Edelman Pediatric Echo Flashcards

Question

How is the pulmonary artery wedge pressure determined?

Answer 1

A Swan-Ganz catheter is positioned in the pulmonary artery, and a small balloon is inflated at the catheter’s tip. The balloon is then floated and wedged into a smaller pulmonary artery. A pressure reading is obtained distal to the balloon. The inflated balloon prevents the tip of the catheter from sensing the pulmonary pressure, and the left atrial pressure is recorded as it is reflected across the pulmonary bed.

Answer 2

The ventricular segments are the:  * inferolateral (1)  * anterolateral (2)  * anterior (3)  * anteroseptal (4)  * inferoseptal (5)  * inferior (6)

Answer 3

* Both right and left aortic arches are present, i.e. the ascending aorta splits into two limbs encircling the trachea and esophagus; the two limbs join to form a single descending aorta. * There are several forms such as widely open right and left arches or hypoplasia/atresia of one arch (usually the left). This anomaly is commonly associated with patent ductus arteriosus. * Double aortic arch creates a vascular ring around the trachea and the esophagus. * The double aortic arch is also the most common vascular ring.

Answer 4

The mitral valve normally closes approximately 60 milliseconds after the onset of the QRS complex, or about halfway through the QRS complex.

Answer 5

The aortic valve normally opens at the end of the QRS complex. This answer takes into account the delay between electrical and mechanical systole, as well as the isovolumic contraction time (between mitral closure and aortic opening).

Answer 6

The coronary arteries are located on the outer, epicardial surface of the heart as follows:  * The right coronary artery (RCA) arises from the right aortic-root sinus, follows the right atrioventricular junction, and descends along the posterior interventricular groove.  * The left anterior descending coronary artery (LAD) follows the anterior interventricular groove.  * The circumflex coronary artery (Circ) courses along the left atrioventricular junction.

Answer 7

Mechanical systole follows electrical systole by approximately 12 milliseconds. This delay represents the time it takes for the electrical conductive impulse to spread and thereby cause myocardial contraction. The delay can best be appreciated during M-mode studies that examine the relationship between the electrocardiographic pattern and valvular motion.

Answer 8

At normal pressures, approximately 70% of ventricular filling occurs during the passive phase of diastole; atrial contraction accounts for the remaining 30% of ventricular filling. Of course, these percentages will change in patients with valvular abnormalities such as mitral stenosis or ventricular compliance problems such as hypertrophic cardiomyopathy.

Answer 9

Diastasis denotes the middle portion of diastole, which occurs between early, rapid filling of the ventricles and the start of atrial contraction. The duration of diastasis varies with the heart rate. Diastasis is quite long in patients with bradycardia and quite short in those with tachycardia.

Answer 10

Most commonly, saline contrast material is injected to detect atrial level shunts or intrapulmonary to atrial shunting. It may also be used to document abnormal venous return and to detect right-sided intracardiac masses.

Answer 11

The Valsalva maneuver is performed in two phases (strain and release):  * inhaling half-way closing the mouth and nostrils exhaling forcefully  * straining against the closed mouth for about 5-10 seconds opening the mouth and exhaling.

Answer 12

The four phases of Diastole are: * Isovolumic relaxation time (closure of AV to opening of the MV) * Early filling (passive) * Diastasis * Atrial contraction (active)

Answer 13

With continuous or pulsed wave Doppler scanning, mitral stenosis is best evaluated from the cardiac apex. Because apical views allow the Doppler beam and the mitral stenotic jet to be aligned in parallel fashion, these views yield accurate peak flow velocities.

Answer 14

A congenital connection between the ascending aorta and main pulmonary artery. There are several variations of this anomaly location; proximal, distal, intermediate and total defect of the aortico-pulmonary septum(divisional wall of truncus arteriosus). This defect simulates the physiology of a large PDA, but requires a more demanding repair. It most often occurs with normally related great arteries but more rarely, can be present in transposition of the great arteries as well.

Answer 15

After being injected into a peripheral vein, saline contrast material advances into the right atrium. Alternatively, the contrast material may be injected directly into the right atrium through a Swan-Ganz catheter. The mixed bubbles are too large to pass through the pulmonary bed. If bubbles are seen in the left atrium and the left ventricle within three to five heartbeats after injection, an atrial level communication should be suspected. It is also possible for a pulmonary to atrial shunt to occur, this is usually more than 5-7 beats after injection.

