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DMST 367 Echo 3 > Septal Defects > Flashcards

Septal Defects Flashcards

1
Q

Label the image

A
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2
Q

Label the image

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3
Q

What does this image demonstrate?

A

Patent foramen Ovale

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4
Q

Label the PFO vs ASD characteristics

A
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5
Q

Label the image

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6
Q

Label the image

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7
Q

If you see bubbles in the left heart in the left heart within three beats what does this mean?

A

Positive for a PFO

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8
Q

What does this image represent?

A

ASD hepatic veins with volume overload

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9
Q

Name the areas of VSD

A

Membranous is only visible in A5C

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10
Q

Label the VSD regions

A
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11
Q

Label the image colours in terms of VSD

A
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12
Q

Label the Embryonic heart

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13
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Label the image

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14
Q

Label the image

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15
Q

What is a septal defect?

A

A congenital defect in which there is a hole in the wall of the heart that divides the atria (ASD) or ventricles (VSD) of the heart.

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16
Q

What is ASD?

A
  1. Atria septal defect
  2. Hole in the IAS
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17
Q

What is VSD? 2

A
  1. Ventricular septal defect?
  2. Hole in the IVS
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18
Q

What is AVSD?2

A
  1. Atrioventricular septal defect
  2. Variety of anomalies to the endocardial cushion
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19
Q

What is another name for AVSD?

A

AV canal defect

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20
Q

What are the different types of ASD?5

A
  1. Ostium primum ASD (15%)
  2. Ostium Secundum ASD (80%)
  3. Sinus venosus ASD (5%) (superior and inferior)
  4. Coronary sinus ASD (1%)
  5. Patent foramen Ovale PFO (not a true ASD)
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21
Q

ASDs can lead to what? 2

A
  1. Tricuspid annular dilatation which leads to Tricuspid regurgitaiton
  2. RA dilation which leads to arrhythmias (A-fib)
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22
Q

What are ASDs classified according to?

A

Their location

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23
Q

How often are ASDs detected?

A

Regularly detected at adult echo labs as an incidental finding

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24
Q

What is the most common ASD?

A

Secundum ASD

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25
Q

What S/S is Secundum ASD associated with?

A

MV prolapse (MVP) or pulmonary stenosis

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26
Q

What is the occurrence of secundum ASD between men and women?

A

Women: Men = 3:1

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27
Q

What is the location of Secundum ASDs in 2D?

A

2D characteristic dropout in the central most portion of the atrial septum (IAS)

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28
Q

What chromosomal disorders is secundum ASD associated with?

A

T21

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29
Q

What are some Secundum ASD characteristics?4

A
  1. Mid septum
  2. Big hole (>7mm)
  3. Flow goes straight across IAS
  4. Lower velocity flow = Less/ no aliasing
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30
Q

What do we assess degree of shunts with?

A

Assess degree of shunt with QP:QS ratio

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31
Q

What might secundum ASD be confused with?

A

PFO

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32
Q

What is the treatment for secundum ASD?

A

Most often closed percutaneously if needed, amplatzer closure is used to close the defect

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33
Q

What is the echo role for treatment of secundum ASD?

A

To investigate for a residual defect or leak around the percutaneous closure device or septal patch

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34
Q

Where is the location of ostium primum ASD? and what is it usually associated with? 3

A

Adjacent to the atrioventricular valves and is often associated with
1. Atrioventricular septal defects (inlet VSD)
2. Cleft Mitral valve
3. Trisomy 21

35
Q

What is the echo protocol for identifying the location of Ostium primum ASD?

A

Assess degree of shunt with QP:QS ratio

36
Q

What is the treatment of Ostium Primum ASD? What should be used?

A

Percutaneous device closure of the primum ASD is not an option due to
1. Proximity to the AV values and AV node
2. Woven Dacron Patch must be used

37
Q

What is the post treatment echo protocol for ostium primum ASD?

A

Investigate for a residual defect or leak around the patch repair and assess the AV valves

38
Q

What is the location of sinus venous ASD?

A

Adjacent to SVC/ IVC

39
Q

What is Sinus venosus ASD associated with?

A

PAPVR

40
Q

How common is the Coronary sinus ASD?

A

Rare

41
Q

What is the location of the Coronary sinus ASD?

A

Inferior (CS lies within the AV groove)

42
Q

What is the coronary sinus ASD associate with?

A

Several SV related anomalies

43
Q

What are Patent foramen ovale?

A

Closure at birth due to LT>RT atrial pressures (25% remain patent (PFO))

44
Q

Flow will be what with PFOs?

A

LT > Right unless eisenmengers

45
Q

What are echo features for PFOs?5

A
  1. Look for flap
  2. Small shunt (2-10mm)
  3. Doppler often appears angular, with a winding path as it moves its way around the flap
  4. High velocity
  5. Contrast echo is useful to assess
46
Q

What is the best way to look for PFOs?

A

TEE

47
Q

In terms of Echo and ASD what do we look for?5 (anatomically)

A
  1. RT sided chamber enlargement in both the RA and RV
  2. RV volume overload
  3. Paradoxical septal motion
  4. Document the shunt direction
  5. An ASD may permit a paradoxical embolism resulting in a stroke/TIA
48
Q

How many planes should we image from with echo for ASD?

