
What inheritable condition are Atrio-ventricular septal defects seen with
Downs Syndrome
What is AVSD
Hole in the very centre of the heart
What structures does AVSD involved
Ventricular and atrial septum, mitral and tricuspid valves
What happens to the AV valves in AVSD
Instead of two skepearet valves, there is one big malformed one, causing greater leaks
Physiology of complete AVSD
- Breathlessness as neonate
- Poor weight gain
- Poor feeding
- Torrential pulmonary blood flow
- Needs repair or PA band in infancy
- Repaire is surgically challenging
Physiology of partial AVSD
- Can present in late adulthood
- Presents like a small VSD/ASD
- May be left alone if there is no right heart dilation
What is patent ductus arterioles
Ductus arterioles does not close
Symptoms of patent ductus arterioles
Big heart, breathlessness
Continuous murmur
What can patent ductus arterioles lead to
Eisenmenger’s syndrome
How is Eisenmenger’s syndrome caused by patent ductus arterioles different from other caused eisenmenger’s syndrome
Cyanosis of toes not fingers (fingers remain pink)
Physiology of patent ductus arteriosus
- Torrential flow from aorta to pulmonary arteries in infancy
- Breathlessness
- Poor feeding
- Failure to thrive
Intervention for PDA
Surgically closed
In what babies is PDA more of a concern
Premature
What condition can patent ductus arterioles increase the risk of
Endocarditis
How is PDA surgically closed
- Venous approach
What is coarctation of aorta
- Narrowing of aorta at the site of inception of ductus arteriosus
Consequence of sever coarctation
- Complete obstruction to aortic flow
What can happen to the to the aorta heart failure and coarctation
Collapse
What does mild coarctation of the aorta present with
- Hypertension
2. Mild murmur
Should mild coarctation of the aorta be repaired
Yes
Clinical signs of coarctation
- Right Arm hypertension
- Buzzes (bruits) over scapular and back from collateral vessels
- Murmur
What are long-term problems of coarctation
- Hypertension (early strokes, CAD, sub-arachnoid haemorrhages)
- Re-coarctation requiring repeat intervention
- Aneurysm at site of repair
Surgical vs percutaneous repair
- Surgical - subclavian flap repair
2. End-to-end repair
How many cusps does normal AV have
Three
How common are bicuspid AV valves
Common (more in males)
Effect of Bicuspid AVs on function
Stenotic in infancy or childhood
Properties of bicuspid valves vs normal valved
- Degenerate faster
- Become regurgitant earlier
- Associated with coarctation and dilatation of ascending aorta
What is pulmonary stenosis
- Narrowing of the outflow of RV
Three types of causes for pulmonary stenosis
- Valvular
- Sub-valvular
- Supra-valvular
Consequences of severe pulmonary stenosis
- RV failure as a neonate
- Collapse
- Poor pulmonary blood flow
- RV hypertrophy
- Tricuspid regurgitation
Moderate pulmonary stenosis consequences
- Well-tolerated for many years
2. RV hypertrophy
How is pulmonary stenosis treated
- Balloon valvuloplasty
- Open valvotomy
- Open trans-annular patch
- Shunt (bypass blockage)
