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Module 1 CHD > Morphology > Flashcards

Flashcards in Morphology Deck (32):
1

Features to describe

3 Segments: Atria, Ventricles, Arteries

2 Junctions: AV and VA

2

Atrial Morphology

LA:
Long, tubular hooked appendage with narrow junction to the main atrial compartment

RA:
Triangular appendage with broad junction

3

Atrial Arrangements

Usual (Situs solitus)
Mirror-Image (Situs inversus)
Isomeric left or right

4

Left Ventricle Morphology

MV ALWAYS goes with LV
- not attached to the septum, instead shares fibrous continuity with the aortic valve

Fine apical trabeculation

5

Right Ventricle Morphology

TV ALWAYS goes with RV
- septal leaflet is attached to septum

Moderator band from septum to free wall, joining the anterior papillary muscle

Course apical trabeculation

6

Biventricular Atrioventricular Connections

Concordant (Usual or mirror-image atria)
Discordant (Usual or mirror-image atria)
Ambiguous (Isomeric atria)

7

Univentricular AV Connection

Usually two ventricles, but one dominates and the other lacks direct AV connection

Dominant ventricle may have single or double atrial inlet

Describe the absent AV connection

8

Absent Ventricle

Failed connection of an atrium to the ventricle causes its absence within the first 58 days of development

Seen at 12-14w echo, either absent flow or no crossover

9

Areas of CHDs

Inflow Tract
Atrial Suptum
AV Junction
Ventricular Septum
VA Junction
Outflow Tract

10

Atrial Septum

Patent Foramen Ovale
- Tissue flap covers the hole, only shunting if uncovered under certain conditions.
- Muscle thickens the fibrous layer

ASD (Oval fossa defect)
- Not enough tissue covering the oval fossa, continuous shunting of blood
-Fibrous/Muscular fenestrations (like a web)

11

Conduction

AP from SAN propagates through specifically orientated atrial myocardium (not dedicated conduction tissue)

AVN surrounded by fibrous-fatty tissue to isolate it from the ventricles

Penetrating bundle of His carries AP down ventricular septum (splits to R+L bundle)

Purkinje fibres carry AP from apex, rapidly up the ventricles

12

The AV node

Found in the triangle of Koch, its borders are:
- The Tricuspid valve
- The Coronary sinus
- The Eustachian valve *

* acts in the foetal heart at the IVC, to shunt oxygenated, placental blood from the RA to the LA.

13

VSD and possible locations

- Failure off descending septum primum and ascending ventricular septum to fully fuse

- Adjacent to AV or VA junction

- Underneath/Overridden by a valvular orifice

14

Morphologic Features of VSD

- 90% involve the membraneous septum

Infundibular VSD: Below the PV

Muscular VSD: Often multiple holes in the muscular septum

15

Considerations in VSDs

- Margins of the defect

- Direction of communication (initially from LV to RV, then possibly reversed in pulm.HTN)

- Relationship of defects to conduction tissue

- Malalignment of the fused septa

16

Size in VSDs

- Small holes may close over spontaneously

- Large holes may leak underneath both OFTs and won't close spontaneously

17

Peri-membraneous VSD

- Most common form of VSD (~80%)

- Partly muscular rim, part of rim is continuous with the membraneous septum

18

Muscular VSD

- Second-most common form of VSD (~17%)

- Muscle forms the entire border of the defect, conduction system is not nearby

- Located in inlet, outlet or apical regions

19

Doubly-committed and Juxta-arterial VSD

- Rare (~3%)

- Hole is underneath the aortic and pulmonary valves

- AV and PV and normally offset (angle and level) but are adjacent here

20

Normal AV Junction

- Aorta should be in the centre

- TV and MV should surround it like a figure-of-8

21

AVSD
-Cause
- Structure
- AVN

- When AV cushions do not fully separate in development, a large 5-leaflet valve may form

- May have one common orifice, if superior and inferior bridging leaflets fuse then may have two

- AVN deviated, sits at AV myocardial border

22

Variation in AVSD shunting

Varied by the bridging leaflet attachments:
- VS: interatrial shunting
- AS: interventricular shunting
- Floating bridging leaflets: IA and IV shunting

23

Length of Outlet

- Longer outlet is less efficient
- Risk of OFT obstruction

24

Tetralogy of Fallot

1. Narrowed pulmonary outlet
2. Large VSD (underneath the RVOFT)
3. Overriding aorta (supplied by both ventricles)
4. Hypertrophy of RV

25

Ebstein Malformation

- Failure of TV to delaminate away from the RV wall

- TV is deep within the ventricle

- RV volume decreased (essentially absent RV)

26

Bicuspid AV

- One of the most common genetic variations in man
- sometimes due to congenital lack of 3rd leaflet

- sometimes due to fusion of 2 of the 3 leaflets

27

Common Arterial Trunk

- Failure of the OFT to divide

- All blood leaves the heart via a common truncus

28

Arterial duct
- Patent duct
- Coarctation of the aorta

- In foetus, a duct feeds the pulmonary vessels

- After birth, pulmonary blood pressure increases, ductal cushions emerge and thicken, duct closes and may remain as a ligament or disappear completely

Patent duct: May stay open, mixing blood

Coarctation: ductal tissue may constrict the aortic arch

29

Double-committed or juxta-arterial VSD

- More rare form of VSD (~3%)

- VSD beneath the AV and PV (they are normally offset in angle and level but are next to each other in this condition)

30

Absent Ventricle
- Imaging

- Treatment

- Failure of A and V to connect

Imaging
- 12-14w echo

- flow disturbance (no aorta-pulm cross-over)

Treatment
- Surgery, usually leaving single ventricle heart

31

Absent Left Ventricle (LA inlet and LV outlet missing)
- Blood route

- Enters RA
- Goes to LA (ASD)
- LV
- Goes to RV (VSD)
- Pulmonary trunk

32

AV Valve Defects

- Imperforate, stenotic, common valve

In VSD
- Valve, chordae or both may overlie the septum