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Pediatrics > Congenital Heart Defects: ASD/VSD > Flashcards

Congenital Heart Defects: ASD/VSD Flashcards

1
Q

ASD most commonly occur as defects in the

A

septum primum within the fossa ovalis (secundum ASD)

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2
Q

ASD can also occur

A

can involve the septum secundum near SVC (sinus venosus defects-less common)

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3
Q

cyanotic shunt

A

R -> L. worse for a kid

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4
Q

acyanotic shunt

A

L->R

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5
Q

Blood Flow is quantitated in terms of:

A

PULMONARY BLOOD FLOW (Qp)
 SYSTEMIC BLOOD FLOW (Qs)
 This gives us a ratio of Qp/Qs  This will equal 1:1 (or 1) in a normal individual

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6
Q

The general rule is shunts that DO NOT cause increase in right heart size

A

(Qp:Qs

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7
Q

Ostium Secundum

A

most common
formed by failed growth of the septum secundum or
rapid reabsorption of the septum primum

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8
Q

OSTIUM SECUNDUM LOCATION

A

mid-atrial

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9
Q

PFO

A

A patent foramen ovale (PFO) is a small channel that has little hemodynamic consequence; it is a remnant of the fetal foramen ovale.
 In some cases the PFO can be larger and require treatment

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10
Q

PFO closure from right side

A

The initial inflation of the lungs causes changes:
 Decreases PVR results in increased blood flow from PA.
 That increased amount of blood flows from the RA to the RV and into the PA’s and less blood flows through the foramen ovale to the left atrium.

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11
Q

PFO closure from right side

A

The initial inflation of the lungs causes changes:
 Decreases PVR results in increased blood flow from PA.
 That increased amount of blood flows from the RA to the RV and into the PA’s and less blood flows through the foramen ovale to the left atrium.

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12
Q

PFO closure due to left side

A

In addition, more blood returns from the lungs which increases the pressure in the LA.
 The increased LA pressure and decreased right atrial pressure (due to pulmonary resistance) forces blood against the septum primum causing the foramen ovale to close.
This action functionally completes the separation of the heart into two pumps

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13
Q

ostium primum location

A

located low in the septum and can be considered a type of AV septal defect.

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14
Q

ostium primum sat.

A

could have normal sat. in upper atrium but higher in lower atrium

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15
Q

sinus venosus location and associated with

A

located high in the septum where the vena cava intersects with the right atrium, frequently associated with partial anomalous venous return (PAPVR)
 May be inferior and/or superior

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16
Q

Cardiac Septation - review

 Occurs at ______ and lasts

A

day 27 and lasts 10 days

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17
Q

At day ____ the paired atria fuse together to form a

common atrium.

A

27-28

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18
Q

clinically remarkable left-to-right shunt

A

ASD > 9MM

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19
Q

Any process that increases the pressure in the LV can

A

cause worsening of the left-to-right shunt. It also works on the right heart

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20
Q

IF ASD LEFT uncorrected

A

ressure in the right heart > left heart.
 RA pressure > LA pressure
 The pressure gradient reverses across the ASD the shunt will reverse
 a right-to-left shunt (R->L) will now exist.

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21
Q

This shunt reversal phenomena is known as

A

Eisenmenger’s syndrome

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22
Q

Once right-to-left shunting occurs

A

oxygen-poor blood gets shunted to the left side of the heart.
This will cause signs of cyanosis.

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23
Q

percutaneous closure of ASD aka

A

(Amplatzer)

24
Q

types of surgical closure

A

Primary Closure  Patch Closure

25
Q

Surgical Correction of ASD’s

 Incision:

A

 Mediansternotomy
 Right thoracotomy (going between the ribs on the right side)
 Sub-mammary (under the breast tissue on the right front of the chest)-very difficult

26
Q

Surgical Correction of ASD’s
 Surgical Closure
 Primary

A

– Closure by direct vision suture

27
Q

Surgical Correction of ASD’s

 Surgical Closure patch

A

– Uses pericardial tissue or Gore-Tex patch for closure

28
Q

Surgical Correction of ASD’s

 Surgical Closure patch

A

– Uses pericardial tissue or Gore-Tex patch for closure

29
Q

ASD cannulation and VENTING

A

Arterial: Aortic
 Venous: Bicaval (total CPB)  Single Atrial if the infant is small and DHCA is
anticipated
 Venting: may use direct venting with a flexible since the heart is open

