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Congenital echo
congenital cardiac defects
| Question | Answer |
|---|---|
| Eisenmenger's syndrome | Any left-to-right shunt that becomes right-to-left, or bidirectional. Due to pulm.vascular resistance. |
| Eisenmenger's syndrome : Which side of heart is effected? | RAE, RVE, MPA dilated. Left side unchanged. |
| Eisenmenger's syndrome consist of: | VSD, Dextro-position of Aorta, PHTN, RVH.Measure TR, PR. |
| Hypo-plastic Left Heart Syndrome | Small or non existing (absent morphologic) LV with underdeveloped MV and AV. Also called mitral and aortic atresia. Male predominant.67% |
| Most Common cause of death from heart disease during first week of life. | Hypo-plastic Left Heart Syndrome |
| Hypo-plastic Left Heart Syndrome surgical repair involves: | Ballon atrial septostomy, Norwood I, II, III. possible transplant. |
| Hypoplastic LV echo views: | PLAX, Apical Long axis, PSAX, Apical Subcostal 4ch, supersternal long/short axix. |
| Pulmonary Atresia with intact Ventricular Septum | Complete obstrcdtion of RVOT with atretic PV, intact VentrSeptum, variable hypoplasia of RV and TV |
| Pulmonary Atresia with intact Ventricular Septum also will use Prostaglandin E2 to : | Keep PDA open. PDA helps sustain life until repaired. |
| Pulmonary Atresia with intact Ventricular Septum surgical management includes: | BT shunt, Pulm. valvotomy or valvectomy, RVOT reconstruction(transannular patch), Fontan, (possible transplant) |
| Views for Pulmonary Atresia(intact V-septum) | PLAX of RVOT, PSubcostal SAX of AV, Apical/subcost four chamber. |
| TOF/TET- Tetrology of Fallot defined as combo of 4 cardiac abnormalities | 1. Overriding Aorta(bivent ao) 2. VSD(malignment) 3. RVH 4. PS (infundibular) TOF 10 % of all CHD and is the most common cyanotic lesion in adults. |
| TOF/TET caused by underdevelopment of ________ and abnormal separation of _____________. | infundibulum and truncus arteriosus. |
| Two typs of Tetrology of Fallot (TOF/TET) | 1. Cyanotic - severe PS with predominant R-L shunt 2. Acyanotic- mild PS with predominant L-R shunt. note(Severity of lesion based on severity of PS) |
| TOF/TET associated disorders may include: | - RtArch30% -Secundum ASD 25% - Persistent SVC11% -Coronary Abn.s, complete AV canal, trabecular VSD,sub AS, PV and/or PA atresia. |
| TOF/TET associated surgeries: | BT shunt, Waterston shunt, Potts shunt, pulm. valvotomy or valvectomy, Close VSD, repair ASD, remove muschle bundles in rvot and Rastellie for pts with pulmonary atresia. |
| Types of Pulmonic Stenosis: | -Subvalvular, sub-infundibular, annular(hypoplasia), bicuspid pv, supravalvular, branch stenosis, pulmonary atresia. |
| Define (TAPR) Total Anomalous Pulmonary Venous Return | pulmonary Veins drain directly into the right atrium. Dialates RV and RA,can cause CHF |
| What is necessary for patient to have in order to survive if born with TAPR. | A PFO or ASD |
| List Cyanotic cardiac defects. | |
| TAPR assoc. surgical procedures involve | Rashkind, Park, Blalock-Hanlon, reconnect or anastomosis of Common pulm.vein to LA, close ASD.. |
| TAPR 2d/mmode shows | ASD/PFO , RAE, RVE, RVVO pattern, MPA/branching dialitation, dialated vertical vein, innom.v. rt. svc. ivc, and hepatic veins. |
| Most common type of mixed defect in regards to TAPR type IV is a | Connection to coronary sinus and left innom.vein. |
| Tricupsid Atresia | Absence of Tricuspid vavle with hypoplasia of RV |
| Tricupsid Atresia possible associated conditions | PFO/ASD 80% PDA, RT Arch, VSD, Transpo Great Arteries, persistent svc, juxtaposition of atrial appendages, PS |
| TriAtresia assoc.surgeries: | BT shunt, Glenn, PA band( to decrease hight PA flow), fontan |
| Truncus Ateriosis | Absence of normal division of Truncus Ateriosus. Type I,II,III |
| Truncus Ateriosis define: | The coronary arteries, MPA, AoArch all arise from a common truck.Type I,II,III Type I . PA arises from truncal root.60% Type II. Each PA arises directly from posterior side truncal root as seperate vessels, |
| Univentricular heart: | Presence of two atrioventricular valves with only one ventricle chamber or one large dominant ventricle.D-transposistion come with UniVent.heart. |