Answer 16

During the straining phase, the venous return decreases, so that the cardiac output diminishes and a reflex tachycardia occurs. Once the strain is released, the venous return increases, along with right-sided cardiac pressures and the cardiac output; a reflex bradycardia also occurs.

Answer 17

Imperforate, used with reference to an orifice, valve, or vessel.

Answer 18

The most important constant (empirical number) to remember for the mitral pressure half-time equation is 220. If the pressure half-time in milliseconds is greater than 220 then the MV area is less than one centimeter square (severe stenosis).

Answer 19

A procedure to redirect venous return to the contralateral ventricle. When used in complete transposition of the great arteries (either the Mustard or the Senning procedure) this accomplishes physiologic correction of the circulation, while leaving the right ventricle to support the systemic circulation. SVC/IVC flow is baffled to the mitral valve and LV which gives rise to the pulmonary artery and the pulmonary venous blood is baffled to the tricuspid valve and RV which gives rise to the aorta.

Answer 20

A defect often involving the left AV valve in atrioventricular septal defects (AVSD) formed by the conjunction of the superior and inferior bridging leaflets. Horseshoe appearance on 2D echo. A cleft may also be seen in the right AV valve. A similar but morphogenetically distinct entity may involve the anterior or rarely posterior leaflet of the mitral valve in otherwise normal hearts.

Answer 21

As documented by Doppler imaging, the normal flow velocity through the mitral valve * In children, the flow velocity is usually a mean of 1.0 m/sec and a range of 0.7 to 1.4 m/sec. 19

Answer 22

Describes an AV valve that empties into both ventricles. It overrides the interventricular septum above a VSD.

Answer 23

Describes an AV valve with anomalous insertion of tendinous cords or papillary muscles into the contralateral ventricle (VSD required).

Answer 24

Tissue or organ transplanted to a new site within the same individual.

Answer 25

The mitral valve is a bi-leaflet valve situated between the left atrium and the left ventricle. * The valve’s anterior leaflet is relatively long, lies close to the aorta, and comprises one third of the valve’s circumference. * The posterior leaflet is shorter and is usually divided into three sections (scallops). * Both the anterior and the posterior leaflets are attached to the ventricular papillary muscles by multiple chordae tendineae.

Answer 26

An anomaly of systemic venous connections wherein: * The inferior vena cava is interrupted distal to its passage through the liver * IVC flow reaches the right atrium through an enlarged azygos vein connecting the IVC to the superior vena cava * Usually, only hepatic venous flow reaches the right atrium from below

Answer 27

The changes seen in the Doppler spectral trace in patients with mitral stenosis include: * an *increase* in flow velocity * an *increase* in flow turbulence (as detected by pulsed Doppler or color flow studies) * *decrease* in the rate of drop-off for the early diastolic slope (pressure half-time).

Answer 28

Complete discontinuation between the ascending and descending thoracic aorta. * Type A: Interruption occurs after the aortic isthmus, just beyond the left subclavian artery and proximal to the ductal insertion. * Type B: Interruption occurs between the left common carotid artery and the left subclavian artery. An aberrant right subclavian artery may be seen in this type. * Type C: Interruption occurs between the innominate (or brachiocephalic) artery and the left common carotid artery.

Answer 29

anomalous left coronary artery arising from the pulmonary artery.

Answer 30

A self-centering device delivered percutaneously by catheter most commonly used for closure of an atrial septal defect, a patent foramen ovale , patent ductus arteriosus, ventricular septal defect and other cardiac malformations.

Answer 31

Left cervical aortic arch. In this anomaly, the aorta arches above the clavicular level. It may be associated with tortuosity and aneurysmal formations.

Answer 32

d. Performing three-dimensional multi-planar reconstruction of the mitral orifice is the most accurate way to measure the mitral orifice, provided that: * there is no echo dropout * the beam is perpendicular to the leaflets and is directed at the leaflet tips * the highest-frequency transducer and the lowest gain settings possible are used Note: if the question is which is the EASIER method then the answer is Doppler pressure half-time.

Answer 33

Left cervical aortic arch. In this anomaly, the aorta arches above the clavicular level. It may be associated with tortuosity and aneurysmal formations.

Answer 34

All pulmonary veins connect to the right side of the heart, either directly or via venous tributaries. * The connection may be supracardiac, usually via a vertical vein to the innominate vein or the SVC. * The connection may also be infracardiac via a descending vein to the portal vein, the IVC or one of its tributaries.  The connection may also be cardiac type via a connection to the coronary sinus or mixed type with connection the right atrium, vena cavae or coronary sinus or a combination of the above. * Pulmonary venous obstruction is common in supracardiac connection, and almost universal in infracardiac connection.

