Multiple Cardiac Anomalies- Topic 12 Flashcards Preview

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Flashcards in Multiple Cardiac Anomalies- Topic 12 Deck (91)
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1

Cor Triatriatum

Heart with 3 apparent atria (tri-atrial heart); left atrium or right atrium is divided into 2 parts by a fold of tissue, a membrane, or a fibromuscular band.

2

Left Atrium AKA

Cor triatriatum sinistrum

3

Right Atrium AKA

Cor triatriaum dextrum

4

Right Atrium AKA

Cor triatriatum dextrum

5

Right Atrium AKA

Cor triatriatum dextrum

6

Describe the membrane that separates the atrium into 2 parts in cor triatriatum.

Varies significantly in size and shape

7

Describe the membrane that separates the atrium into 2 parts in cor triatriatum.

Varies significantly in size and shape
May be:
a diaphragm
Funnel-shaped, bandlike, entirely intact (imperforate)
Contains 1 or more openings (fenestrations) ranging from small, restrictive-type to large and widely open

8

Describe the membrane that separates the atrium into 2 parts in cor triatriatum.

Varies significantly in size and shape
May be:
a diaphragm
Funnel-shaped, bandlike, entirely intact (imperforate)
Contains 1 or more openings (fenestrations) ranging from small, restrictive-type to large and widely open

9

Cor Triatriatum (Dextrum)

Right atrial
Extremely rare

10

Cor Triatriatum (Sinistrum)

Left atrial
Misdiagnosed frequently as asthma, mitral stenosis or obstructed pulmonary venous return

11

Cor Triatriatum (Sinistrum)

Left atrial
Misdiagnosed frequently as asthma, mitral stenosis or obstructed pulmonary venous return

12

Cor Triatriatum (Sinistrum): Pathophysiology

Occurs when pulmonary vein fails to incorporate the pulmonary circulation into the left atrium; the result is a septum-like structure that divides the left atrium into 2 compartments

13

Cor Triatriatum (Sinistrum): Pathophysiology

Occurs when pulmonary vein fails to incorporate the pulmonary circulation into the left atrium; the result is a septum-like structure that divides the left atrium into 2 compartments

14

What do others believe that the membrane dividing the left atrium in Cor triatriatum is?

Abnormal growth of the septum primum

15

What do others believe that the membrane dividing the left atrium in Cor triatriatum is?

Abnormal growth of the septum primum

16

What unique cases have been reported in cor triatriatum?

Cases have been reported in which 1 or 2 pulmonary veins drain into the proximal (accessory) chamber and the others drain directly into the true LA

17

What unique cases have been reported in cor triatriatum?

Cases have been reported in which 1 or 2 pulmonary veins drain into the proximal (accessory) chamber and the others drain directly into the true LA

18

Cor Triatriatum (Dextrum): Pathophysiology

During embryogenesis, the original embryologic RA forms the trabeculated anterior portion of the RA; complete persistence of the right sinus valve of embryonic life results in separation of the smooth and trabeculated portions of the right atrium and constitutes cor triatriatum dextrum

19

Cor Triatriatum (Dextrum): Pathophysiology

During embryogenesis, the original embryologic RA forms the trabeculated anterior portion of the RA; complete persistence of the right sinus valve of embryonic life results in separation of the smooth and trabeculated portions of the right atrium and constitutes cor triatriatum dextrum

This forms a sheet that serves to direct the oxygenated venous return from the IVC across the foramen ovale to the left side of the heart. If this membrane is fenestrated and weblike, then it is referred to as the chiari network

20

Cor Triatriatum (Dextrum): Pathophysiology

During embryogenesis, the original embryologic RA forms the trabeculated anterior portion of the RA; complete persistence of the right sinus valve of embryonic life results in separation of the smooth and trabeculated portions of the right atrium and constitutes cor triatriatum dextrum

This forms a sheet that serves to direct the oxygenated venous return from the IVC across the foramen ovale to the left side of the heart. If this membrane is fenestrated and weblike, then it is referred to as the chiari network

21

Why is the morbidity and mortality of cor triatriatum sinistrum high in those who are symptomatic in infancy?

Severely restrictive opening in the accessory membrane and the association with major cyanotic or acyanotic congeital heart lesions

22

What is the mortality in cor triatriatum sinistrum?

May exceed 75% in untreated symptomatic infants
Severe obstruction = poor prognosis

23

How soon is surgery performed after diagnosis of cor triatriatum?

Performed soon after diagnosis

24

What type of surgical entry is performed in correction of cor triatriatum?

Median sternotomy

25

What are some surgery notes for correcting cor triatriatum?

CPB + XC
XC time is short

26

What are some surgery notes for correcting cor triatriatum?

CPB + XC
XC time is short
Surgical correction can be done through the foramen ovalve
Procedure will be quick if pulmonary veins are not involved
Mild to "drift" cooling
Circ arrest if a small child or pulmonary veins involved

27

Cor Triatriatum: Cannulation

Aortic Arterial
Bicaval venous (open procedure)

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Cor Triatriatum: Cannulation

Aortic Arterial
Bicaval venous (open procedure)

29

Patent Ductus Arteriosus (PDA)

the ductus arteriosus fails to close normally in an infant soon after birth

30

PDA leads to what?

Abnormal blood flow between the aorta and pulmonary artery (A-P shunt)