Congenital Heart Disease Flashcards Preview

Cardiovascular > Congenital Heart Disease > Flashcards

Flashcards in Congenital Heart Disease Deck (44)
Loading flashcards...
1

enlargement vs. dilatation

enlargement is a term used to describe an increase in volume in a chamber that is unrelated to failure of the myocardium

dilatation is when enlargement can be attributable to failure

2

hemodynamic changes of the valves due to pressure

mostly thickening at the line of closure and edge

3

hemodynamic changes of the valves due ot flow

generalized thickening of the valve

4

complex

a single abnormality or group of abnormalities that have a tendency to be associated

includes the effects of the abnormalities on the economy of the heart

5

categories of congenital heart disease

shunt

obstruction (left and right)

shunt with obstruction

other complexes

6

types of shunts

atrial septal defect

ventricular septal defect

common AV orifice

patend ductus arteriosus

aortico pulmonary septal defect

total anomalous pulmonary venous drainage

7

atrial septal defects

fossa ovalis or secundum type - common

ostium primum type

sinus venosus or proximal type of atrial septal defect - uncommon

coronary sinus type of atrial septal defect - rare

8

secundum type ASD

defect in the fossa ovalis

9

hemodynamics of secundum type ASD

RA, RV, and PA pressures are normal in childhood and rarely elevated

LA and LV pressrues are normal

R -> L shunt at the atrial level

increased pulmonary flow

10

secundum type ASD pathologic complex

RA and RV are hypertrophied and dilated

dilatation of tricuspid and pulmonary orifices and pulmonary trunk

11

primum type ASD

defect in distal to fossa ovalis, close to mitral and tricuspid valves

12

hemodynamics of primum type ASD

RV and PA pressures are normal or slightly elevated

RA, LA, and LV pressures are normal

L -> R shunt at trial level, slight R -> L

increased pulmonary flow

increased pulmonary vascular resistance and pulmonary hypertension may develop in adult life

13

pathologic complex of primum type ASD

cleft aortic leaflet of mitral valve

RA and RV hypertrophied and dilated

dilatation of tricuspid and pulmonic orifices

LA and LV are normal

LV hypertrophy present if mitral regurgitation or subaortic stenosis

14

ventricular septal defect

can occur anywhere in the ventricular septum

predilection for the defect to occur beneath the aortic valve, confluent in part with the membranous septum and extending anteriorly to some extent

most common is called subaortic, in part membranous and in part perimembranous type

15

hemodynamics of VSD

RV and PA pressures normal if defect is small, increased if large

RA and LA pressures normal or elevated

LV pressure normal

L -> R shunt

increased pulmonary flow

increased pulmonary vascular resistance and pulmonary hypertension may develop causing R -> L shunt and cyanosis if defect is large

16

pathologic complex of VSD

RA hypertrophied

RV hypertrophied and dilated

LA and LV hypertrophied and dilated

dilatation of pulmonic orifice and pulmoanry trunk

17

large VSD defect

additional pressure hypertrophy of the RV

18

patent ductus arteriosus

communication between the aorta and left pulmonary artery distal to isthmus

19

hemodynamics of PDA

RV and PA pressures normal or elevated

LA and LV pressures normal or elevated

RA pressure normal

L -> R shunt at ductus level

increased pulmonary flow

if pulmonary vascular resistance is high, may have bidirectional shunt at ductus level

20

pathological complex of PDA

without pulmonary hypertension - LA and LV hypertrophied and dilated

dilatation of PA with pulmonary hypertension

RA and RV hypertrophied and dilated

LA and LV vary

21

pulmonary hypertension

flow increases beyond the distensibility of the lung vasculature

vasoconstriction of the vascular bed

secondary pathologic changes in the inima or media of the muscular arteries and arterioles of the lungs restricting the pulmonary bed

most common in large VSD, then PDA, and least common in ASD

22

Eisenmenger complex

the reversal of a left-to-right shunt due to pulmonary hypertension

usually happens at the ventricular level or at the ductal level but not very common at the atrial septal defect level

23

obstructive lesions without shunts

isolated pulmonary stenosis

isolated aortic stenosis

coarctation of the aorta

24

isolated pulmonary stenosis

usually consists of a diaphragm-liek structure with an attempted formation of cusps with a central opening, which may be minute or small

uncommonly, the valve is failry well formed, but the cusps are agglutinated at the commissures - the annulus is quite small

25

hemodynamics of isolated pulmonary stenosis

RV systolic pressure elevated

PA pressure normal or low

no shunts except R -> L may occur via patent foramen ovale or in severe PS

26

pathologic complex of IPS

stenosis usually valvular or valvular and infundibular - rarely infundibular alone

RA and RV are hypertrophied

LA and LV are normal

poststenotic dilatation of PA often present

27

congenital isolated aortic stenosis

valvular or ring

suprevalvular

subaortic

valve cusps may be bicuspid or unicuspid and may show irregular thickening termed as dysplastic valve

28

hemodynamics of IAS

LV pressure elevated

RA, RV, and LA pressures normal unless LV fails

usually no shunts

normal flows

severe stenosis has large LV -> aortic systolic gradient and decreased pulse pressure

29

pathologic complex of IAS

stenosis valvular, subvalvular, or supravalvular

LV hypertrophied

LA usually hpertrophied

RA and RV normal

30

supravalvular aortic stenosis

two types

one consists of thickening and accentuation at the normal supravalvular aortic ridge at the upper margins of the sinuses of valsalva

the other consists of ridge thickening about a centimeter above the sinuses of valsalva