ASD, VSD, PDA

Question 1

In a pediatric echo the apical and subcostal views are usually ____.

Answer 1

Inverted

Question 2

Majority of pediatric echo labs begin exam in the ____ view to help determine situs of abdominal organs.

Answer 2

Subcostal

Question 3

During a pediatric exam, look for the ____ and ____, if abnormal situs is found, scan for the ____.

Answer 3

Liver and stomach; spleen

Question 4

High right parasternal view: Used to image _____ most often or to check ____ if surgical repair has been completed.

Answer 4

SVC; baffles

Question 5

High ____ parasternal view (aka. ductal or “pants” view): Shows some of ____ and right and left branches.

Answer 5

Left; MPA

Question 6

The ____ view is used most commonly to find a PDA.

Answer 6

High left parasternal view

Question 7

____ ____ is when the chambers connect correctly. Primarily the LA to the LV and the RA to the RV.

Answer 7

Atrioventricular concordance

Question 8

____ ____ is when the chambers are reversed and the LA connects to the RV and the RA connects to the LV.

Answer 8

Atrioventricular discordance

Question 9

____ ____ is the normal connection of the RV to the pulmonary artery and the LV to the aorta.

Answer 9

Ventriculoarterial concordance

Question 10

____ ____ is when the RV is connected to the aorta and the LV is connected to the pulmonary artery.

Answer 10

Ventriculoarterial discordance

Question 11

A ____ is when the ductus between the descending aorta and left PA does not close spontaneously after birth.

Answer 11

Patent ductus arteriosus (PDA)

Question 12

A PDA causes extra blood flow to the ____.

Answer 12

Lungs

Question 13

The ____-to-____ shunt across the PDA can create symptoms of CHF or respiratory problems.

Answer 13

Left-to-right

Question 14

A PDA is the most common extracardiac shunt, comprising __-__% of congenital heart disease.

Answer 14

5-10%

Question 15

What is the murmur associated with a PDA?

Answer 15

Continuous “machinery” murmur

Question 16

Where is a PDA murmur best heard?

Answer 16

At the left upper sternal border

Question 17

Small PDA’s are often ____.

Answer 17

Asymptomatic

Question 18

Moderate to large PDA’s symptoms include: ____, ____, and ____.

Answer 18

CHF, Dyspnea, Poor weight gain

Question 19

For a PDA, within ____ - ____ hours of birth, the smooth muscle of the ductus should contract causing closure.

Answer 19

10-15

Question 20

By 2-3 weeks of age, the newborn should form endothelial tissue which permanently seals off the ductus and leads to the development of the ____ ____.

Answer 20

Ligamentum arteriosum

Question 21

If the PDA does not close, it is usually because the pulmonary vascular resistance is ____ to decrease.

Answer 21

Slow

Question 22

The degree of shunting is related to the ____ diameter of the PDA.

Answer 22

Internal

Question 23

During fetal life, the diameter of the ductus arteriosus is the same as that of the ____.

Answer 23

Aorta

Question 24

While pulmonary resistance is greater than systemic resistance, there is ____-to-____ shunting across the PDA.

Answer 24

Right-to-left

Question 25

As the pulmonary resistance begins to drop, the ____-to-____ flow across the ductus may be quite large.

Answer 25

Left-to-right

Question 26

In patients with large PDAs, the aorta and PA have a wide open connection for blood to flow back and forth creating nearly ____ systolic pressure.

Answer 26

Equal

Question 27

With a PDA, ____ overload occurs in the LV which may lead to failure.

Answer 27

Volume

Question 28

With a PDA, ____ overload occurs in the RV usually resulting in RVH

Answer 28

Pressure

Question 29

With a right-to-left shunt, what may develop if the PDA is longstanding?

Answer 29

PHTN

Question 30

With a PDA, you may find the main pulmonary artery/pulmonary branch to be ____.

Answer 30

Dilated

Question 31

In a PDA, you may find the bowing of interatrial septum toward ____ atrium.

Answer 31

Right

Question 32

With PDA's, you need to measure a peak ____ with CW Doppler.

Answer 32

Velocity

Question 33

The highest PDA velocity measured is used to to calculate the ____.

Answer 33

PA pressure

Question 34

What is the formula for PA pressure?

Answer 34

PA pressure = systemic BP – 4(V)^2

Question 35

What medication is given to close a PDA?

Answer 35

Indomethacin

Question 36

What is the non-medication treatment for a PDA

Answer 36

Surgical ligation or occluder device in PDA

Question 37

What are the three types of ASD's?

Answer 37

Ostium Secundum – (70%) Ostium Primum – (20%) Sinus venosus defects – (10%)

Question 38

Ostium Secundum: Defect in the region of the ____.

Answer 38

Fossa ovalis

Question 39

What is the most common ASD?

Answer 39

Ostium secundum

Question 40

Ostium ____ defects represent failure of the endocardial cushions to merge.

Answer 40

Primum

Question 41

Ostium primum defects are found in the region ____ and ____ to the fossa ovalis.

Answer 41

Anterior and inferior

Question 42

What are ostium primum defects associated with?

Answer 42

Abnormalities of the AV valves

Question 43

Sinus venosus defects generally occur near the ____/____ junction.

Answer 43

SVC/RA

Question 44

Sinus venosus defects are usually associated with an abnormal connection of the ____ to the RA (anomalous pulmonary vein).

Answer 44

Right pulmonary vein

Question 45

For an ASD, ____ in the heart determines degree of the flow across the shunt, not the size of the hole.

Answer 45

Pressure

Question 46

What is the murmur for an ASD?

Answer 46

Soft mid-systolic crescendo-decrescendo ejection murmur

Question 47

Where is an ASD best heard?

