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Echo 3 > Module 1: Basic Embryology and Septal Defects > Flashcards

Module 1: Basic Embryology and Septal Defects Flashcards

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1
Q

when is the heart formed in the fetus

A

3-7 weeks gestation

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2
Q

which organ is the first develop in the fetus

A

heart

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3
Q

at week 3 what structure begins to appear

A
  • the cardiogenic area
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4
Q

where is the fetal heart tup located

A
  • within the pericardium
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5
Q

what is the direction of the blood flow in the endocardial tube

A
  • unidirectional
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6
Q

what must the heart tube do to form the heart

A
  • heart tube must fuse and twist
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7
Q

where is the trunks arteriosis located

A
  • remains near the superior part of the heart
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8
Q

what structures are formed from the trunks arteriosis

A
  • semilunar valves

- aortic root and pulmonary root

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9
Q

what does the looping of the heart form

A
  • forms the 2 atria and 2 ventricle
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10
Q

what is the normal direction of looping

A
  • right wards
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11
Q

what is the abnormal direction of looping and what does it result in

A
  • leftwards

- left transposition of the great arteries

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12
Q

what are the three stages of atrial septal formation

A 
stage one - septum premum 
stage two - foramen secundum 
stage three - secundum septum 
stage four - foramen ovale valve 
stage five - at birth
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13
Q

stage one of atrial septal formation: septum premum - what does the septum premum separate

A
  • divides atrium into right and left halves
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14
Q

stage one of atrial septal formation: septum premum - where is the origin of the septum and where does it travel

A
  • extends downward from roof of common atrium

- towards the endocardial cushions

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15
Q

stage one of atrial septal formation: septum premum - what is the foramen premum

A
  • between the lower margin of the septum primum and the endocardial cushion
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16
Q

stage two of atrial septum formation: foramen secundum - how is the foramen secundum formed

A
  • septum primum grows inferiorly toward the endocardial cushions closing the foramen primum
  • a perforation appears int eh upper portion of the septum primum becoming the foramen secundum
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17
Q

stage three of atrial septum formation: secundum septum: where is the origin of the secundum septum and what does it form

A
  • grows inferiorly to eh right of the septum primum
  • this partially overlaps the foramen secundum
  • forms the foramen ovale
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18
Q

what pressure keeps the flap of the foramen ovale open

A
  • increased right atrial pressure in the fetus
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19
Q

stage four of atrial septum formation: foramen ovale valve - how is the valve formed

A
  • upper septum primum disappears
  • lower part of septum primum becomes the valve for the foramen ovale
  • the septum secundum starts growing superiorly from AV cushions
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20
Q

stage five of atrial septum formation: at birth - how is the foramen ovale shut

A
  • increased systemic vascular resistance + decreased RA pressure
  • the increase in pressure pushes the valve against the septum secundum closing the hole
  • eventually they fuse
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21
Q

what are the 4 locations of interatrial septal defects

A
  1. ostium primum ASD
  2. ostium secundum ASD
  3. patent foramen ovale (fossa ovalis)
  4. sinus venosus ASD
    • superior (SVC), inferior (IVC)
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22
Q

what is the most common type of ASD

A
  • ostium secundum
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23
Q

what are the 4 stages to ventricular septal formation

A

stage one = trabecular IVS
stage two = TO and MO formation
stage three = truncus formation
stage four = membranous septum

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24
Q

stage one of ventricular septal formation : trabecular IVS - how are the RV and LV formed

