Ventriculoarterial connection Flashcards

D-TGA, L-TGA

1
Q

d-TGA definition

A

where the AO arises from the morphological RV and the PA from the LV
-creating a Parrell circuit

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2
Q

d-TGA is an
atrioventricular ____
Ventricular arterial ____

options concordance or discordance

A

atrioventricular concordance
Ventricular arterial discordance

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3
Q

d-TGA is more common in ____
and in infants with ___ mothers?

Male vs Female

A

Males
infants with diabetic mothers

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4
Q

d-TGA is highly associated with what type of septal defect?

A

VSD but not always present

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5
Q

In d-TGA where does most mixing of blood occur?

A

at the atrial level

often requires balloon septostomy within first few days of life to increase mixing of blood

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6
Q

Because of the parrell circuit what is necessary for survival?

A

ASD
mixing of oxygenated and deoxygenated blood, most commonly done at the atrial level.

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7
Q

d-TGA present on a chest x-ray as

A

Oval cardiac silhouette

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8
Q

clinical signs of d-TGA are

A

tachypnea
cyanosis
RVH/LVH

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9
Q

D-TGA
Diagnosis can be made in PLAX and PSAX because of what 2D findings?

A

PLAX:Double barrel from two outflow vessels running parrell to each other
PSAX: both vessels are on the same plane as one another, AO is anterior and to the right of the PA

AO is usuall anterior and rightward in PSAX

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10
Q

Does d-TGA affect the coronary arteries?

A

Yes, 50-70% of the time they are in their normal location, however, two common variants are
-left circumflex off the right coronary
-single right coronary artery

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11
Q

d-TGA surgical repair consist of

A

Jatene procedure/arterial switch procedure
or
atrial switch/Mustard/Senning procedure (mostly seen in adults rarely performed anymore)

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12
Q

Congenital defects associated with d-TGA

A
  • anomalous coronary arteries (1/3 of patients)
  • pulmonary stenosis
  • right AO arch
  • CoA
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13
Q

d-TGA two different surgical procedures are

A

Jatene “arterial switch” procedure
or
mustard and sennings procedure

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14
Q

Rastelli procedure is used for d-TGA with a

A

VSD

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15
Q

Explain the Rastelli procedure

A

creating a tunnel by using a patch, connecting the left ventricle to the aorta and effectively closing the VSD. Conduit is then placed between RV and the pulmonary outflow.

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16
Q

With d-TGA the arch can be mistaken for

A

PDA due to its size, look for the branches on the arch

17
Q

L-TGA the pulmonary and systemic circuits are “corrected” as a result of

A

ventricular inversion

18
Q

L-TGA is a result of multiple malformations, what are those?

A

Aorta and pulmonary arteries are transposed like in (d-TGA)
and the right and left ventricles are inverted

As a result, the RA is attached to the LV from which the PA arises; and the LA is attached to the RV where the AO arises making them physiologically corrected.

atrioventricular discordance and ventriculoarterial discordance

19
Q

in L-TGA the AO is positioned ____ in relation to the PA?

A

anterior and leftward

20
Q

If the patient has isolated L-TGA the symptoms are

A

patient may be asymptomatic well into adulthood if no other congenital defects are associated.

21
Q

What 2D echo findings are commonly found with L-TGA?

A
  • VSD
  • pulmonary stenosis
  • TV abnormal, underdeveloped, Ebsteins, TR
  • RVE
  • RV function diminished (not made to work as the systemic chamber)
  • dextrocardia

The combination of severe PS and VSD can lead to cyanosis

22
Q

By 2D echo what findings can help differentiate between L-TGA and D-TGA?

A

Look at the ventricles and determine which ventricle is trabeculated and has a moderator band which are characteristics of the RV

both will have the parrell vessels in PLAX, PSAX will be slightly different where the AO will be slightly rightward in D-TGA than in L-TGA

23
Q

In L-TGA the atriums position are normal or switched

A

they are in normal position with the LA being on the left and the RA being on the right.

24
Q

Other associated congenital complex associated with L-TGA are?

A
  • CoA
  • IAA
  • DORV
25
Q

In L-TGA the AV valves always stay with the corresponding?

atria or ventricle

A

the AV valves will stay with the ventricles

mitral with the LV and tricuspid with RV

look at the relation of placement to the crux, Tricupid septal leaflet further down the ventricle

26
Q

The Jatene procedure is used with what congenital defect and what is performed in this operation?

A

Surgical repair for transposition of the great arteries D-type
-involves switching the AO and PA back to a semi normal arrangement by detaching them from above their roots/coronary arteries and attaching them to their new roots. coronaries will be attached to the “neo-aorta”
-PDA ligated
-ASD and VSD repair

27
Q

What maneuver involves the main pulmonary and pulmonary branches being pulled anterior to the AO, and straddle the ascending AO

A

Lecompte maneuver

used in the Jatene procedure

28
Q

Mustard and Senning procedures (atrial switch) consist of and was used to correct what complex?

A

intra-atrial surgical repairs used to treat D-TGA prior to the Jatene procedure

29
Q

What does Mustard and Senning surgery involve?

A

atria are “switched”; IAS excised, and a patch is used to create a tunnel/baffle

Oxygenated pulmonary venous return is directed by the baffle to the TV and is drained into the morphological RV and out the AO

deoxygenated cavae flow is directed to the MV and drains into the morphological LV and out the PA

Unfortunately the RV is not meant to do the systemic work of the LV, later on the RV may fail.
Baffle obstructions are common

30
Q

Double Switch procedure

A

involves the mustard/Senning procedure with a Jatene procedure

isolated L-TGA

If pulmonary stenosis is a factor then Jatene procedure can not be performed. The mustard/senning can be done with a rastelli conduit to connect the RV to the PA.