Answer 47

Left upper sternal border

Question 48

The pathophysiology of an ASD in order:

Answer 48

Right side volume overload > RAE > RVE > IVS paradoxical overload pattern > change in flow direction (Eisenmenger's Syndrome)

Question 49

In the case of right-to-left shunting across an ASD, estimation of ____ pressure is critically important

Answer 49

RV

Question 50

What is the calculation for RVSP?

Answer 50

RVSP = 4(TR vel)^2 + RA pressure

Question 51

A few children with isolated ASDs develop ____ or ____.

Answer 51

CHF or cyanosis

Question 52

Whats the best view to view a primum ASD or a secundum ASD?

Answer 52

Apical 4 and subcostal views

Question 53

In the ____ view, the SVC can be imaged to show a sinus venosus defect.

Answer 53

Subcostal view

Question 54

For an ASD, PW Doppler should be used to trace a ____.

Answer 54

Mean gradient

Question 55

The subcostal SAX and parasternal SAX at aortic valve level are good views to use to look for ____.

Answer 55

Shunting

Question 56

If flow is left to right, assess ____ heart for dilatation.

Answer 56

Right

Question 57

A ratio of __:__ or greater is considered a significant shunt.

Answer 57

1.5:1

Question 58

What is the calculation for Qp:Qs>

Answer 58

Qp/Qs = SV RVOT / SV LVOT

Question 59

How do you calculate SV RVOT?

Answer 59

(CSA RVOT)(VTI RVOT)or (.785)(RVOT diameter)^2 (RVOT VTI, trace the waveform)

Question 60

How do you calculate SV LVOT?

Answer 60

(CSA LVOT) (VTI LVOT) (.785)(LVOT diameter)^2 (LVOT VTI, trace the waveform)

Question 61

How is a small ASD surgically repaired?

Answer 61

Sew the ends together

Question 62

How is a large ASD surgically repaired?

Answer 62

A pericardial patch is used to close the ASD

Question 63

How is an PFO/ASD in adults repaired?

Answer 63

A PFO/ASD closure device is used via catheter in the cath lab

Question 64

A VSD is communication between right and left ventricles resulting in ____ volume overload.

Answer 64

LV

Question 65

What is the most common heart defect through the first 3 decades of life? (20-25% of all CHD)

Answer 65

Ventricular Septal Defects - VSD

Question 66

What is the murmur for a VSD?

Answer 66

High-pitched, harsh holosystolic murmur

Question 67

Where is a VSD best heard?

Answer 67

Lower sternal border

Question 68

The pathophysiology of a VSD in order:

Answer 68

1. Some of the blood from the LV leaks into the RV 2. Passes through the lungs 3. Reenters the left ventricle via the pulmonary veins and left atrium. 4. Volume overload of LV (LVE) 5. Increased RV pressure and RVE 6. PHTN

Question 69

What are the 4 types of VSD's?

Answer 69

Perimembranous - (80%)- most common Muscular – (5-15%) Inlet – (5-8%) Outlet (Supracristal) – (5-7%)

Question 70

__-__% of VSDs close in the first year of life

Answer 70

75-90%

Question 71

Perimembranous VSD's are located in the ____ septum region.

Answer 71

Membranous

Question 72

____ VSD's can also be referred to as subaortic, infracristal, and membranous.

Answer 72

Perimembranous

Question 73

Perimembranous VSD's are associated abnormality of the ____.

Answer 73

TV

Question 74

An outlet VSD is located above the muscular septum but below the ____.

Answer 74

Pulmonary valve

Question 75

____ VSDs are known as supracristal, conal, infundibular, subpulmonary, subarterial, or doubley committed.

Answer 75

Outlet

Question 76

Outlet VSD's are associated with ____ prolapse and ____.

Answer 76

Aortic valve prolapse and AI

Question 77

With a VSD, RVOT obstruction is possible, so a complete ____ assessment of the RVOT is critical.

Answer 77

Doppler

Question 78

Muscular VSD's are also referred to as:

Answer 78

Trabecular, central, apical, and marginal

Question 79

Muscular VSDs are found anywhere in the septum from the ____ to the ____.

Answer 79

TV attachments; apex

Question 80

Occasionally, spontaneous closure of the ____ VSD occurs as the septum grows and forms additional muscle tissue.

Answer 80

Muscular

Question 81

A ____ VSD can also be referred to as an AV canal type or posterior VSD.

Answer 81

Inlet

Question 82

Inlet VSD's are located posteriorly and inferiorly beneath the tricuspid valve ____ leaflet.

Answer 82

Septal

Question 83

Inlet VSD is often associated with ____.

Answer 83

Endocardial cushion defects

Question 84

What are the size classifications for a VSD?

Answer 84

- Small (restrictive): (< .5cm2) , less than 50% of aortic orifice - Moderate: (.5 to 1.0 cm2) , 50% to 100% of aortic orifice - Large (unrestrictive): (> 1.0 cm2), greater than 100% of aortic orifice

Question 85

With a VSD, if closure occurs, turbulence will ____ as the defect decreases in size.

Answer 85

Increase

Question 86

What are the signs and symptoms for a moderate to large VSD?

Answer 86

- CHF - Respiratory distress - Dyspnea - Irritability - Slow weight gain - Cyanosis - Tachypnea - Restlessness - Fatigue when feeding - Excessive sweating

Question 87

For a VSD, use CW Doppler to check the gradient and measure the ____.

Answer 87

Peak velocity

Question 88

Echo protocol for a VSD should also include these four things:

Answer 88

- Calculate Qp:Qs - Look for LA and LV enlargement - Assess for Pulm HTN - Assess for MPA/PA branch dilatation

Question 89

How is a large VSD repaired?

Answer 89

VSD will be surgically closed (similar to ASD - pericardial patch)