A

Multiple planes

49
Q

In terms of echo detection for ASDs, transthoracic echo sensitivity from what window is the best ?

A

Subcostal window, when proper protocol is followed and decreased colour scale with zoom

50
Q

What is contrast injections for ASD/PFO?

A

Peripheral venous injections of contrast material (microbubbles) show passage of micro-bubbles into the LA from RA even when flow is most LT&raquo_space; RT. this is due to the temporary time period in the cardiac cycle when RA pressure exceeds LA pressure

51
Q

In terms of contrast injections for ASD/PFO microbubbles,what may be used?

A

Agitated saline or commercial product

52
Q

In terms of contrast injection for ASD/PFO we should see what to determine positive for PFO?

A

Agitated saline bubbles in the LA within 3 beats if positive for PFO

53
Q

What structures and functions do we use to assess for ASD?5

A
  1. RV size
  2. RA size
  3. TV annulus size
  4. TR
  5. RT heart volume
54
Q

Ventricular septal defects are located where?

A

Within the IVS

55
Q

What are different types of VSD?

A
  1. Membranous VSD (70-80%)
  2. Inlet VSD (5%)
  3. Muscular VSD (trabecular 10-20%)
  4. Outlet VSD (infundibular 5%)
56
Q

VSDs are normally a type of what?

A

Acyanotic CHD, Usually not serious enough to cause hypoxia

57
Q

How does VSDs usually shunt blood?

A

Lt&raquo_space;» Rt shunting

58
Q

VSD can occur in how many positions in the IVS?

A

Various positions

59
Q

What is important to determine in terms of VSD?

A

Amount of blood moving across the IVS

60
Q

How common is Gerbode VSD?

A

Rare

61
Q

What is atrioventricular septal defect?

A

A spectrum of lesions characterized by deficient atrioventricular septation and a variety of AV valve abnormalities

62
Q

What are things we see with AVSD?2

A
  1. AV canal defect
  2. Endocardial cushion defect
63
Q

What are two main sub types of AVSD?

A
  1. Complete AVSD
  2. Incomplete AVSD
64
Q

AVSD has a associations with what chromosomal disorder?

A

Strong association with T21

65
Q

What do we see post operatively with AVSD?

A

AV (MV/TV) regurg

66
Q

What are three things we see with complete AVSD?

A
  1. Primum ASD
  2. Inlet VSD
  3. Common AV valve (MV/TV merged into 1)
67
Q

What are some things we see in a partial/ incomeplete AVSD?2

A

1.Primum ASD
2. Cleft in the anterior MV leaflet
*Absence of an inlet VSD
*Distinct MV and TV (each with a complete and separate annulus)

68
Q

What is Shunt quantification Qp:Qs used for?3

A
  1. ASD
  2. VSD
  3. PDA
69
Q

What does Qp stand for?

A

Volume of blood going to lungs (pulmonary)

70
Q

What does Qs stand for?

A

Volume of blood going to the aorta (systemic)

71
Q

The volume of blood flow (Q) across an intracardiac shunt can be determined by what?

A

Measurements of stroke volume at 2 intracardiac sites

72
Q

In most cases we can see shunt quantification where? (QP/QS)

A
  1. Qp: Uses SV for RVOT (diameter +VTI)
  2. Qs: Uses SV for LVOT (diameter + VTI)
73
Q

In the normal heart, flow through the left and right sides of the heart are what? What does this mean?

A

Equal therefore normal Qp:Qs is

74
Q

A hemodynamically significant shunt has what type of ratio?

A

Qp:Qs > 1.5:1

75
Q

What does this image demonstrate?

A

ASD flow is represented by cylinders

  1. Flow enters the RA from the LA through the ASD
  2. Flow to the lungs through the TV and RVOT flow is increased
  3. Flow entering the LA through the pulmonary veins increased
76
Q

What does this image demonstrate?

A

PDA flow represented by cylinders
Note that

  1. Flow shunts from descending aorta to the pulmonary artery
  2. Flow to lungs is increased
  3. Flow to the pulmonary veins, LA, MV, LV, and LVOT are increased
76
Q

What does this diagram demonstrate?

A

VSD Flow represented by cylinders
Note that:

  1. Flow from the LV enters the RV through the VSD
  2. RVOT flow is increased
  3. Flow to the lungs is increased
  4. Flow to the pulmonary veins and MV is increased, this may lead to dilation of the LA and RA
77
Q

What is the site of measurements?

A
78
Q

RVSP is the absence of what?

A

RV outflow obstruction

79
Q

How do we calculate RVSP with VSD?

A
80
Q

VSDs are usually small and about what?

A

5-6 m/sec, if large in adult, eisenmenger’s will set in

81
Q

What do we report in terms of intracardiac shunts? What did we need to do for a successful interrogation? 4

A
  1. Location (describe the actual name if you can)
  2. When the heart is not immediately visible from parasternal view (try looking for situs abnormalities form the subcostal window)
  3. Interrogate every heart thoroughly for VSD/ASD
  4. Classify and quantify the VSD/ ASD using colour and spectral Doppler
82
Q
A

DMST 367 Echo 3 (27 decks)

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