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Congenital echo

congenital cardiac defects

QuestionAnswer
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