Cardiac Situs And The Segmental Approach

Question 1

Label these three images in terms of Cardiac position.

Answer 1

From left to right

1. Dextroposition
2. Mesoposition
3. Levoposition

Question 2

Which position is this? And label the image?

Answer 2

1. Apex position

From left to right

1. Levocardia
2. Mesocardia
3. Dextrocardia

Question 3

What is the difference between the two images?

Answer 3

The left is a normal situs and the right is dextrocardia

Question 4

What does this image demonstrate?

Answer 4

Dextrocardia in sub 4CH

Question 5

Label the images in terms of Visceral Situs?

Answer 5

Question 6

What does this image demonstrate?

Answer 6

VSD with overriding Aorta

Question 7

What are segments? 4

Answer 7

The anatomical structures which the cardiovascular structure system is divided for purposes of evaluation which include:
1. Systemic and pulmonary veins
2. Atria
3. Ventricles
4. Great arteries

Question 8

What does connectives describe?

Answer 8

The anatomical sequence of the structures

Question 9

What does connections include? 3

Answer 9

1. Venous to atria (veno-atrial)
2. Atria to ventricle
3. Ventricle to great arteries (ventriculo arterial)

Question 10

What does concordants describe?

Answer 10

Normal Sequential relationship between the hearts chambers, valves, and great vessels

Question 11

What is a term used for concordant?

Answer 11

Appropriate

Question 12

What does discordant refer to?

Answer 12

Abnormal sequential relationship between chambers, valves, great vessels

Question 13

What does commitment describe?

Answer 13

The degree of abnormality of flow through the valves into ventricles and great vessels

Question 14

What is an example of commitment?

Answer 14

A valve which overrides a large VSD is committed to more than one ventricle

Question 15

Commitment is assigned based on what rule?

Answer 15

50% rule

Question 16

In terms of commitment if more that _____% of a valve overrides a VSD, it is said to be committed

Answer 16

50%

Question 17

What does ambiguous mean?

Answer 17

When precise identification of a chamber can not be determined

Question 18

What are inlet/outlet anomalies? 2

Answer 18

Anomalies of structure and flow
1. Into the ventricle (inlet)
2. Out of the ventricle (outlet)

Question 19

What are things we would see in terms of congenital heart defects in the first 8 weeks of development? 4

Answer 19

1. Looping
2. Twisting
3. AV canal formation
4. Septal formation

Question 20

What is a segmental approach to CHD?

Answer 20

A systematic approach to defining and characterizing congenital heart defects

Question 21

What does segmental approach to CHD focus on?

Answer 21

Focuses on segments of the heart and connections between them

Question 22

How does segmental approach to CHD differ from old classification system?

Answer 22

Differs based on the associated abnormalities

Question 23

What are three steps for segmental approach of CHD?

Answer 23

1. Visceral atrial situs + atrial connections
2. Orientation of the ventricles + connections
3. Orientation of the great vessels + connections

Question 24

What does cardiac position mean?

Answer 24

Where the heart lies within the chest

Question 25

What is right dextroposition?

Answer 25

Most of the heart lies to the right of the sternum

Question 26

What is midline mesoposition?

Answer 26

Heart lies directly behind the sternum

Question 27

What is left levoposition?

Answer 27

Most of the heart lies to the left of the sternum

Question 28

What is normal cardiac position?

Answer 28

Left - levoposition *The apex may still point to the left in any of these cases*

Question 29

What does Step 1. visceral atrial situs refer to?

Answer 29

The position of the atria in relation to the nearby anatomy

Question 30

In terms of step 1. Visceral atrial situs, it is standard to start with what window?

Answer 30

Subcostal view

Question 31

What do we look at during step 1. Visceral atrial situs?

Answer 31

1. Identify which way the apex is pointing 2. Identify atria 3. Relate to surrounding structures

Question 32

What is cardiac position?

Answer 32

The direction the apex points

Question 33

What is right- dextrocardia?

Answer 33

Apex points to the right side of the body

Question 34

What is midline mesocardia?

Answer 34

Apex lies under the sternum

Question 35

What is Left Levocardia?

Answer 35

Apex points to the left

Question 36

What is the normal cardiac orientation?