Answer 35

The normal mitral valve measures 4 to 5 cm2 in area and is therefore smaller than the tricuspid valve.

Answer 36

The valve areas associated with mitral stenosis are: * mild stenosis = >1.5 cm2 * moderate stenosis = 1.0 to 1.5 cm2 * severe stenosis = <1 cm2 Note: > means “greater than” and < means “less than”

Answer 37

One or more, but not all the pulmonary veins connect to the right atrium directly, or via a vena cava, coronary sinus or innominate venous pathway.

Answer 38

This anomaly is frequently associated with sinus venosus atrial septal defect. You can have either a superior or inferior sinus venous atrial defect, both of which are highly associated with anomalous pulmonary venous connection.

Answer 39

A structure surgically created to divert blood flow. * For instance, in atrial switch operations for complete transposition of the great vessels, an intra-atrial baffle is constructed to divert systemic venous return across the mitral valve to the LV and pulmonary artery, and pulmonary venous return across the tricuspid valve to the RV and aorta.

Answer 40

An anomaly wherein the aortic valve is comprised of only two functional cusps instead of the usual three. The most common bicuspid aortic valve involves fusion of the right and left aortic commissures.

Answer 41

* Color flow Doppler imaging (which is similar to pulsed Doppler scanning) maps the area of regurgitant flow. Unlike the pulsed Doppler approach, color flow imaging shows the regurgitant jet within a single cardiac cycle. * The larger the size of the jet, the more severe the regurgitation. In determining the severity of mitral regurgitation, the examiner must take into account the total size, length, and width of the jet.

Answer 42

This anomaly is seen in 2% of the general population and in 75% of patents with aortic coarctation

Answer 43

As documented by two-dimensional echocardiography, mitral valve prolapse is defined as systolic displacement of one or both mitral leaflets into the left atrium in the parasternal or apical long-axis views.

Answer 44

A palliative procedure to improve arterial oxygen saturation in patients with complete transposition of the great arteries, first described in 1950. A surgical atrial septectomy is accomplished through a right lateral thoracotomy, excising the posterior aspect of the interatrial septum to provide mixing of systemic and pulmonary venous return at the atrial level. This is rarely done in the modern era. The Rashkind procedure(balloon atrial septostomy) is often used in newborns with transposition of the great arteries to improve oxgenation via increased pulmonary venous flow into the right atria and thus the aorta before corrective surgery.

Answer 45

A palliative operation for the purpose of increasing pulmonary blood flow, hence systemic oxygen saturation is increased. It involves creating an anastomosis between a subclavian artery and the ipsilateral pulmonary artery either directly with an end-to-side anastomosis (classical) or using an interposition tube graft (modified).

Answer 46

The superior and the inferior bridging leaflets of the common atrioventricular valve are two leaflets uniquely found in association with AVSD. They bridge, or pass across, the interventricular septum.

Answer 47

* A historically distant palliative operation to increase pulmonary blood flow and reduce right to left shunting in tetralogy of Fallot. It involved resection of part of the RV infundibulum using a punch or biopsy-like instrument introduced through the right ventricle so as to reduce RV outflow tract obstruction, without VSD closure. * The operation was performed without cardiopulmonary bypass. * This is an open procedure not used anymore.

Answer 48

* An embryological term describing the connection between the left-sided inflow segments (primitive atrium and presumptive left ventricle) and the right-sided outflow segments (presumptive right ventricle and conotruncus) in the primitive heart tube. * syn primary foramen, primary ventricular foramen, primary interventricular foramen. This embronic interventricular communication involves extensive remodeling during cardiac development. This foramen eventually becomes the tertiary interventricular foramen(the membranous septum).

Answer 49

The normal area of the aortic valve ranges from 2.5 to 3.5 cm2.

Answer 50

The normal gradient across the aortic valve during systole 2 to 4 mmHg.

Answer 51

* Levoposition - to the left * Mesoposition - central/midline * Dextroposition - to the right

Answer 52

A significant increase in the peak Doppler velocity is demonstrated correlating to an elevated peak and mean gradient across the aortic valve. If the cardiac output is normal, a peak aortic valve gradient of more than 100 mmHg would correlate to severe stenosis.

Answer 53

The best noninvasive method for quantifying aortic valve stenosis is to use the continuity equation to calculate the area of the aortic valve.