A
  • the bulbus Cordis becomes the RV

- he Primitive Ventricle becomes the LV

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25
stage one of ventricular septal formation : trabecular IVS - where is the origin of the trabecular IVS (muscular) and are does it travel
- grows from apex to base - stops part way between the ventricles - this allows blood flow from other ventricles to exit the truncus arteriosus through the inter ventricular foramen
26
stage two of ventricular septal formation: TO and MO formation - how is the TO and MO formed
- truncus arteriosus and AV cancan move more centrally | - tricuspid and mitral orifices form
27
stage two of ventricular septal formation: TO and MO formation - how is the rest of the IVS formed
- growth of the inlet portion of the inter ventricular septum - fusion of the inlet and trabecular IVS form the IVS
28
stage three of ventricular septal formation: truncus formation - how are the two great vessels formed from the truncus arteriosis
- truncus arteriosus divides with formation of conotruncal septum to form the proximal aorta and pulmonary artery - septum then forms in spiral fashion
29
hoe is the aortic and pulmonary root form
- conus cordis divides outflow tract into right and left - two swelling in the truncus arteriosus begin to grow which form a septum -
30
Step four of ventricular septum formation: membraneous septum
- once truncus arteriosus divides, the membranous IVS forms to complete the right heart and left heart separation sequence
31
what are the 4 typical locations of VSD and which is most common
- membraneous MOST COMMON - inlet VSD - muscular VSD - outlet VSD
32
what are the 2 sub locations of outlet VSDs and what is there location
- supracristal = above crista supraventricularis ridge (seen close to PV in SAX) - infracristal = below crista supraventricularis ridge (seen directly anterior to AO valve in SAX)
33
what type of CHD is a VSD
- acyanotic | - not bad enough to cause serious hypoxia
34
which way is the blood shunted with a VSD
- left heart to right heart
35
what is the tool used to assess any shunt
- Qp/Qs
36
where and what views would we see a perimembraneous VSD
- PLAX, - PSAX at AO valve 9-12 O'clock - AP 5 - subcostal 5
37
where and what views would we see a muscular/trabecular VSD
- PLAX - PSAX (LV-pap level & apex) - AP 4 &5 - subcostal 4 & 5 - SAX views
38
where and what views would we see a outlet VSD
- PLAX - PSAX (ao valve 12-3 o'clock) - subcostal 5 - SAX of AO
39
where and what views would we see an inlet VSD
- PSAX (MV and LV at pap level) - AP 4 - subcostal 4
40
what is Qp
- volume of blood going to lungs
41
what si Qs
- volume of blood going to aorta
42
how is Qp calculated
- from pulmonary arterial stoke volume | - RVOT diameter and VTI of RVOT flow
43
how is Qs calculated
- LVOT diameter and VTI of LVOT
44
what is the normal Qp/Qs
1:1
45
what Qp/Qs indicated a hemodynamically significant shunt
- ratio greater than 1.5:1
46
what Qp/Qs corresponds to a small shunt and what is the treatment
- 1 - 1.5: 1 | - none or septal occlude device
47
what Qp/Qs corresponds to a moderate shunt and what is the treatment
- 1.5-2.0: 1 | - septal occluder device or septal patch
48
what Qp/Qs corresponds to a large shunt and what is the treatment
- >2.0:1 | - foetal patch
49
what is the flow through the heart with an ASD
- flow enters RA from the LA through the ASD - flow to the lungs through the TV and RVOT flow in increased - flow entering the LA through the pulmonary veins is increased
50
what is flow through the heart with a VSD
- flow from the LV enters the RV through the VSD - RVOT flow in increased - flow to the lungs is increased - flow to the pulmonary veins and MV is increased - may lead to the dilation of RV and LA
51
how to calculate Qp
``` - measure RVOT diameter + during systole, <5mm from pulmonary annulus, inner to inner - CSA = 0.785 x d^2 - trace RVOT VTI - Qp = CSA x VTI ```
52
how to calculate Qs
``` - measure LVOT diameter + during systole + < 5mm from annulus - CSA = 0.785 x d^2 - trave LVOT VTI - Qs = CSA x VTI ```
53
what rules is changed when obtaining a Qp and Qs with a PDA
- Qp derived from LVOT | - Qs derived from RVOT
54
what is the flow through the heart with PDA flow
- flow shunts from descending ao to the pulmonary artery - flow to the lungs is increased - flow the pulmonary veins, LA, MV, LV, LVOT increased - entire left heart has increased volume
55
how to calculate RVSP in presence of VSD
RVSP = BP systolic - 4 x (Vmax VSD)^2
56
what is eisenmengers syndrome
- shunt direction is switched to right to left | - caused by large shunt with high volume to lungs causing lung damage increasing pulmonary resisitncae
57
what are 6 complications of eisenmengers syndrome
- CHF - early death - brain abscess - SBE - pulmonary infarction - pregnancy contraindicated
58
how do we report intracardiac shunts
- segmental approach to describe VSD
59
what are the 2 function of the endocardial cushions
- divide AV canal into 2 atrioventricular orifices | - assist in closure of ostium primum portion of IAS and membranous portion of IVS
60
what are the different endocardial cushions
- 2 medial | - 2 lateral
61
what do the 2 medial endocardial cushions form
- septal leaflet of tricuspid valve | - anterior leaflet of mitral valve and portion of inflow perimembranous IVS
62
what do the 2 lateral endocardial cushions form
- anterior and posterior TV leaflets | - posterior leaflet of mitral valve
63
how many sets of aortic arches are formed in the fetus
6
64
which aortic arch develops into the adult aorta
4th
65
what two structures are the other aortic arches formed
- carotid artery | - ductus arteriosus
66
how are the AV valves formed
- from portion of the AV canal - connective tissue - endocardial lateral cushions
67
how are the semilunar valves formed
- from truncus arteriosus | - swelling of tissue forms vessels/valves
68
what is the normal route of oxygenated blood to the fetal heart
- umbilical vein > DV > IVC > RA | - eustacian valve directs most of the blood through foramen ovale
69
what ar ether 2 possible paths of oxygenated flow one blood reaches the fetal heart
1) RA > LA > ... LA > LV > AO | 2) RA > TV > RV > PA > ductus arteriosus > AO
70
what six events happen at birth in the fetal heart
- umbilical vein closes - ducts arteriosus closes - becomes ligamnetum arteriosum - foramen ovale closes - become fossa ovalis - RV and pulmonary artery walls decrease in thickness (pressure decreases) - LV walls increase in thickness (pressure increase) - ductus venosus closes - becomes ligamentum venosum

Echo 3 (4 decks)

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