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pte masters + a practical approach to transesophageal echocardiography > Anatomic Variants and Pitfalls > Flashcards

Anatomic Variants and Pitfalls Flashcards

1
Q

What is the purpose of the Eustachian valve?

A

The eustachian valve (also known as the “valve of the inferior vena cava”) is a ridge of variable thickness in the inferior right atrium. It is a remnant of a fetal structure that directed incoming oxygenated blood to the foramen ovale and away from the right atrium.

Highly oxygenation fetal blood in the IVC goes directly to the coronaries via the Eusatchian valve thorough the fossa ovalis

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2
Q

Chiari networks can result in what?

A

Thromboembolic phenomenon

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3
Q

What is the Crista Terminalis thought to promote?

A

Atrial Tachyarrythmias

high density of adrenergic nerve fibers

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4
Q

Other than thromboembolic events, what are chiari networks also associated with? (Name 3)

A
  1. PFO
  2. Aneurysmal intraatriaal septum
  3. Atrial Arrythmias
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5
Q

What is the Thebesian Valve?

A

Valve of the Coronary Sinus

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6
Q

What is the problem with a prominent thebesian valve?

A

Problems with retrograde cardioplegia due to insertion of the cannula into the coronary sinus

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7
Q

What is another name for the Moderator Band?

A

septomarginal trabecula

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8
Q

What is another name for the Coumadin Ridge?

A

A coumadin ridge, also called warfarin ridge or left lateral ridge, is a band-like embryological remnant in the left atrium between the left superior pulmonary vein and the left atrial appendage. The ridge contains the ligament of Marshall, autonomic nerve bundle, and small atrial or sinoatrial node artery.

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9
Q

What is the primary problem with Cor Triatriatum Sinister from a physiological standpoint?

A

LV inlet obstruction

“Mitral stenosis like physiology”

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10
Q

What is the primary problem with Cor Triatriatum Sinister from a surgical standpoint?

A

Open-chamber procedure

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11
Q

What is the primary etiology with Cor Triatriatum Sinister?

A

Failure of resorption of common pulmonary veins during embryogenesis

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12
Q

Which Cor triatriatum is more common:

Sinister or Dexter?

A

Sinister > Dexter

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13
Q

Label 1

A

1 Eustachian Valve

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14
Q

Label 2

A

2 Septum Primum

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15
Q

Label 3

A

3 Septum Secundum

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16
Q

What can be associated with lipomatous hypertrophy?

A

Atrial Arrythmias

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17
Q

Where is the location of the fat that develops within the lipomatous hypertrophy?

A

Superior Interatrial Groove

AKA
Waterston’s Groove

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18
Q

Identify the green structure

It’s “serpentine” and hypermobile on the echo clip

A

Chiari Network

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19
Q

Where does the Chiari network originate from?

A

Eustachian Valve

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20
Q

Are the chiari networks clinically significant?

A

No

but can be associated with PFO, Aneurysmal intraatrial septums or thromboembolic disease

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21
Q

What is the major echo differences from chiari network vs. eustachian valve

A

Chiari Network = Serpentine and Mobile

Eustachian valve = Thicker less mobile

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22
Q

What is the Eustachian valve an embryological remnaant of?

A

Sinus Venosus

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23
Q

Identify 1

A

1 Crista Terminalis

24
Q

Identify 2

A

2 Eustachian Valve

25
Q

Identify 3

A

3 Coronary Sinus

26
Q

How do you identify a secundum ASD vs. Sinus Venosus ASD?

A

Look at where the Crista Terminalis is

Secundum ASD = Inferior / Caudad in reference to crista terminalis

Sinus Venosus ASD = Superior / Cephalad in reference to crista terminalis

27
Q

What is a secundum ASD Associatad with

A
  1. Mitral Valve Prolapse
28
Q

What is a sinus venousus ASD associated with?

A

Anomalous venous drainage* or *anomalous venous return

29
Q

What does the moderator band carry?

What is the function of this?

A

Carries part of the RBB of the AV bundle of the conduction system to the anterior papillary muscle

Function = Electrical shortcut across the chamber of the ventricle seems to facilittae conduction time, aallowing coordinated contraction of the anterior papillary muscle

30
Q

What view is this?

What is this structure?

A

TG RV inflow View

Moderator Band

31
Q

How many lobes is MOST common in the left atrial appendage?

A

2 lobes = 54%

32
Q

What is at the arrow

A

False tendon

33
Q

What is another name for False Tendon?

A

LV bands

34
Q

Are these clinically significant?

A

No, They are false tendons (LV bands)

35
Q

What is the estimated cutoff for intraatrial aneurysm?

How would you obtain this?

A

1.1 - 1.5 cm

In image, you see 2.9 cm which can be diagnostic for intraatriaal aneurysms

36
Q

What are aneurysmal intraatriaal septums associated with?

A
  1. PFO (50-89%)
  2. Strokes
37
Q

What is the prevalence of aneurysmal intertatrial septums?

A

1.0 - 2.2%

38
Q

How much higher are aneurysmaal interatrial septum patients with PFO at risk for stroke compared to PFO alone?

A

3-5x higher

39
Q

Omniplane at 0 degres and turned to the right:

Label 1

A

Right Lower Pulmonary Vein

40
Q

Omniplane at 0 degres and turned to the right:

Label 2

A

Right Upper Pulmonary Vein

41
Q

Label each arrow

A

See image

42
Q

Label 1

A

Left Atrial Appendage

43
Q

Label 2

A

Coumadin Ridge

AKA Warfarin Ridge

AKA Ligament of Marshall

44
Q

Label 3

A

LUPV

45
Q

What is the structure at the purple arrow?

A

Left Atrial Appendage Membrane

46
Q

The probe was at 0 degrees and turned LEFT.

What is this?

A

Left Lower Pulmonary Vein

47
Q

Label 1

A

Right PA

48
Q

Label 2

A

Transverse Sinus

49
Q

Label 3

A

Aorta

50
Q

What TEE view is this?

A

ME Ascending Aorta SAX

51
Q

Can the oblique sinus be seen on TEE?

A

No

52
Q

Label 1

A

Lambl’s excrescences

Lambl’s excrescences are filiform fronds that occur at sites of valvular closure. They may be found without any other evidence of cardiac disease. They originate as small thrombi on endocardial surfaces where the valve margins make contact. These are the sites of minor endothelial damage, due to wear and tear.

53
Q

What is at 1 on the Aortic Valve?

A

Papillary Fibroelastoma

54
Q

Where are fibroelastomas seen in relation to the valve position?

A

Downstream

Ex: LV side fo the MV and Aorta sie of the AV)

55
Q

What is the crista supraventricularis?

A

Crista supraventricularis is a muscular ridge within the right ventricle of the heart.

It is located between the tricuspid and pulmonic valves, at the junction of the right ventricular anterior (free) wall and the interventricular septum.

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