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Define: ASD
- Atrial septal defect
- hole or tear in atrial septum allowing communication btw Rt & Lt atrium (>5mm discontinuity of IAS)
4 main types of ASD's are:
- Primum - 20% - AV valves (endocardial cushion defect)
- Secundum - 70% - Central (MVP)
- Sinus Venosus - 10% - SVC&IVC entry; PV drain problems
- Coronary Sinus - rare
MC ASD:

Secumdum - 70% - central (MVP)
The Primum ASD is at the level of ___________________ and is usually associated with ___________________ ___________________ _________________ _________________.
- AV valves
- partial endocardial cushion defect
The secundum ASD is situated ______________________ of the septum and can be associated with __________________.
- central
- MVP (cleft MV)
The Sinus Venosus ASD is at the entrance of the ____________ & _____________ & is associated with _______________ ________________ of the ________________ ________________.
- IVC SVC
- anomalous drainage
- pulmonary veins
The patient who presents with an ASD will have symptoms such as: (5-6)
- 1. 50% asymptomatic
- 2. dyspnea, palpatations, atrial arrhythmias, PHTN, RHF, QP/QS >2:1
List 5 complications of patient with ASD:
- 1. CHF
- 2. PHTN
- 3. Eisenmengers Syndrome
- 4. Atrial Arrhythmias
- 5. Cerebrovascular Accident (paradoxical embolis ) Rt-->Lt --> brain (cough)
List the M-Mode & 2D features of significant ASD (9)

RVE, RAE, RVVO, PAE, PHTN (flying W), T artifact, cleft MV, MVP
Explain the difference one would see in the PSSX view of the RV & LV with PHTN vs. RVVO.
- PHTN = D shape --> IVS always flat
- RVVO = D shape --> IVS flat in SYSTOLE only
The shunt of an ASD would be first Lt --> Rt. Why? What would the color flow look like?
- Higher Lt sided pressures.
- Color above the baseline (towards the Transducer)
What is the formula for Cardiac Output?

CO = (d²)(0.785)(TVI)(HR)/1000 = L/min
The diastolic TV flow of a hemodynamically significant ASD would be increased? T/F

True.
What is Lutenbacker?

ASD + MS = small LA d/t shunt
The Qp/QS would be _________________ in a patient with significant ASD?

1.5:1
What does Qp/Qs mean?

SV RVOT / SV LVOT
The average velocity of an ASD is ____________________m/sec.

0.3-0.9
Define: VSD
- Ventricular septal defect. Hole in IVS allowing communication between LV and RV.
- VSD = Large Left side
- ASD = Large Right Side
- PDA = Large Left Side
Define: Eisenmengers Syndrome

Initially Lt--> Rt shunt, but PAP increases & > or = systemic pressure (120/80)
4 VSD locations are:
- 1. Output - 12-3 (more anterior)
- 2. Membransous 9-12 80% PSLX
- 3. Inlet (more posterior)
- 4. Muscular
3 chambers enlarged with perimembranous VSD are:
- 1. LVE
- 2. LAE
- 3. RVE
A small VSD would have a low velocity? T/F
- False
- small hole = high velocity
- large hole = low velocity (pressure equilizing faster)
RVSP = ?

Systemic BP - 4V²
Why is it important to assess RVSP in the presence of VSD?

The patient can develop PHTN.
What's the difference between + and - contrast study?
- + Rt --> Lt shunt = bolus in Lt heart
- - Bolus stays in Rt heart. Fresh echo free blood in contrast echo
Define: PDA
- Patent Ductus Arteriosus
- Residual communication between LPA and Descending AO. Necessary during gestation.
Describe the flow pattern of a patient with a PDA

Ductal channel arises @ PA bifurcation near origin LPA --> lesser curve AO just opposite Lt Subclavian Artery
3 etiologies of PDA
- 1. Premies
- 2. Genetic Abnormality (Down's)
- 3. Mother had Rubella
What 2 chambers are enlarged with a PDA that has a Lt to Rt shunt?

LAE, LVE
why would a baby have cyanosis in their lower body?

Rt-->Lt shunt ; desaturated blood enters systemic system below subclavian artery. 02 saturation increased in upper extremeties than lower.
What can a major clinical problem with a baby who has a PDA?
- PHTN
- CHF
- Eisenmengers
What does ductal dependence mean?

Antegrade flow across RVOT to show flow going through PA
When doing Qp/Qs why do we have to change the measurements around for PDA?

because we're using PDA jet
Explain the difference between a partial and a complete endocardial cushion defect.

Partial = atrail septal involvement with septal, mitral & tricuspid orifices

Complete = both atrial and septal defective and have a COMMON AV VALVE
2D of cleft MV and consequences?
- noncoapt AMVL
- ASD primum
MR ALWAYS!!!!!
What is a hypoplastic Lt Ventricle?
2D?
LV doesn't develop d/t Mitral & AO atresia
- Bar of tissue in mitral position
- Thin slit-like LV
- Thread-like AO
What is the difference between congenitally corrected transposition of great arteries vs. transposition of great arteries?

Cong corrected (adult) = inverted ventricle & transposition GA. AO anterior with normal flow pattern

TGV --> PA with LV & AO with RV
Why do we use Qp/Qs ratio for shunts?
- Indicates the magnitude of shunt
- 1.5:1.0 indicates a significant shunt
- Qp = SV of Qp site = (csa)(fvi)
- Qs = SV of Qs site = (csa)(fvi)
Define: Supracristal

lies immediately above the Pulmonary valve
Define: Infracristal

inferior and posterior to crista supraventricularis and are divided into mmb, muscular and defects that are part of endocardial cushion formation
Tetralogy of Fallot is a _____________________

malalignment
PA systolic pressure = ?

RVSP
VSD is seen in __________________ only. Why?
- systole
- High Lt sided pressure
Why is ASD flow lower than VSD flow?

Pressure gradients
When calculating:
Systolic BP - 4V² what velocity do you use?

velocity of vsd jet
Apical shadowing occurs in a contrast study when the volume (rate of contrast) injection is too (low / high)?

high
Swirling of ventricular contrast is seen when volume of injection rate is too (high / low)?

too low
Detection of intracardiac shunts, enhancement of doppler signals, LV opacification, and myocardial perfusion are 4 indications to perform _____________________ ____________________.

contrast study

Author

lstaal1

22030

Card Set

Echo 530

Description

Acyanotic CHD

Updated

2010-06-05T03:28:29Z

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