Term
|
Definition
| The intentional and temporary cessation of the heart to produce asystole. A specialized solution that is introduced into the coronary circulation. Its done to slow the metabolism of the heart to prevent damage to the LV and RV. |
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Term
| What are 4 types of ASD's( Atrial Septal Defects) |
|
Definition
-Ostium Secundum
-Sinus Venosus
-Ostium Primum
-Common Atrium |
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Term
| Out of the 4 ASD'a Which is the largest and most common? |
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Definition
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Term
| What are some surgical corrections for the ostium secundum ASD? |
|
Definition
| septal occluders and closures or pericardial patches or gortex graphs. |
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Term
| Where is the Sinus Venosus ASD located? |
|
Definition
| High within the IAS near or at the level of the SVC/PV's |
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Term
| How is the ostium primum ASD caused. |
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Definition
| When the septal primum and endocardial cushions do not meet. Its also classified as endocardial cushion defect. |
|
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Term
| Describe common atrium ASD? |
|
Definition
| Very large looks like one large atrium, a lot of atrial mixing |
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Term
| What are some surgical corrections for common atrium ASD |
|
Definition
| large pericardial graphs and they have to rebuild the IAS |
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Term
| With an ASD assuming its small what is the direction of flow? |
|
Definition
| Usually from left to right because the pressures in the LA are higher |
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Term
| With an ASD and if we heard a murmur describe it? |
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Definition
| Itwill be systolic, from left sternal 3rd or 4th intercostal space by the tricuspid valve from left to right |
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Term
| How would an ASD look in a chest x-ray? |
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Definition
| may look normal. you might see an increased cardiac silhouette and see some pulmonary congestion |
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Term
| How would an ASD effect the heart and which chambers would be impacted? |
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Definition
| It depends on the severity of the lession. If small nothing. Eventually all chambers would be impacted but it would start with the RA and RV. |
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Term
| What are some symptoms that couls accompany and ASD? |
|
Definition
feeding difficulties
shortness of breath
arrhythmias
fatigue
*Varies with age*
*Normally right sided |
|
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Term
|
Definition
| Right heart failure, seen in apical VSD's |
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Term
| Listening with a stethescope, what is the sound a VSD would most likely mimic. |
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Definition
| Sounds like an Aortic Stenosis |
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Term
| What are size classifications for VSD's |
|
Definition
1) insignificant
2) small
3) moderate
4) large |
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Term
| What is a common ventrical VSD |
|
Definition
absence of the IVS
may have remnants of tissue distally, sometimes ventricals are inverted and again mixing of blood. |
|
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Term
| What is a supracristal ASD |
|
Definition
Goes from left ventrical to right outflow track, under the PA |
|
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Term
| Where would the Gerbode VSD be located |
|
Definition
| lies under the Ao, also left to right |
|
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Term
| what type of murmur would be heard with a VSD |
|
Definition
| systolic murmur, very harsh sounding, between the 2nd and 3rd intercostal space |
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Term
| How would a chest x-ray look like if the patient has a VSD |
|
Definition
| if significant, a bigger cardiac silhouett with right side bigger |
|
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Term
| what are some VSD small defects |
|
Definition
goes undetected
no change in growth
no symptoms
no feeding issues
EKG may be normal with mild murmur |
|
|
Term
| what are some large defects with a VSD |
|
Definition
growth failure
large left to right shunt
decreased immune system
shortness of breath |
|
|
Term
Which VSD is rare in adolescents but more often seen in adults
|
|
Definition
|
|
Term
|
Definition
| small, narrow, or not present |
|
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Term
| what are some clinical findings with tricuspid atresia? |
|
Definition
cyanosis after birth and increases with crying
causes cerebral hypoxia
rapid breathing, increased HR
may squat a lot(increases venous flow to heart)
Clubbing |
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Term
|
Definition
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Term
| What are some treatments of TV atresia |
|
Definition
make the ASD or VSD bigger
blood flow to lungs needs to be established or increased
keep the PDA open with ProstagladinE |
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Term
|
Definition
|
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Term
| there are three surgeries over a two year period dealing with TV atresia, what are they? |
|
Definition
Blalock-Tausigg
Glen Shunt
Fontane |
|
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Term
| What is the reason behind Blalock Tausigg procedure |
|
Definition
| left subclavien artery is divided and connected to the left pulmonary artery, allowing blood flow to the lungs to pick up oxygen |
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Term
| what is the glen shunt used for |
|
Definition
| seperates the Right Atrium from the SVC, attatch the SVC to the RPA and drains right into lungs |
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Term
| What is the end result with a glen shunt procedure |
|
Definition
| completely seperate the right side |
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Term
| What is the fontane procedure |
|
Definition
3rd and final surgury hopefully
complete seperation of systemic from pulmonary circ.
