CHD Flashcards
(26 cards)
End stage L->R shunting in ASD
Management
pulmonary hypertension, RV failure, and Eisenmenger syndrome
Define structure first with imaging including MRI, then RHC
CI for ASD closure
Severe pulmonary arterial hypertension
PFO sequalae
stroke, migraine, platypnea-orthodeoxia, or provoked exercise desaturation
No or minimal shunting
Anomalous coronary artery from opposite sinus
Left from right
Right from left+ ischemia or VT
Interarterial
High risk of SCD, Slit like orifice of ostium
Surgery
between aorta and pulm artery
Screening of first degree relatives
Bicuspid aortic valve
familial form of thoracic aortic aneurysm and dissection
Young woman with a bicuspid valve
Turner syndrome (XO)- short stature, a webbed neck, lymphedema, and premature ovarian failure.
Get CTA/ MRA to rule out coarctation -> CTA of head if there is coarctation
ASD closure indicated in
symptomatic patients with a left-to-right shunt, pulmonary vascular resistance <1/3 of systemic vascular resistance, pulmonary arterial systolic pressure (PASP) of <50% systemic, and a large shunt (Qp:Qs >1.5
Loud murmur equals
High gradient- restrictive
Coarct echo
Diastolic forward flow in the abdominal aorta
Congenital abnormalities with syndromes: Noonan Holt-Oram DiGeorge William Trisomy 21
pulmonary stenosis atrial septal defects, tetralogy of Fallot supra aortic stenosis AV canal defect (AV valves at same levels, VSD, ASD)
VSD management
Small with no significant shunt
Indications for surgery
Surveillance q 24 hrs
symptoms,
left heart enlargement from a volume overload (in adults this means evidence of at least a 1.5:1 shunt and enlarged left ventricle and left atrium),
pulmonary hypertension (as long as the pulmonary arterial systolic pressure is <50% systemic and the pulmonary vascular resistance is <1/3 systemic vascular resistance),
endocarditis
Tetralogy of fallot
VSD, overriding aorta, right ventricular hypertrophy, and outlet obstruction.
Early systolic click
Mid systolic click
Bicuspid valve
MVP
Right heart enlargement without ASD
partial anomalous pulmonary venous return, sinus venosus defect, or unroofed coronary sinus.
Ebstein anomaly
arrhythmia
apical displacement of the posterior/septal leaflet >20 mm (>8 mm/m2), and the presence of a redundant elongated anterior tricuspid valve leaflet-loud click-sail sound-billowing anterior leaflet
WPW
platypnea-orthodeoxia syndrome (POS
Causes
dyspnea and hypoxemia in the upright position that resolve when lying supine
(PFO), atrial septal defect, or atrial septal aneurysm
ILD, hepatopulmonary syndrome, and pulmonary arteriovenous malformations.
(bifid uvula, thin and velvety skin, easy bruising)
translucent skin, dystrophic scars, intestinal rupture)
Loeys-Dietz syndrome
Ehlers-Danlos syndrome
Coarctation surgery follow up
Restenosis
Cardiac MRI or CTA every 3-5 years in asymptomatic patients
lower extremity blood pressure difference is >20 mm Hg, there is significant radiofemoral delay, and/or claudication
Chronically large RV in young person
Look for shunting and Partial anomalous pulmonary venous return with echo, then cardiac MRI
Holosystolic murmur+ palpable thrill
VSD. The smaller, the louder
Fix coarctation if
CoA gradient >20 mm Hg, radiologic evidence of clinically significant collateral flow, systemic hypertension attributable to CoA, or heart failure attributable to CoA
Stent preferred over balloon angioplasty
Tetralogy of fallot associated with
ICD if
Atrial and ventricular arrhythmias, increased in middle age
LV systolic or diastolic dysfunction, NSVT, QRS duration ≥180 msec, extensive RV scarring, or inducible sustained ventricular tachycardia at electrophysiologic study
Differential cyanosis (toes, not fingers)
PDA (shunt is distal to subclavian arteries)
Eisenmenger’s syndrome complications
secondary erythrocytosis, thromboembolic events, cerebrovascular complications (stroke and brain abscesses), hyper viscosity syndrome, hypertrophic osteoarthropathy, and renal dysfunction
