Congenital Disease Flashcards by Harpreet Bhatia

ASD echo

RV enlargement
TR, pHTN
Color flow for shunt
Looks at PVs

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Secundum ASD

Most common
Central / fossa ovalis
Device closure
Associated with Holt-Oram

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Primum ASD

AV septum / inlet to ventricle

Portion of septum between septal TV leaflet and anterior MV leaflet

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Primum ASD echo

Cleft mitral valve anterior leaflet, MR
LVOT obstruction (enlongated outflow tract, accessory chordal tissue)
VSD
LAD on EKG

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Sinus venous ASD

Abnormal communication between SVC, pulmonary vein and LA
Anomolous PVs in most
Big right heart

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Unroofed coronary sinus

Absence of portion of common wall between CS and LA

A/W persistent left SVC

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PFO

Potential opening between RA and LA

Does not cause RV volume overload

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Atrial septal aneurysm

Redundant and mobile atrial septum flap
Phasic excursion of 10 mm from midline or total of 15 mm during cardiac cycle
A/w PFO or multiple fenestrations

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Chiari network

Meshwork connecting edge of IVC and coronary sinus with Crista terminalis
A/W PFO and ASA

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VSD

Left to right shunt

Causes left heart dilatation

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Types of VSD

Outlet / sub arterial
Membranous
Inlet
Muscular

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Outlet / sub arterial VSD

Located in outlet septum
Under PV and AV
AR due to prolapse of AV cusps

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Membranous VSD

Between TV and AV
Most common
TV may become aneurysmal
AR

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Inlet VSD

At inlet to ventricle (AV septal defect)
Immediately below both AV valves
Trisomy 21

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Muscular VSD

Muscular portion of septum
Children
Not near valves, close with device
Apical 4, parasternal views

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VSD in PLAX

Right below AV = membranous or subarterial

Further out = muscular

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VSD in RV inflow/outflow SAX

9-12:00 = membranous
12-3 = subarterial

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VSD in LV SAX

9-11 = inlet
11-2 = muscular

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VSD apical 4

Base of septum = inlet

Rest of septum = muscular

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VSD in apical 5

Base of septum = membranous

Rest of septum = muscular

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RVSP using VSD velocity

RVSP = SBP - 4 (VSD vel^2)

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PDA characteristics

Communication between descending thoracic aorta and PA

Left heart enlargement

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PDA echo

High left parasternal or SSN
Color and CW doppler across PDA
LV enlargement
Holodiastolic flow reversal in abdominal aorta
pHTN

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PASP in PDA

PASP = SBP - 4 (PDAv^2)

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Ebstein's anomaly

Exaggerated apical displacement of TV septal leaflet Atiralized RV, RV dysfunction ASD / PFO Accessory pathway Rotational displacement of TV towards RVOT Sail like and large anterior TV leaflet

Indexed apical displacement of TV septal leaflet in Ebstein's

>8 mm/m2

Tetralogy of Fallot

``` Displacement of part of ventricular septum -> RVOT obstruction Secondary RV hypertrophy VSD Associated aortic override ```

ToF associated with

Right aortic arch Secundum ASD Anomalous coronary arteries

Problems after ToF repair

PR due to patch in RVOT PS Residual VSD AR

Coarctation aorta PW doppler

Later upstroke in systole | Persistent flow in diastole

Coarctation echo

Dilated ascending aorta BAV Abnormal aorta PW doppler

d-loop TGA

RV is on right side

l-loop TGA

Morphologic RV with TV is on left side

Congenitally-corrected TGA echo

RV with coarse trabeculation, septoparietxal muscle bundle, TV chordal insertions into RV TV apical compared to MV

Cardiac crux

Meeting between AV septum and septal portion of MV and TV | Inflow portion of LV and RV

Corrected TGA a/w

``` Systemic TR Decreased ventricular function VSD, PS, RV dysfunction Dextrocardia, mesocardia CHB ```

Heart on fire

Anomalous RCA from pulmonary artery

Blalock-Taussig shunt

Subclavian artery transected, connected to pulmonary artery

Surgical shunts

For cyanotic patients with low pulmonary blood flow

Echo in Blalock-Taussig Shunt

High velocity signal, continuous flow in diastole

Classic Glenn Shunt

SVC to PA connection | Low velocity flow (venous)

Bidirectional Glenn shunt

SVC to both PAs

Problems with shunts

PA distortion | pHTN, LV volume overload with large shunts

Baffles

Typically for transposition

Atrial switch baffle (mustard, senning)

IVC / SVC -> LV -> lungs | -> Pulmonary venous baffle -> RV -> body

Atrial switch echo

Redirection of PV blood to morphologic RV to body | LV connected to PA

Rastelli shunt

When VSD present LV -> aorta RV -> pa conduit

Arterial switch

Transect both great vessels, redirects them | Reimplants coronary arteries

ToF most common post op problem

l-TGA correction problems

Systemic TR Systemic RV dysfunction CHB

d-TGA corrected problems

RV dysfunction Arrhythmias Baffle problems

Arterial switch problems

Valve and vessel (CA) problems

Rastelli problems

Subaortic stenosis | Conduit obstruction

Big RV DDx

ASD or PV shunt TR and PR RV myopathy Systemic RV

VSD leads to enlargement of

ASD leads to enlargement of

RV / RA

Best view for ASD

Subcostal 4-chamber

Trisomy 21 a/w

AV septal defect | ToF

Best view for sub pulmonary VSD

Parasternal short axis

Large VSD physiology effect

Equalization of right and left ventricular pressures Elevated PA pressure Left atrial and ventricular volume overload

Most common type of subaortic stenosis

Discrete membrane

VSD associated with coarctation

Perimembranous VSD

Aortic arch interruption most common in

DiGeorge syndrome

Type A interruption of aortic arch

Distal to origin of left subclavian

Type B interruption of aortic arch

Between left common carotid and left subclavian artery

Type C interruption of aortic arch

Between right innominate and left common carotid arteries

Muscular VSD spontaneous closure rate in childhood

80-90%

Direction of atrial shunting determined by

Compliance of ventricles

Most common site of coarctation

Opposite insertion site of ductus arteriosus

Noonan syndrome

Short stature, triangular face, webbed neck PV stenosis HCM ASDs

Most common cyanotic CHD

ToF

Truncus arteriosus

Large VSD Overriding great vessel Single great vessel giving rise to aorta and PA A/w DiGeorge syndrome

Tricuspid valve atresia

Must have atrial shunt to decompress RA 25% have transposition Single ventricle lesion; lateral Fontan connects IVC to PA

Hypoplastic left heart syndrome

Two atria. single ventricle, single AV valve Ductal dependent CO maintained by circumventing left heart

Pulmonary atresia with intact ventricular septum

RV hypoplasia | Needs to repair as single ventricle

Pulmonary atresia with VSD

Severe form of ToF

Total anomalous pulmonary venous return

PVs converge in midline, posterior and superior to LA | See pulmonary venous confluence

TGA most commonly a/w

VSD

Congenital Disease Flashcards

(78 cards)