Answer 54

* The aortic valve is comprised of three cup-shaped leaflets: the right, left, and noncoronary leaflets. * Behind each leaflet, the aortic wall dilates to form a sinus of Valsalva. The left and right coronary arteries originate from the sinuses of the left and right aortic valve leaflets, respectively.

Answer 55

The normal aortic valve flow velocity is 1.5 m/sec, with a range of 0.9 to 1.8 m/sec.

Answer 56

Starting at the top of the transverse arch closest to the aortic valve are: * the innominate (right brachiocephalic artery) * then the left common carotid * finally the left subclavian artery

Answer 57

The two-dimensional echocardiographic findings associated with aortic valvular stenosis are: * thickening of the aortic leaflets, with decreased leaflet mobility * left ventricular hypertrophy * poststenotic dilatation of the aorta

Answer 58

If the cardiac output is low, the valve area may be critically small, but the gradient may be as low as 3 m/sec (36 mmHg). Thus, the clinician needs to know the valve area as well as the gradient.

Answer 59

The various degrees of stenosis are associated with the following aortic valve areas: * mild = >1.5 cm2 * moderate = 0.7 to 1.5 cm2 * severe = <0.7 cm

Answer 60

Aortic stenosis causes pressure overload of the left ventricle. The ventricle responds to this overload (increased wall stress) by becoming hypertrophied. Over time, the pressure overload may cause left ventricular dilatation and decreased contractility. The right ventricle is not usually affected.

Answer 61

Aortic stenosis may produce poststenotic dilatation of the aorta because of the high-velocity aortic jet’s impact on the aortic walls. The pulmonary artery is not usually affected.

Answer 62

A synthetic material often used to fashion conduits and other prosthetic devices for the surgical palliation or repair of congenital heart disease.

Answer 63

* Of these three methods, Doppler calculation of the continuity-of-flow equation (c) is the most accurate means of determining the aortic valve area. * Measurement of aortic leaflet separation does not determine the aortic valve area or indicate what the third aortic leaflet is doing. * In most patients, planimetric calculation of the aortic valve area is impossible from the chest wall orientation because of multiple reverberations from the calcified/fibrotic leaflets.

Answer 64

The continuity-of-flow equation for aortic valve area is that the aortic valve area (A2) equals the area of the left ventricular outflow tract (LVOT) (A1) times the velocity in the LVOT (V1) divided by the peak aortic velocity (V2). **A1 X V1** **A2** = --------------- **V2**

Answer 65

* Levocardia - apex directed to the left of the midline * Mesocardia - apex oriented inferiorly in the midline * Dextrocardia - apex directed to the right of the midline

Answer 66

A stenosis of the proximal descending aorta varying in anatomy, physiology and clinical presentation. It may present with discrete or long-segment stenosis, is frequently associated with hypoplasia of the aortic arch and bicuspid aortic valve and may be part of a Shone complex.

Answer 67

Typical findings associated with congenital bicuspid aortic valve stenosis are: * concentric left ventricular hypertrophy * mild-to-moderate thickening of the aortic leaflet * systolic doming of the leaflets in the parasternal long-axis view.

Answer 68

* Large atrium characterized by a non-restrictive communication between the bilateral atria due to the absence of most or all of the atrial septum. * Frequently associated with complex congenital heart disease (heterotaxy/isomerism, atrioventricular septal defect, etc.).

Answer 69

* An anomaly wherein the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. * syn classic transposition; d-transposition; d-TGA; atrioventricular concordance with ventriculoarterial discordance

Answer 70

* A structure that connects non-adjacent parts of the cardiovascular system, allowing blood to flow between them. * Often fashioned from prosthetic material. May include a valve and/or may be derived from human cadaver harvesting.

Answer 71

* Color flow Doppler imaging (which is similar to pulsed Doppler scanning) maps the area of regurgitant flow. * Unlike the pulsed Doppler approach, color flow imaging shows the regurgitant jet within a single cardiac cycle. The larger the jet, the more severe the regurgitation. * In determining the severity of aortic regurgitation, the examiner must take into account the total size, length, and width of the jet.

Answer 72

A direct communication between a coronary artery and cardiac chamber, great artery or vena cava, bypassing the coronary capillary network.

Answer 73

Mild aortic regurgitation does not usually affect the left ventricle with any significance. In contrast, moderate-to-severe regurgitation results in left ventricular dilatation because of volume overload. In such cases, left ventricular contractility is hyperdynamic. The left ventricle continues to dilate until decompensation sets in and ventricular function decreases.

