congenital cardiac defects
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| Eisenmenger's syndrome | Any left-to-right shunt that becomes right-to-left, or bidirectional.
Due to pulm.vascular resistance.
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| Eisenmenger's syndrome : Which side of heart is effected? | RAE, RVE, MPA dilated.
Left side unchanged.
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| Eisenmenger's syndrome consist of: | VSD, Dextro-position of Aorta, PHTN, RVH.Measure TR, PR.
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| 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%
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| Most Common cause of death from heart disease during first week of life. | Hypo-plastic Left Heart Syndrome
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| Hypo-plastic Left Heart Syndrome surgical repair involves: | Ballon atrial septostomy, Norwood I, II, III.
possible transplant.
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| Hypoplastic LV echo views: | PLAX, Apical Long axis, PSAX, Apical Subcostal 4ch, supersternal long/short axix.
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| Pulmonary Atresia with intact Ventricular Septum | Complete obstrcdtion of RVOT with atretic PV, intact VentrSeptum, variable hypoplasia of RV and TV
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| Pulmonary Atresia with intact Ventricular Septum also will use Prostaglandin E2 to : | Keep PDA open. PDA helps sustain life until repaired.
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| Pulmonary Atresia with intact Ventricular Septum surgical management includes: | BT shunt, Pulm. valvotomy or valvectomy, RVOT reconstruction(transannular patch), Fontan, (possible transplant)
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| Views for Pulmonary Atresia(intact V-septum) | PLAX of RVOT, PSubcostal SAX of AV, Apical/subcost four chamber.
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| 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.
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| TOF/TET caused by underdevelopment of ________ and abnormal separation of _____________. | infundibulum and truncus arteriosus.
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| 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)
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| 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.
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| 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.
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| Types of Pulmonic Stenosis: | -Subvalvular, sub-infundibular, annular(hypoplasia), bicuspid pv, supravalvular, branch stenosis, pulmonary atresia.
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| Define (TAPR) Total Anomalous Pulmonary Venous Return | pulmonary Veins drain directly into the right atrium.
Dialates RV and RA,can cause CHF
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| What is necessary for patient to have in order to survive if born with TAPR. | A PFO or ASD
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| List Cyanotic cardiac defects. |
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| TAPR assoc. surgical procedures involve | Rashkind, Park, Blalock-Hanlon, reconnect or anastomosis of Common pulm.vein to LA, close ASD..
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| TAPR 2d/mmode shows | ASD/PFO , RAE, RVE, RVVO pattern, MPA/branching dialitation, dialated vertical vein, innom.v. rt. svc. ivc, and hepatic veins.
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| Most common type of mixed defect in regards to TAPR type IV is a | Connection to coronary sinus and left innom.vein.
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| Tricupsid Atresia | Absence of Tricuspid vavle with hypoplasia of RV
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| Tricupsid Atresia possible associated conditions | PFO/ASD 80% PDA, RT Arch, VSD, Transpo Great Arteries, persistent svc, juxtaposition of atrial appendages, PS
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| TriAtresia assoc.surgeries: | BT shunt, Glenn, PA band( to decrease hight PA flow), fontan
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| Truncus Ateriosis | Absence of normal division of Truncus Ateriosus.
Type I,II,III
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| 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,
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| Univentricular heart: | Presence of two atrioventricular valves with only one ventricle chamber or one large dominant ventricle.D-transposistion come with UniVent.heart.
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| Uni-Ventricle assoc.surgeries | BT shunt, Glenn, PA band, fontan partitioning of single ventricle.
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| Kawasaki syndrome | Unknow etiology, also called mudodutaneous lymph node syndrome, strawberry tongue,
Involves coronries dilated, ectasia, aneurysms
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| Abnormal coronary artery sizes in child less than 5 | > or = to 3mm look for anneurysms and thrombus.
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| Abnormal coronary artery sizes in child 5 and up | > or = 4mm
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| Myocarditis | inflamation of the myocardium caused by virus.
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| Pericardial effusion | collection of fluid between epicardium (visceral) and parietal pericardium.
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| Post-pericardialtomy syndrome | immune response to blood in pericardia lsac
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| PA sling | LPA arises abnormally from RPA passes posteriorly between trache and esophagus causing respiratory distress.
