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57 Cards in this Set
- Front
- Back
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What is the most common CHD with symptoms initially presenting in adulthood?
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ASD, Secundum type
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How many types of ASDs are there?
What % are Secundum? |
4 types:
Secundum 90%, Primum, Sinovus venosus Upper and Lower |
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What is a secundum ASD NOT? How do we know?
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Not a patent foramen ovale; that would allow only right to left flow; this is left to right.
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What % of patients with secundum type ASD develop pulmonary hypertension?
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<10% - it is well tolerated usually
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What are patients with secundum type ASD at risk for?
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Paradoxical embolism
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Where are primum defects causing ASD located?
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Just above the tricuspid annulus
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Where are the secundum type ASDs located?
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Right in the interatrial septum
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What are the primum type ASDs often associated with?
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AVSD
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Where are upper sinus venosus defects causing ASDs located?
What about lower ones? |
Upper: by the SVC
Lower: by the coronary sinus |
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What are sinus venosus defects usually associated with/
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Anomalous right pulmonary vein
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What are the 4 physiologic effects of an ASD?
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-Right volume overload 4X
-Dilated tricuspid and pulmonic valves - regurgitation -Dilated pulmonary vascular bed -Obstructive pneumonia |
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Where in the lungs will obstructive pneumonia develop in an ASD?
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-Left upper lobe
-Right middle lobe |
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What will auscultation show in an ASD?
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Wide S2 splitting
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What can develop in a wide ASD?
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-Increased pulmonary vascular resistance
-R-L shunt (reversal) -Ultimately cyanosis |
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What % of all CHDs are VSDs?
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21%
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What happens in 75-80% of small VSDs?
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Spontaneous closure
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What % of VSDs are
-isolated -associated w/ other intracardiac lesions |
Isolated = 30%
Associated = 70% |
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What % of VSDs are
-Perimembranous -Subpulmonic or intramuscular -AVSD |
Perimemb = 90%
Subpulmon/intramusc = 8% AVSD = 2% |
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What determines the significance of a VSD?
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Size
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What are the 3 features of a small VSD?
(Symptom/Pressure) |
-High pressure gradient across the small opening
-Loud murmur -Normal RV pressure |
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What is considered a medium sized VSD?
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1/3 - 2/3 the diameter of the aorta
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What happens to most med sized VSDs?
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The pressure gradient tends to close them spontaneously
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Why can medium VSDs close?
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The defect is restrictive to flow
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Can Large VSDs close? What is considered large? Why can't they close?
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No; the size of the aorta; the defect is not restrictive to flow.
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What is the pressure gradient in a large VSD?
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Non-existent - the pressure in the ventricles is equalized
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What determines whether pulmonary hypertension will develop in a large VSD?
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The degree of pulmonary stenosis
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What normally needs to be done for large VSDs?
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Surgical closure - to prevent pulmonary hypertension
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So most VSDs are what?
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Perimembranous
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What area is considered perimembranous?
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The outflow tract of the LV, just under the aortic valve.
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What tissue can be used to close a perimembranous VSD?
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Reduncant tricuspid leaflet tissue
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What will result if there is deficient septal commissural tissue?
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Right atrial -> left ventricular septal defect
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Where is an "outlet defect" VSD?
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In the outlet tract beneath the pulmonic valve
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Why is an outlet defect called "doubly committed"?
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Because the VSD is beneath both the pulmonic and the aortic valves; the right aortic cusp can herniate thru the VSD and cause aortic regurgitation
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What is an inlet defect VSD?
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An AVSD
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Where are AVSDs seen?
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Below the papillary muscle of the conus.
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What do left-right shunts do as pulmonary hypertension develops?
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Reverse into right-left shunts
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How are med-large defects treated?
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By repairing them in the 1st year before pulmonary hypertension onset
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What are most PDAs?
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Isolated defects - 90%
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What are three important histologic features of the ductus?
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-LH/RH spiral smooth muscle
-Thick intima -Increased mucoid substance |
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What maintains the patency and relaxation of the ductus in utero?
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Prostaglandins E2 and I2
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What happens at delivery?
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-Prostaglandins are lost
-Increased oxygen causes ductal contraction |
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How soon after birth does the ductus close?
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12 hours
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What is the 2nd stage in ductus closing, and when does it occur?
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-Fibrous replacement of muscle
-Fibrous obliteration of lumen Occurs by weeks 2-3 |
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What happens to preemies in regards to their ductus?
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They don't lose responsiveness to prostaglandins, so their ductus remains patent; this is not considered a CHD though.
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What is a HALLMARK symptom of PDA?
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Machine gun like harsh murmur
-Holosystolic |
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What is the ultimate result of a PDA?
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R-L reversal and obstructive pulmonary vascular disease
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Why is PDA so bad for the heart, when it's the systemic aortic blood that is flowing back into pulmonary circulation?
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It steals the coronary blood, causing LV hypoperfusion and mural ischemia
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What are 2 treatments for PSD?
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-Surgery (w/in first year)
-Indomethacin/NSAIDs |
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What is another name for an AVSD?
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Endocardial cushion defect
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What are the 2 components that make up an AVSD?
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-Deformed anterior leaflet of the mitral valve
-Primum atrial septal defect |
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What are 2 variations of an AVSD?
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-Partial form
-Complete form |
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What is a Partial AVSD?
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Incomplete fusion of the endocardial cushions
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What is a Complete AVSD?
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Complete failure of the endocardial cushions to fuse
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What is the result of Partial AVSD?
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Mitral valve insufficiency
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What is the result of Complete AVSD?
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a hole in the heart
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What is the major cardiac alteration in AVSD?
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Volume hypertrophy of all four chambers of the heart.
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What are 30% of AVSDs due to?
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Trisomy 21
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