Answer 74

Another word used to describe diastolic flow reversal in the descending aorta is retrograde.

Answer 75

Bicuspid aortic valve is the most common congenital cause of aortic regurgitation.

Answer 76

Patients with mild aortic regurgitation will usually not have diastolic flow reversal in the descending aorta. Patients with *moderate aortic regurgitation** will usually have early diastolic flow reversal in the descending aorta. Patients with severe aortic regurgitation will usually have holodiastolic flow reversal in the descending aorta. This is generally considered a qualitative assessment of aortic regurgitation.

Answer 77

Marfan’s syndrome is a connective-tissue disease characterized by increased joint flexibility and elongation of the long bones. Ocular lens problems and cardiac abnormalities are often present.

Answer 78

* An anomaly wherein the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, and, in addition, the atrioventricular connection is discordant such that the right atrium connects to the left ventricle and the left atrium connects to the right ventricle. * There are usually associated anomalies, the most common being VSD, pulmonic stenosis, and/or a hypoplastic ventricle. The right ventricle supports the systemic circulation. * syn cc-TGA; l-transposition; l-TGA; ventricular inversion. The ventricles have undergone an embryonic l-looping, positioning the morphologic RV to the left of the morphologic LV. Known also a “ventricular inversion”

Answer 79

Conotruncal anomalies include: * truncus arteriosus * interrupted aortic arch * tetralogy of Fallot * transposition of the great arteries * double outlet right ventricle * aortopulmonary septal defect * tricuspid atresia * others

Answer 80

The normal flow velocity through the tricuspid valve is a mean of 0.6 m/sec, with a range of 0.4 to 0.8 m/sec.

Answer 81

Cardiac manifestations of Marfan’s syndrome include ascending aortic dilatation and mitral valve prolapse. Depending on the severity of the disease, varying degrees of aortic or mitral regurgitation may be present. Aortic dissections may also occur.

Answer 82

* The tricuspid valve is located between the right atrium and the right ventricle. * It most commonly has three leaflets: the anterior, inferior and medial (or septal) leaflets. These names reflect the leaflet’s anatomic relationships to the right ventricle. * The medial (septal) leaflet is connected to the septal wall. Its insertion is located closer to the cardiac apex than that of the anterior mitral leaflet.

Answer 83

* The most common two-dimensional echocardiographic findings associated with tricuspid stenosis are: * thickening and tethering (doming) of the tricuspid leaflets * decreased leaflet mobility during diastole * mitral stenosis

Answer 84

In tricuspid stenosis, changes in the Doppler spectral trace include: * an increase in flow velocity * an increase in flow turbulence (as detected by pulsed or color flow Doppler imaging) * a decrease in the rate of drop-off for the early diastolic flow (pressure half-time).

Answer 85

* Located below the crista ventricularis in the RV outflow tract. * Pertaining to a ventricular-great arterial connecting segment. * Normally subpulmonary, but can be subaortic, and may be bilateral or absent. * Bilateral infundibulum may be seen in patients with TGA/VSD/PS, DORV with VSD/PS, and anatomically corrected malposition.

Answer 86

* A membrane divides the left atrium into an accessory pulmonary venous chamber and a left atrial chamber contiguous with the mitral valve. * The pulmonary veins enter the accessory chamber. * The connection between the accessory chamber and the true left atrium varies in size and may produce pulmonary venous obstruction. * The cor-triatriatum membrane is located proximal to the left atrial appendage.

Answer 87

* A rotational abnormality of the ventricular mass around its long axis resulting in relationships of the ventricular chambers not anticipated from the given atrioventricular connections. * If the rotated ventricles are in a markedly superoinferior relationship, the heart may also be described as a superoinferior or upstairs-downstairs heart. There may be ventriculoarterial concordance or discordance. * syn. criss-cross atrioventricular connection. In criss-cross ventricular relationship, a large VSD is often present where the atrial inflow cross in three-dimensional space to reach their respective ventricles.

Answer 88

* A vestigial remnant of the right valve of the sinus venosus located at the junction of the trabeculated right atrial appendage and the smooth-walled sinus component of the right atrium receiving IVC, SVC and the coronary sinus. * A feature of right atrial internal anatomy. * syn. terminal crest

Answer 89

* Color flow Doppler imaging (which is similar to pulsed Doppler scanning) “maps” the area of regurgitant flow. * Unlike the pulsed Doppler approach, color flow imaging shows the regurgitant jet within a single cardiac cycle. * The larger the jet, the more severe the regurgitation. In determining the severity of tricuspid regurgitation, the examiner must take into account the total size, length, and width of the jet.