| Uni-Ventricle assoc.surgeries | BT shunt, Glenn, PA band, fontan partitioning of single ventricle. |
| Kawasaki syndrome | Unknow etiology, also called mudodutaneous lymph node syndrome, strawberry tongue, Involves coronries dilated, ectasia, aneurysms |
| Abnormal coronary artery sizes in child less than 5 | > or = to 3mm look for anneurysms and thrombus. |
| Abnormal coronary artery sizes in child 5 and up | > or = 4mm |
| Myocarditis | inflamation of the myocardium caused by virus. |
| Pericardial effusion | collection of fluid between epicardium (visceral) and parietal pericardium. |
| Post-pericardialtomy syndrome | immune response to blood in pericardia lsac |
| PA sling | LPA arises abnormally from RPA passes posteriorly between trache and esophagus causing respiratory distress. |
| PA sling echo views: | PSAX at base tilted posteriorly, Suprast.notch, high left parasternal. |
| PHTN | pulmonary hypertension in pulmonary artery pressure. |
| Causes of PHTN(pulmonary hypertension) | L-R shunt, alveolar hypoxia, airway obstruction, collegen disease, connective tissue disease, high altitude, vascular disease. |
| Vascular ring | Caused by Double Aortic Arch(most common type)and other abnormalities of the aortic arch and vessels, causing a ring encases trachea and esophagus. Causes tracheal compression and respiratory distress. |
| Anomalous Origin of LCA (RARE) (Bland-Garland White syndrome). | When LCA originates from abnormally from PA |
| Cardiac Tamponade | Fast accumulation of pericardial fluid with elevation of venous pressure and pulsus paradoxus.leads to impaired fill and decreased cardiac output. "Swinging Heart" Diastolic collapse.25% resp.variation |
| Most common type of Cardiac benign tumor. | Rhabdomyoma( involves myocardium) assoc.with TB |
| Second most common cardiac tumor | Fibroma intra mural in IVS |
| Myxoma | heart tumor within atrium , has stalk or pedicle attached to wall , most common in females |
| Teratoma cardiac tumor | pedicle attached to base of Great Vessels. |
| Cervical Ao Arch | Ao arch elongates above clavicle into neck |
| CHF | Congestive Heart failure, failure to pump sufficient blood to meet body's demands due to myocardial damage or pressure or volume overload, diastolic dysfuntion. |
| Cardiac pericarditis | fibrotic thickening restricting pericardium and diastolic filling.dialated IVC, hepatics , and lack of IVC collapse on inhale. |
| Dextrocardia )like dextro position Mirror Image dextro Dextro-rotation Dextro-position | Heart in Rt side of chest.(thorax) Heart all structures a mirror image of what norm is. Left apex rotated toward the right from its normal left position. Heart just shifted to right chest all structures normal |
| BT Shunt Blalock-Taussig | proceedure where Rt. Subcv.A. is attached to the RPA (in a left Arch) in order to increase pulmonary blood flow. (In patients with Rt. Arch the Left Subclv. A. is attached to the LPA) |
| What corrective surgery involves attaching right or left subclavian artery to RPA or LPA to increase pulmonary flow in cases that involve PA atresia, TOF, Univentricle heart. | BT Shunt. |
| What defects involve a BT shunt surgery to increase pulmonary flow. | Pulmonary atresia, tetrology of fallot, tricuspid atresia, univentricle. |
| 2 D echo views to eval BT shunt. | Supersternal notch(supraclavicle) SAX for a RT. BT Supersternal notch long axis with anterior tilt for LPA and BT. |
| Modified BT Shunt | prosthetic tube used( usually Gortex) |
| Temporal Resolution -Poor tempRes equals poor image quality. | determines frame rate, the time it takes to update all lines in image. |
| Ways to increase or make faster the Temperal Resolution: | -Decrease depth (takes less time for farthest wave to return) -Narrow sector(fewer scan lines) -Lower Density ( fewer scan lines) -Single focal point -Parallel beam forming. |
| Note: M-mode is faster that 2D, 2D faster than 3D | no answer, just a fact |
| Doppler Effect ( Frequency shift is directly proportional to..... | Velocity |