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| PA sling echo views: | PSAX at base tilted posteriorly, Suprast.notch, high left parasternal.
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| PHTN | pulmonary hypertension in pulmonary artery pressure.
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| Causes of PHTN(pulmonary hypertension) | L-R shunt, alveolar hypoxia, airway obstruction, collegen disease, connective tissue disease, high altitude, vascular disease.
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| 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.
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| Anomalous Origin of LCA (RARE) (Bland-Garland White syndrome). | When LCA originates from abnormally from PA
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| 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
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| Most common type of Cardiac benign tumor. | Rhabdomyoma( involves myocardium) assoc.with TB
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| Second most common cardiac tumor | Fibroma intra mural in IVS
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| Myxoma | heart tumor within atrium , has stalk or pedicle attached to wall , most common in females
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| Teratoma cardiac tumor | pedicle attached to base of Great Vessels.
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| Cervical Ao Arch | Ao arch elongates above clavicle into neck
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| 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.
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| Cardiac pericarditis | fibrotic thickening restricting pericardium and diastolic filling.dialated IVC, hepatics , and lack of IVC collapse on inhale.
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| 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
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| 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)
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| 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.
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| What defects involve a BT shunt surgery to increase pulmonary flow. | Pulmonary atresia, tetrology of fallot, tricuspid atresia, univentricle.
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| 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.
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| Modified BT Shunt | prosthetic tube used( usually Gortex)
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| Temporal Resolution -Poor tempRes equals poor image quality. | determines frame rate, the time it takes to update all lines in image.
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| 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.
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| Note: M-mode is faster that 2D, 2D faster than 3D | no answer, just a fact
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| Doppler Effect ( Frequency shift is directly proportional to..... | Velocity
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| 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.
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| 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
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| Nyquist Limit | Maximum velocity.
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| Lower Frequency Tx's have a ---------------- Nquist limit. | Higher
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| Shallow depth has a --------------Niquist limit. | Higher
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| Tissue Doppler only detects: | velocity components that are parallel to the beam in pulswave and color doppler display.
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| Higher Frequency Transducers (12) | Better resolution, less depth penetration, more attenuation, lower Nyquist limit or lower max velocity limit with PW.
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| Bernoulli Equation |
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| LV Global systolic function (Ejection Fraction) Normal range | 55 - 70 %
Measured by , Mmode, 2D, 3D 2D modified simpsons
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| limitations on determining EF% | load dependent
Apical forshortening
poor acoustic windows
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| 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
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| Decreased myocardial stiffness = a ------------- in volume. | Increase
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| 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
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| MV E wave in regards to Ventricular diastolic function, the steeper the slope the ------------- | shorter the deceleration time
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| 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.
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| PW tissue doppler E/A prime wave below base line.diastole, but systolic flow shows | Above the base line.
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| 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.
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| 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
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| 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
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| Define Aortopulmonary Window | Communication b/n Asc.Aorta and PA above the semilunar valves , Type I -proximal Type II- Distal TypeIII-Complete
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| 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.
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| Classic Blalock -Taussig shunt rarely used but one advantage was | it Grew with the patient.
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| Modifiet BT | most used today and prefered,: , PTFE graft from subclv a or innom a to the RPA
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| Potts shunt reinvented. |
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| GERBODE VSD | communication between the LV and RA.. Hard to seperate with a perimembraneous VSD echo wise.
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| Complete AVSD atrial ventricular septal defect. | a common AV valve. VSD, ASD,
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| Rastellie classification Type A, B, C | a common , c. second most comon
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| single patch technique use to repair |
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| double patch repair |
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| Tricuspid Atresia Surgical management | Cyanosis- neonatal shunt, cath 6 mos and Bidirectional Glen, then Fontatn at 2 - 3 years old
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| Bi Directional Glenn: | Most common, SVC to RPA, Blood goes from SVC to RPA and to over to LPA
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| Glenn types, fenestrated, etc. In what order , and why, |
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| Echo shows in Apical 4 view what in regards to chamber size in Restrictive Cardiomyopaythy. | Small Ventricles and Huge Atrias
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