30
Q

ASD cardioplegia

A

Antegrade, usually a single dose will suffice

31
Q

ASD case notes

A

Case is very, very quick, 5-10 min pump run  Will XC, Stay warm “drift down temp”
 Can be challenging: (on CPB, XC, give CP, warm, correct Ca++,lytes, ABG’s, off CPB-MUF)

32
Q

A ventricular septal defect (VSD) is a

A

defect in the ventricular septum, the wall dividing the left and right ventricles of the heart.

33
Q

The ventricular septum consists of:

A

Inferior muscular portion  Superior membranous portion

34
Q

Common Regions of Ventricular Septal Defects

A

 Inlet  Outlet (supracristal)  Peri-membranous Septum  Muscular Septum

35
Q

prevalence of VSD

A

Membranous 75%  Muscular 20% Supracristal (Outflow) 5%

36
Q

Muscular ventricular septal defect is found in four locations

A

anterior, mid-ventricular, posterior, apical. Muscular VSDs are found in the lower part of the septum. They’re surrounded by muscle.
(most close on their own during early childhood.)

37
Q

the membranous portion, which is close to the atrioventricular node, is most common in

A

adults and older children

38
Q

Membranous VSDs are located near

A

the heart valves

39
Q

membranous VSD can close

A

at any time.

40
Q

Supracristal is an

A

outflow tract VSD sub-valvular in nature

41
Q

The crista supraventricularis can be considered

A

synonymous with the infundibular (or conus) ventricular septum

42
Q

Outlet VSDs are found in

A

the part of the ventricle where blood leaves the heart. These are the rarest type of VSD.

43
Q

The infundibular (or conus) septum separates

A

the tricuspid and pulmonary valves and accounts for the more superior placement of the pulmonary valve relative to the aortic valve.

44
Q

The infundibular (or conus) septum also provides

A

muscular rigid support for the aortic valve, especially the right coronary cusp (think prolapse)

45
Q

The infundibular (or conus) septum also provides

A

muscular rigid support for the aortic valve, especially the right coronary cusp (think prolapse)

46
Q

During systole, some of the blood from the left ventricle leaks

A

Into the right ventricle, passes through the lungs and reenters the left ventricle via the pulmonary veins and left atrium.

47
Q

two net effects from VSD

A

First, the circuitous refluxing of blood causes volume
overload on the LV.
 Second, because the left ventricle normally has a much higher systolic pressure (~120 mm Hg) than the right ventricle (~20 mm Hg), a LR shunt persists
this leakage of blood into the right ventricle elevates right ventricular pressure and volume, causing pulmonary hypertension

48
Q

VSD pathophysiology is more noticeable

A

in patients with larger defects, who may present with breathlessness, poor feeding and failure to thrive in infancy.
 Patients with smaller defects may be asymptomatic.

49
Q

The ventricular septum is formed by the outgrowth

A

of the muscular ridge at the interventricular foramen.

50
Q

vsd cannulation and venting

A

Arterial: Aortic  Venous: Bicaval (Total CPB)  Single Atrial if the infant is small and DHCA is anticipated
 Venting: may use direct venting with a flexible since the heart is open

51
Q

vsd cannulation and venting

A

Arterial: Aortic  Venous: Bicaval (Total CPB)  Single Atrial if the infant is small and DHCA is anticipated
 Venting: may use direct venting with a flexible since the heart is open

52
Q

vsd cardioplegia

A

Antegrade, usually a single dose will suffice

53
Q

vsd case notes

A

 Case is quick depending on VSD location
 Case may be 32°C, or DHCA if a small infant
 Can be challenging, but usually you have more time with VSD

54
Q

ventricular function after case

A

may be related to of the length of time the VSD has been present

55
Q

vsd percutaneous closure

A

Percutaneous closure (Amplatzer)  Can be tough to close VSD’s percutaneously

56
Q

surgical correction of VSD

A

Probably will not

see primary closure. mostly patch

Pediatrics (14 decks)

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