Answer 90

* A saddle-shaped muscular crest in the right ventricular outflow tract intervening between the tricuspid valve and the pulmonary valve, consisting of septal and parietal components, which demarcates the junction between the outlet septum and the pulmonary infundibulum. * Less commonly but more accurately termed crista supraventricularis.

Answer 91

* To calculate the RVSP, add the tricuspid regurgitation (TR) velocity (converted to mmHg by 4v2) and the estimated right atrial (RA) pressure. * The equation is:  RVSP = TR velocity + RA pressure * This calculation is a means of noninvasively calculating the pulmonary artery pressure. In the absence of pulmonic stenosis, the pulmonary artery pressure will be the same as the right ventricular systolic pressure. In pediatrics, it is common to add 3-5mmHg for the RA estimated pressure if not directly measured to the TR gradient for RVSP.

Answer 92

* A bluish discoloration due to the presence of an increased quantity of desaturated hemoglobin in tissues. * In congenital heart disease, cyanosis is generally due to right to left shunting through congenital cardiac defects, bypassing the pulmonary alveoli, or due to acquired intrapulmonary shunts (central cyanosis). * Cyanosis can also occur due to increased peripheral extraction due, for instance, to critically reduced cutaneous flow (peripheral cyanosis).

Answer 93

Tricuspid valve prolapse denotes systolic displacement of one or more tricuspid leaflets into the right atrium beyond the annular level. The anterior and septal (medial) tricuspid leaflets prolapse more frequently than the posterior leaflet.

Answer 94

Almost 90% of patients with tricuspid valve prolapse also have mitral valve prolapse.

Answer 95

The pulmonic valve is the most anteriorly positioned cardiac valve. It lies within the right ventricular outflow tract, to the left of the aortic valve. The pulmonic valve has three leaflets: the anterior, right (posterior), and left.

Answer 96

In children, the normal pulmonic flow velocity is approximately 0.8-1.2 m/sec. The normal systolic pulmonic valve gradient is 1 to 3 mmHg

Answer 97

In pulmonic stenosis, the Doppler spectral trace shows increased flow velocity and turbulence (spectral broadening). In severe stenosis, the interval from the onset of flow to peak velocity is prolonged as well as demonstrating a high velocity jet.

Answer 98

Pulmonic stenosis causes pressure overload of the right ventricle. In response to this overload (increased wall stress), the ventricle becomes hypertrophied. Over time, the pressure overload causes right ventricular dilatation and decreased contractility. The left ventricle is not usually affected.

Answer 99

The primary two-dimensional echocardiographic findings associated with pulmonic stenosis are: * valve thickening * decreased leaflet excursion * systolic doming * right ventricular hypertrophy * post-stenotic dilatation of the pulmonary artery

Answer 100

If the cardiac output is normal, a gradient of more than 75 mmHg denotes severe stenosis.

Answer 101

Pulmonic stenosis may result in post stenotic dilatation of the pulmonary artery owing to the high velocity jets impact on the artery’s walls. The aorta is rarely affected.

Answer 102

Mild pulmonic regurgitation does not affect the right ventricle. Moderate-to-severe regurgitation results in right ventricular dilatation and hyperdynamic contractility owing to volume overload. The right ventricle may eventually decompensate and right ventricular function decrease. The left ventricle is not affected

Answer 103

The most common cause of pulmonic stenosis is a congenital abnormality of the valve leaflets.

Answer 104

In mitral valve endocarditis, a typical two dimensional echocardiographic study may show: * thick, redundant leaflets * mass lesions on the flow (atrial) side of the leaflets * mobile masses in the left atrium during systole and in the left ventricle during diastole.

Answer 105

* In trivial or mild pulmonary insufficiency, the echocardiographic findings may be normal. * Moderate-to-severe insufficiency is indicated by early right ventricular dilatation, paradoxical septal motion, and hypercontractility. * Later in the disease process impairment of right ventricular function appears.

Answer 106

* Pulmonary hypertension causes the peak regurgitant velocity to increase. Normally, the peak regurgitant velocity is about 1 m/sec. * In pulmonic hypertension, however, the peak regurgitant velocity may be greater than 4 m/sec.

Answer 107

Pulmonary insufficiency in the moderate to severe range may dilate the pulmonary artery due to increased systolic volume passing the pulmonary valve.

