Asd & Vsd

Front 1

CHD IN THE ADULT

WHAT DO YOU DO?

Back 1

Present with untreated, undiagnosed congenital abnormalities
Identify abnormality(ies) and hemodynamic effect(s)

Front 2

ASD IS FLOW IS FROM

Back 2

LEFT TO RIGHT

Front 3

PFO FLOW IS FROM

Back 3

RIGHT TO LEFT

Front 4

BAV occurance

Back 4

1-2% general population

Front 5

When does BAV manifest?

Back 5

Generally become manifest around age 50-60

Front 6

BAV has a high occurrence of

Back 6

descending aorta coarctation -(use PW)

Front 7

Type 1 BAV?

Back 7

Ant and post orientation (nc & lft)

Front 8

Type II BAV?

Back 8

most common
Right and left cusp orientation

Front 9

with BAV are peak and mean gradients elevated?

Back 9

YES!Peak and mean gradients ***always elevated***

Front 10

Using doppler with BAV what should you calculate?

Back 10

Peak and mean gradients
AVA
AR

Front 11

Describe Endocardial cushion defect

Back 11

Primum ASD and membranous VSD
Failure of septum primum to fuse with cushions
High association with Down Syndrome (Trisomy 21)

Front 12

Describe complete Endocardial cushion defect

Back 12

Inferior IAS, posterior IVS missing (large VSD) with common A-V valve

Front 13

Describe incomplete Endocardial cushion defect

Back 13

Primum ASD, Cleft MV

Front 14

Describe intermediate Endocardial cushion defect

Back 14

2 A-V rings
Primum ASD
Restrictive VSD

Front 15

Which endocardial cushion defect is most common?

Back 15

Secundum

Front 16

List symptoms of A-V CANAL DEFECT

Back 16

Fatigue
Asymptomatic
Dyspnea
HF
Volume overload sx
Recurrent pulmonary infections
Elevated PAP

Front 17

What should you look for with Echo and A-V Defects?

Back 17

Structural abnormalities
Associated findings
CF shunt/turbulence
QP:QS
SPAP
Gradients through communications
Subcostal imaging
4-ch, 5-ch apical imaging

Front 18

What is SUPRAVALVULAR AS associated with

Back 18

William’s syndrome
PLAX often best approach
Echo:
Generally normal AV
LVH if obstructive**

Front 19

What is SUBVALVULAR AS
Type 1

Back 19

Fibrous collar 1-1.5 cm proximal to AV
MV attachment may be involved

Front 20

What is SUBVALVULAR AS
Type 2

Back 20

Muscular IVS deformity proximal to LVOT

Front 21

What is SUBVALVULAR AS
Type 3

Back 21

Tunneling of LVOT

AV annulus and Ascending Ao may be hypoplastic (least common)

Front 22

What is CLEFT MV

Back 22

Split in the anterior leaflet sometimes with posterior leaflet involvement

Front 23

What is CLEFT MV associated with

Back 23

Full or partial endocardial cushion defect
ASD, VSD, PDA

Front 24

What are echo finding with CLEFT MV

Back 24

Fibrotic/retraction changes in the leaflet tips
MR
Associated abnormalities

Front 25

What is the treatment for CLEFT MV

Back 25

Surgical repair if MR severe or if nexus for IE

Front 26

Describe EPSTEIN ANOMALY

Back 26

Inferior displacement of posterior and septal leaflets
Anterior leaflet large with often tethering to RV wall
Often accompanying ASD (75% have)
TR common, SPAP

Front 27

What sound will your hear with EPSTEIN ANOMALY

Back 27

S1 and S2 split, RBBB
30% will also have WPW syndrome

Front 28

With EPSTEIN ANOMALY which views are important?

Back 28

All views important, especially
Apical 4-ch, Subcostal LAX
Visualize TV/annular structure for extent of abnormality
RVSP (generally elevated)
ASD/PFO ****** ASD left to right shunt PFO – right to left shunt
Relatively small RV evaluate right side
Look for associated abnormalities
VSD, PFO, PDA, PS, TS, TOF, TGA (transposition of the great arteries)

Front 29

What is TRICUSPID ATRESIA

Back 29

Absence of TV with hypoplastic RV

Front 30

What does survival depend on with TRICUSPID ATRESIA

Back 30

Survival depends on ASD***

Front 31

What might accompany TRICUSPID ATRESIA

Back 31

Transposition of Great Arteries
VSD
PS

Front 32

What are echo findings with TRICUSPID ATRESIA

Back 32

Hypoplasic RV
Absent TV
LVVO

Front 33

What is the surgical correction for TRICUSPID ATRESIA

Back 33

Fontan
RA to PA
Seen in high parasternal and subcostal views

Front 34

What is Pulmonic Stenosis (PS)

Back 34

Congenital most common (fusion of cusps)

Front 35

What isPulmonic Stenosis associated with

Back 35

Often associated with TOF

Front 36

List 3 causes of Pulmonic Stenosis

Back 36

If VALVULAR

Congenital
Rheumatic (rare)
Carcinoid

Front 37

List 3 kinds of Pulmonic Stenosis

Back 37

Valvular
Infundibular
Supravalvular

Front 38

Where does Infundibular PS occur

Back 38

RVOT:

Congenital
AoRoot dilation
RVH

Front 39

Where does Supravalvular
PS occur

Back 39

Distal to PV in the MPA (congenital)

Front 40

PS Echo Findings

Back 40

Thickened leaflets with reduced excursion

Front 41

What is the only differnce between AS and PS?

Back 41

ASD/VSD

Front 42

What are associated finding with PS

Back 42

RVH, dilation, RHF

Front 43

Describe HYPOPLASTIC LEFT HEART SYNDROME

Back 43

Small, underdeveloped LV
Atresia of MV/AV
Endocardial thickening
Small LA
Ao diameter small
Enlarges beyond dilated ductus
Usually dilated RV

Front 44

What should you document with HYPOPLASTIC LEFT HEART SYNDROME

Back 44

Shunts? (PDA)
RVSP
Valvular regurgitation
Chamber sizes/dimensions/ventricular systolic function

Front 45

What is stage 1 of surgical repair for HYPOPLASTIC LEFT HEART SYNDROME

Back 45

Create new Ao (often from PA)
Blalock-Taussig shunt (SBCL A to PA)
Creation of ASD

Front 46

What is stage 2 of surgical repair for HYPOPLASTIC LEFT HEART SYNDROME

Back 46

Bi-directional Glenn or hemi-Fontan
Blalock-Taussig shunt closed
SVC anastamosed with PA

Front 47

What is stage 3 of surgical repair for HYPOPLASTIC LEFT HEART SYNDROME

Back 47

Completion of Fontan (Norwood III)
RA to PA (All systemic venous blood shunted to PA)