Answer 36

Left levocardia

Question 37

What is the process to determine dextrocardia? 4

Answer 37

1. Start with a transverse subcoastal sweep 2. Determine visceral situs 3. PLAX 4. Label RT chest for the reading physician

Question 38

How many people are afflicted with Dextrocardia?

Answer 38

1:12000 people

Question 39

If all organs are mirrored the correct term is what?

Answer 39

Dextrocardia situs inversus totalis

Question 40

Individuals with Dextrocardia may be prone to what? 4

Answer 40

1. Esophageal, bronchial, cardio pulmonary disorders 2. Endocardial cushion defect 3. Pulmonary stenosis 4. Double outlet RV

Question 41

What is a situs solitus (normal) visceral situs?

Answer 41

1. LT sided: Stomach, spleen, pancreas 2. RT sided: Liver, cecum, appendix

Question 42

What is a situs inversus visceral situs?

Answer 42

Mirror image of normal

Question 43

What is situs ambiguous?

Answer 43

1. Inconsistent organ placement 2. Duplication/absence of organs

Question 44

What is atrial situs solitus (normal)?

Answer 44

Morphologic RA is on the RT of the morphologic LA

Question 45

What is Atrial situs inversus?

Answer 45

Morphologic RA is to the LT of the morphologic LA

Question 46

What is atrial situs ambiguous?

Answer 46

Confident assignment of morphologic left and right atria cannot be made

Question 47

What does morphologic mean?

Answer 47

Has morphologic features of that chamber

Question 48

What are some morphologic RA features that are defining? 5

Answer 48

1. Eustachian valve 2. Venae cave 3. Coronary sinus 4. Chiari network 5. RA appendage

Question 49

What are some definitive morphologic LA structures? 2

Answer 49

1. Pulmonary veins 2. LA appendage

Question 50

What do we use to evaluate with venous segments position? 5

Answer 50

1. Hepatic veins 2. IVC 3. SVC 4. Coronary sinus 5. Pulmonary veins

Question 51

What are some identifiable features of veno-atrial connections? 2

Answer 51

1. Systemic venous return (SVC/IVC) 2. Pulmonary venous return (Pulmonary veins)

Question 52

What are morphologic RV features? 7

Answer 52

1. Crescent shaped 2. TV (3 leaflets) 3. Large apical trabeculations 4. Multiple small papillary muscles 5. Moderator band 6. Septal leaflet apically displaced 7. Infundibulum

Question 53

What features define the morphologic LV? 5

Answer 53

1. Bullet shaped 2. MV (2 leaflets) 3. Two papillary muscles 4. May have false tendons 5. Inlet and outlet valves in continuity

Question 54

What is the crux?

Answer 54

Where the atria and the ventricles meet at the center of the heart

Question 55

What is a bi-ventricular?

Answer 55

One atrium connected to both ventricles

Question 56

What is uni-ventricular?

Answer 56

Both atria connect to one ventricle

Question 57

What is common curx?

Answer 57

Atria connect to ventricles through a single multi-leaflet structure

Question 58

What are some things we look for in terms of Ventriculo- arterial concordance? 4

Answer 58

1. AV and PV anatomically identical 2. Look for fibrous continuity between AV and MV 3. Look for overriding vessels 4. Assess spatial relational of AV/PV in SAX

Question 59

In terms of ventricular-arterial connections, what are 3 main variations from normal?

Answer 59

1. Transposed connection 2. Double outlet connection 3. Single outlet connection

Question 60

What is a transposition of the great arteries in terms of ventricular arterial connections?

Answer 60

1. Main PA arises from the LV 2. Aorta arises from the RV

Question 61

In terms of Ventriculo-arterial connections, what is double outlet connections?

Answer 61

Both the great arteries arise from a single ventricle (almost always the RV)

Question 62

In terms of ventriculo-arterial connections, what is a single outlet connection? 2

Answer 62

1. Only 1 overriding great artery (aorta) coming from the ventricle 2. Great arteries are fused into a single truncal artery with branches from the ventricle

Question 63

What are some defining features of the pulmonary trunk?

Answer 63

Bifurcations to the branch PAs in the 1. LPA 2. RPA

Question 64

What are defining features in the Aorta?

Answer 64

1. Coronary arteries 2. Branches (innominate a, LCC, LSC)