Answer 108

* A procedure reserved for patients with abnormal ventriculoarterial connections who are not suitable for an arterial switch operation (e.g. TGA and non-suitable coronary patterns, DORV with severe subaortic stenosis). * The operation involves anastomosis of the proximal end of the transected main pulmonary artery in an end-to-side fashion to the ascending aorta to provide unobstructed blood flow from the systemic ventricle to the aorta; coronary arteries are not translocated and are perfused in a retrograde fashion. * The aortic orifice and a VSD (if present) are often closed(dependent on anatomy) with a patch. A conduit between the right ventricle and the distal pulmonary artery or systemic to pulmonary shunt provides venous blood to the lungs.

Answer 109

In aortic valve endocarditis, a typical two dimensional echocardiographic study may show: * thick, redundant leaflets * mass lesions on the flow (ventricular) side of the leaflets mobile masses in the left ventricular outflow tract during diastole and in the aorta during systole.

Answer 110

* Separation of the right ventricle into a higher pressure inflow chamber, and a lower pressure infundibular chamber, the separation usually being produced by hypertrophy of the septomarginal band or anomalous muscle bundles. * When a VSD is present, it usually communicates with the high pressure RV inflow chamber but may communicate with the low pressure distal chamber.

Answer 111

* The mitral valve orifice is partially or completely divided into two parts by a fibrous bridge of tissue. Both orifices enter the left ventricle. * Mitral regurgitation and/or mitral stenosis may be present. * Aortic coarctation and atrioventricular septal defect are commonly associated defects.

Answer 112

With mechanical prosthetic valves, more valve masking is present, and more reverberations emanate from the valve disc, leaflets or ball. With bioprosthetic valves, some masking is present; because the central area of these valves is fabricated of a biologic material, however, comparatively few reverberations emanate from this area.

Answer 113

Mechanical valves are extremely durable (over 20 years without complications) but necessitate lifelong anticoagulation therapy. Although bioprosthetic valves are less durable (10-12 years), they do not require anticoagulation. Mechanical valves also make more noise (especially the caged-ball/tilting disc valves) than bioprosthetic ones.

Answer 114

Both the pulmonary artery and the aorta arise predominantly from the morphologic left ventricle. DOLV is rare, and much less frequent than double outlet right ventricle (DORV).

Answer 115

Both great arteries arise predominantly from the morphologic right ventricle. * There is often no fibrous continuity between the semilunar and the AV valves; a ventricular septal defect is almost always present. * When the VSD is in the subaortic position without RV outflow tract obstruction, the physiology simulates a simple VSD. With RV outflow tract obstruction, the physiology simulates tetralogy of Fallot. * When the VSD is in the subpulmonary position (the Taussig-Bing anomaly) the physiology simulates complete transposition of the great arteries with VSD.

Answer 116

An operation used in patients with l-transposition of the great arteries (l-TGA; congenitally corrected transposition of the great arteries) and also in patients who have had a prior Mustard or Senning atrial switch operation for complete transposition of the great arteries (d-TGA). * It leads to anatomic correction of the ventricle to great artery relationships such that the left ventricle supports the systemic circulation. * It includes an arterial switch procedure (Jatene operation) in all cases, as well as an atrial switch procedure (Mustard or Senning) in the case of l-TGA, or reversal of the previously done Mustard or Senning procedure in the case of d-TGA. The double switch procedure is more commonly performed in children.

Answer 117

The most common malformation caused by trisomy 21.

Answer 118

Congenital heart defects are frequent, atrioventricular septal defect and ventricular septal defect being the most common.

Answer 119

* Congenital malformation consisting of nearly total absence of the right ventricular myocardium, presenting with marked enlargement of both the right ventricle and right atrium and subsequent tricuspid regurgitation. * Arrhythmogenic right ventricular dysplasia may be one end of a spectrum and Uhl anomaly the other but they are distinct entities.

Answer 120

An extreme form of irreversible pulmonary vascular obstructive disease arising as a consequence of pre-existing systemic to pulmonary shunt, wherein pulmonary vascular resistance rises such that pulmonary pressures are at or near systemic levels and there is reversed (right to left) or bi-directional shunting at great vessel, ventricular, and/or atrial levels.

Answer 121

A remnant of the right valve of the sinus venosus guarding the entrance of the inferior vena cava to the right atrium.

Answer 122

An opening(s), or window (usually small) between two structures, which may be spontaneous, traumatic, or created surgically.