| CW doppler | -Continuous transmission -a Pair of PZ crystals -Range of velocities along entire beam No Distance Range Resolution = Range Ambiguity -Useful to detect max. velocities. |
| PW doppler | -at a single fixed time and place after transmission -Displays velocities at a SPECIFIC distance. (sample volume) _Range gated -limit on maximum velocity, if exceed = aliasing |
| Nyquist Limit | Maximum velocity. |
| Lower Frequency Tx's have a ---------------- Nquist limit. | Higher |
| Shallow depth has a --------------Niquist limit. | Higher |
| Tissue Doppler only detects: | velocity components that are parallel to the beam in pulswave and color doppler display. |
| Higher Frequency Transducers (12) | Better resolution, less depth penetration, more attenuation, lower Nyquist limit or lower max velocity limit with PW. |
| Bernoulli Equation | |
| LV Global systolic function (Ejection Fraction) Normal range | 55 - 70 % Measured by , Mmode, 2D, 3D 2D modified simpsons |
| limitations on determining EF% | load dependent Apical forshortening poor acoustic windows |
| Diastoic Phases of the Heart are | 1. Isovolumetric relaxtion = semilunar valve closure to AV valve flow onset 2. Rapid Filling: atrial pressre > ventriclar pres. PW Ewave.3. Diastasis: equal atrial/ventricular pressures with little flow.4 Atrial contr atrial kick A-pressr >Ventr=pw a wave |
| Decreased myocardial stiffness = a ------------- in volume. | Increase |
| Main parameters for diastolic Ventricular function for Echo are | -PW dop AV valve inflow. (mitral and tricuspid) -PW pulmonary vein flow -TR jet -PW tissu doppler (TDI AV annulus) -Color m-mode (speed of propagation) -Atrial size: reflects duration and severity -RV pressure estimates |
| MV E wave in regards to Ventricular diastolic function, the steeper the slope the ------------- | shorter the deceleration time |
| Pulm Vein PW doppler for Ventricular dias.fx. | wave flow shows above baseline S and D peak(systolic and diastolic) and Below baseline A wave Atrial contraction.(shows how much flow goes back up into pulm vein. |
| PW tissue doppler E/A prime wave below base line.diastole, but systolic flow shows | Above the base line. |
| Peds Cardiology TEE indications would be | Poor Transthoracic echo images, large patient, eval for R-L shunting for a pt evaled for stroke or transvenous pacemaker,Vegi,abcess, central line infec.thrombus before cardioversion, intraop , guid for cath procedures. |
| TEE Absolute Contraindications | Unrepaired trach-esph fistula, eshop obstruction, poor airway control , uncooperate unsedative pt. , esophageal varieces, vascular ring poor airway, severe coagulopathy,spine injury |
| peds contrast echo | microbubbles reflect uswaves, for detect PFO R-L, visual of systemic venous drainge(LSVC to LA), AV malfr, define RV enodocardial border,see cath tip |
| Define Aortopulmonary Window | Communication b/n Asc.Aorta and PA above the semilunar valves , Type I -proximal Type II- Distal TypeIII-Complete |
| Waterston Shunt | Waterston Shunt. Not used anymore,, but anastomosis was between Asc.Ao and RPA Problems ,,either too large or too small and destroys RPA as child grows. |
| Classic Blalock -Taussig shunt rarely used but one advantage was | it Grew with the patient. |
| Modifiet BT | most used today and prefered,: , PTFE graft from subclv a or innom a to the RPA |
| Potts shunt reinvented. | |
| GERBODE VSD | communication between the LV and RA.. Hard to seperate with a perimembraneous VSD echo wise. |
| Complete AVSD atrial ventricular septal defect. | a common AV valve. VSD, ASD, |
| Rastellie classification Type A, B, C | a common , c. second most comon |
| single patch technique use to repair | |
| double patch repair | |
| Tricuspid Atresia Surgical management | Cyanosis- neonatal shunt, cath 6 mos and Bidirectional Glen, then Fontatn at 2 - 3 years old |
| Bi Directional Glenn: | Most common, SVC to RPA, Blood goes from SVC to RPA and to over to LPA |
| Glenn types, fenestrated, etc. In what order , and why, | |
| Echo shows in Apical 4 view what in regards to chamber size in Restrictive Cardiomyopaythy. | Small Ventricles and Huge Atrias |
Created by:
Moom1234
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