Outflow obstruction Flashcards Preview

Paeds CP2 > Outflow obstruction > Flashcards

Flashcards in Outflow obstruction Deck (17):

What is aortic stenosis?

the aortic valve leaflets are partly fused together
there may be 1 to 3 aortic leaflets, leading to restrictive exit from the LV
aortic stenosis may not be associated with an isolated lesion, there may be mitral valve stenosis and coarctation of the aorta and these must be excluded


what are the clinical features of aortic stenosis?

present with an asymptomatic murmur

severe: reduced exercise tolerance, chest pain, syncope

neonatal: heart failure, duct dependent circulation


What are the physical signs of aortic stenosis?

small volume
slow rising pulse
carotid thrill
ejection systolic murmur maximal at upper right sternal edge
delayed soft aortic second sound
apical ejection click


What investigations are performed is aortic stenosis is suspected?

CXR: normal or post stenotic dilatation of the aorta

ECG: LVH, deep S wave in V2 and tall R in V6, downgoing T wave suggests severe stenosis


Management of aortic stenosis

regular clinical and echo assessment is required to determine when to intervene
symptomatic children: balloon valvotomy
children with significant stenosis often require aortic valve replacement


What is Pulmonary stenosis

leaflets are partly fused together leading to restrictive exit from the RV


What are the clinical features of pulmonary stenosis?

clinically diagnosed


Physical signs of pulmonary stenosis

an ejection systolic murmur best heard at upper left sternal edge, thrill may be present

an ejection click

soft or absent p2

severe lesion: prolonged RV impulse with delayed valve closure


pulmonary stenosis investigations

CXR: normal or post stenotic dilatation

ECG: RVH, upright T wave in V1


pulmonary stenosis management

transcatheter balloon dilatation required when pressure across the pulmonary valve becomes markedly increased


coarctation of the aorta

not duct dependent, uncommon lesion


clinical features of coarctation of the aorta

systemic HTN in right arm
ejection systolic murmur upper right sternal edge
collateral supply towards posterior
radio-femoral delay due to collateral supply


investigations for coarctation of the aorta

CXR: 'rib notching' due to large collateral intercostal arteries.
3 sign, visible notch at site of coarctation

ECG: LVH, deep S wave in V2 and tall R in V6, downgoing T wave

palpate for absent femoral pulses in children


management for coarctation of the aorta

echo, when severe insert stent


what is interruption of the aortic arch?

severe coarctation with no connection between the aorta proximally and distally
VSD also usually present
presents in neonatal period
features of duct dependent circulation


what is hypoplastic left heart syndrome?

underdevelopment of the entire left side of the heart
mitral valve is small
LV is diminutive
aortic valve is abnormal
usually coarctation


hypoplastic left heart syndrome features and management

detected antenatally at USS
very sick at birth with duct dependent circulation
absent PP's

neonatal operation known as Norwood procedure, followed by Glenns
Prostaglandin for duct dependent lesions