Answer 123

* A palliative operation for patients with a univentricular circulation, involving diversion of the systemic venous return to the pulmonary artery usually without the interposition of a subpulmonary ventricle. * There are several variations, all leading to normalization of systemic oxygen saturation and elimination of volume overload of the functioning ventricle.

Answer 124

The pericardium consists of a visceral and a parietal layer. * The visceral layer lies directly upon the external surface of the heart and is commonly referred to as the epicardium. * The parietal (or fibrous pericardium) is the thick outer sack. The pericardial cavity lies between the two layers.

Answer 125

If the descending aorta is used as a landmark: * Pericardial effusions will be seen between the left atrium and the descending aorta; in some patients, the descending aorta will be displaced posteriorly. * On the other hand, pleural effusions will be inferior and posterior to the descending aorta and will not displace the aorta away from the left atrium.

Answer 126

Pericarditis is an inflammation of the pericardium. In response to this inflammation, the visceral pericardium exudes serous fluid. Pericarditis is more common in men than women; it is also more prevalent in adults than young children.

Answer 127

* Originally, a valved conduit between the right atrium and the pulmonary artery. * Subsequently changed to a direct anastomosis between RA(RAA) and PA.

Answer 128

Although most echo textbooks only refer to TWO layers of the pericardium there are three anatomic layers. * The serous visceral (covering the outer surface of the heart-epicardium) * The serous parietal which lines the inside of the fibrous pericardium (the parietal or thick outer sack).

Answer 129

Cardiac tamponade is an impairment of diastolic filling, caused by an increase in intrapericardial pressure. Tamponade most often results from a moderate-tolarge pericardial effusion, although it may result from a small, rapidly accumulated effusion (as when a ventricle is accidentally perforated during cardiac catheterization).

Answer 130

Because surgical removal of the pericardium may not produce any ill effects, the exact function of the pericardium is unclear. In general, the pericardium limits ventricular filling, reduces the friction that results from cardiac motion and may act a barrier to infectious organisms.

Answer 131

Classic physical findings associated with pericarditis and/or pericardial effusions include: * chest pain, which is atypical and often positional, being most severe in the supine position and relieved by sitting up or leaning forward * a pericardial friction rub (scratchy, high-pitched sound) that classically has 3 components: early diastolic filling, atrial systole, & ventricular systole * dyspnea

Answer 132

IVC blood is directed to the pulmonary artery via an extracardiac conduit. The SVC is anastomosed to the PA as in the bi-directional Glenn shunt

Answer 133

Surgical creation of an communication(hole) in the atrial patch or baffle to provide an escape valve, allowing right to left shunting to reduce pressure in the systemic venous circuit, at the expense of systemic hypoxemia.

Answer 134

The classic physical findings associated with cardiac tamponade include: * pulsus paradoxus, which causes a >10-mmHg decrease in the systolic blood pressure during inspiration * tachycardia * dyspnea * Beck’s triad (elevated venous pressure, hypotension, and a quiet precordium)

Answer 135

* In cardiac tamponade, two-dimensional echocardiographic findings include: * right ventricular diastolic collapse * right atrial systolic collapse * right and left ventricular volume changes associated with respiration (these changes are better appreciated on M-mode studies) * a dilated inferior vena cava without inspiratory collapse. * In cardiac tamponade, Doppler investigation is aimed at measuring transvalvular flow velocities and detecting respiration-related changes in flow. Normally, mitral inflow varies by less than 10%. In tamponade, however, the peak flow velocity may vary by as much as 40%. In general, tamponade may be indicated by respiration-related flow changes greater than 25% for the mitral valve and greater than 50% for the tricuspid valve. * Doppler flow measurements correlate better with the clinical hemodynamics of tamponade than do two-dimensional echocardiographic secondary signs such as right ventricular wall collapse.

Answer 136

* IVC flow is directed by a baffle within the right atrium into the lower portion of the divided SVC or the right atrial appendage, which is connected to the pulmonary artery. * The upper part of the SVC is connected to the superior aspect of the pulmonary artery as in the bidirectional Glenn procedure. The majority of the right atrium is excluded from the systemic venous circuit.

Answer 137

* A palliative operation for the purpose of increasing pulmonary blood flow, hence systemic oxygen saturation, in which a direct anastomosis is created between the superior vena cava and a pulmonary artery. * This procedure does not cause systemic ventricular volume overload.

Edelman Pediatric Echo Flashcards

(162 cards)