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The 3 regions of AO are:
- 1. Ascending AO
- 2. AO arch
- 3. Descending AO
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The 3 layers of the AO are:
- 1. Tunica Interna
- 2. Tunica Media
- 3. Tunica Externa
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Dimensions of the AO should be taken in _________________.
diastole
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What 2 views should be done to obtain a compete echo examination (transthoracic)
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Bicuspid AO valve 2D / M-Mode / Doppler appearance:
- 2D = thickened leaflet, football shape, systolic doming
- M-Mode = eccentric diastolic closure, LVH, LVE, LAE
- Doppler = AVA (continuity equation), AI, MR, measure for diastolic dysfunction
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What is the most common congenital abnormality in an adult?
Bicuspid AO valve
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Bicuspid AO valve ratio male:female =?
4:1
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MC clinical symptom of bicuspid AO valve is ________________ on exertion.
dyspnea (labored breathing)
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List the types of SUPRAvalvular AO stenosis: (4)
- 1. Hourglass
- 2. MMB
- 3. Strand (HLHS)
- 4. Coarctation
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List the types of SUBvalvular stenosis:
- 1. Fibromuscular (tunnel)
- 2. MMB (collar)
- 3. DSAS=early closure of AV (closes in systole)
- IHSS (idiopathic hypertrophy subaortic stenosis) = mid closure of AV
- 4. LVH d/t LV pressure overload
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Subvalvular Stenosis is aka:
discreet sub aortic stenosis
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Define: coarctation of AO
Localized congenital narrowing of AO lumen
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Doppler appearance of coarctation of AO?
Sawtooth
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Define: Marfan's Syndrome
Genetic disorder of connective tissue which runs in the family.
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Echo appearance of Marfan's Syndrome:
Balloon shape--> loss of sinotubular jxn (leads to dissection)
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Name & Describe the 2 classifications of AO dissections:
- 1. Debakery I (throughout AO), II(ascending), III(descending AO)
- 2. Stanford A(ascending AO), B(descending AO)
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Echo appearance of sinus of valsalva aneurysm is?
Is there a difference in echo appearance with congenital sinus of valsalva aneurysm?
- Congenital = windsock - protrudes from AO sinus to adjacent cardiac structures; RCC MC affected (RVOT); may be associated with a fistula.
- Flow continuous unlike VSD where high flow seen in systole only
- Aquired - spherical, less irregular
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Name the 3 types of AO aneurysms:
- 1. Fusiform
- 2. Sacular
- 3. Pseudo
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What can give a false + for dissection?
venous flow adj AO arch = normal venous communication from SVC with flow toward the heart
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What measurement do we use to quantify simple vs complex debris?
- < 5 mm = simple (no disruption of intimal surface)
- > 5 mm = complex (disruption of intimal surface)
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Where is the AO isthmus?
Just below Lt Subclavian where arch meets descending AO
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Dimensions of AO root are taken at ___________________.
End diastole
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Name the congenital diseases of AO valve: (5)
- Bicuspid valve
- Supravalvular stenosis
- Subvalvular stenosis
- Coarctation of AO
- Marfan's Syndrome
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Supravalvular stenosis means:
narrowing of ascending ao
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Subvalvular stenosis (discreet sub aortic stenosis) means
narrowing of the left ventricle just below the aortic valve
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What syndrome is coarctation associated with?
Turner's (big chest, little legs, more flow in upper body)
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In children coarctation is MC preductal / postductal?
In adults " " " "
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What is BP before and after coarctation?
- increased before
- decreased after
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What is the MC risk factor for AO dissection?
Chronic Hypertension
-
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MC abnormality of AO is ____________________.
Dilation
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Most sever abnormality of AO is ____________________.
aneurysm
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