IVC is connected to the RPA
ASD and VSD are closed
PA banding may be necessary |
|
|
Term
| What is ebstiens malformation |
|
Definition
the TV is displaced inferiorly towards apex
leaflets are abnormal
RV becomes arterialized
is compatible with life unless really severe
RVOT is main pumping chamber
decreased bloodflow to lungs
associated with ASD and VSD and pulmonary HTN |
|
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Term
|
Definition
| normal cardiac position, anterior inferior and to the left |
|
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Term
|
Definition
| Apex is still on the left owever the heart is on the right |
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Term
|
Definition
|
|
Term
| What does it mean if the heart is in concordance |
|
Definition
| Normal alignment; LV w/LA and RV w/RA |
|
|
Term
|
Definition
| abnormal alignment with great vessels and chambers |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
| Where is the membranous VSD located |
|
Definition
| High in the IVS at the level of the Ao |
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Term
|
Definition
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Term
| What are characteristics of TET |
|
Definition
RVOT Obstruction; due to Pulmonic Stenosis
RVH; response to volume overload
Large VSD; can be biderectional but normally L to R
Overriding the Ao |
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|
Term
| Name Physical findings and symptoms of TET |
|
Definition
Cyanosis
Clubbing
Squatting- changes pressure in the abdominal cavity vs. thoracic cavity |
|
|
Term
| What is the most severe form of TET |
|
Definition
Pulmonary atresia- complete closure of RVOT |
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|
Term
| Some congenital lessions in TET |
|
Definition
Bicuspid pulmonic valve
right sided arch in 25% of cases
coronary anomalies
R to L shunt |
|
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Term
|
Definition
there was pallative surgery first and a total repair over a 2 to 4 year period.
Now with advancement total repair is done within first 6 months |
|
|
Term
| Surgical complications with TET |
|
Definition
Infection
Arrhythmias
CHF
SBE
Pacemaker
Death |
|
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Term
|
Definition
| number of deaths from a specific disease |
|
|
Term
|
Definition
| the rate or incidence of that specific disease |
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Term
| Steps of TET surgical repair |
|
Definition
- Blalock Tausigg sunt is removed
- VAD and ASD are closed
- Close PDA
- In PS the RVOT can be surgically resected and reconstructed
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|
|
Term
| How is the Eisenmengers complex characterized |
|
Definition
Large VSD
Over riding Ao
No RVOT obstruction
PA can be dialated
Abnormal TV ( thickened or Stenotic)
increase in pulmonary vascular resistance
shunts reversed |
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|
Term
| Findings with a bicuspid Ao valve |
|
Definition
2 cusps rather than 3
can be smooth, thinned or abnormally thick
found more in males
Ao root can be normal or dialated
can be an incidental finding |
|
|
Term
| What is coarctation of the desending Ao |
|
Definition
| A narrowing, almost a pinch from malformation |
|
|
Term
| What are the symptoms/signs of a bicuspid Ao |
|
Definition
SOB
Murmur (AS or AI)
evidence of failure
Pulmonary HTN
Vent. arrhythmias |
|
|
Term
| Surgical repair for Ao or Pa valves are possible due to technology advancements? |
|
Definition
No, There is no repair only full replacements for semi-lunar valves.
Aortic valvuplasty |
|
|
Term
| Is it possible for congenital AS to be tolerated |
|
Definition
| Yes it can be well tolerated if there are no symptoms |
|
|
Term
|
Definition
| The cusps are fused and not thickened, may become calcific later in life |
|
|
Term
| What are some key symptoms for congenital AS |
|
Definition
Fatigue
CHF, chest pain
Arrhythmias
dyspnea
LVH
murmur
pulmonary congestion
increased cardiac silhouette on the left side and wide media steinum b/c Ao dilated |
|
|
Term
| What is the Ross Procedure |
|
Definition
| Taking the PA valve and put it in the place of the Ao valve, then fully replace the PA valve |
|
|
Term
Name some surgical options for Congenital AS
|
|
Definition
- valvuplasty
- Ao replacement
- ross procedure
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|
|
Term
| Define Hypoplastic left heart syndrome. |
|
Definition
A single ventrical.
The LV is small or not there at all, Ao can be narrowed, Ao valve may be stenotic and can have MS or coarctation. |
|
|
Term
| Additional Characteristics for hypoplastic syndrome |
|
Definition
- hypoplastic LA
- RVE, RVH
- hypoplastic LV might be filled with a clot
- Coronaries perfused from PDA down ascending Ao
- systemic perfusion
- need a very large ASD for one common atrium
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|
|
Term
| Medical care for Hypoplastic syndrome |
|
Definition
- Keep PDA open
- Correct metabolic acidosis
- Manipulate PVR
- Intubation
- Cardiac medication managment
- O2 supplement
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|
|
Term
| What are thenumber of stages in the Norwood Procedure |
|
Definition
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|
Term
| Stage II of the Norwood Procedure is what? |
|
Definition
| also known as the Glenn procedure. preformed 4 to 6 months as a bridge to stage III.Blalock Tausigg shunts will be disconnected and removed from the RPA. The SVC is excised and anastomised to the RPA creating systemic venous to pulmonary connection. Intracardiac mixing still occurs through IVC |
|
|
Term
| What is stage I of the Norwood Procedure |
|
Definition
Pallative and usually performed within first few days
Involves constructing a neo-aorta( dividing the MPA below its confluence with R and L pulmonary branches and attatching the pulmonary trunk together with the pulmonic valve to the hypoplastic base of the Ao. The PA below R and L branches is closed. |
|
|
Term
| Which stage is also known as the Fontane completion? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Facts about idiopathic sub-aortic stenosis |
|
Definition
- small LV cavity demensions, EF@75-80%
- a degree of LVOT obstruction
- SAM of the MV
- change in contour, shape of LV
- the venture effect
- preserves systolic function but will lead to diastolic failure
- intracardiac pressures increase. high pressure in LV reflected in LA and back to Right heart
|
|
|
Term
| What are someclassifications of Heprthropic cardiomyopathies |
|
Definition
- Obstructive or non-obstructive( is there an outflow track obstruction)
- ASH
- LVH
- abnormal LV chamber
- Decreased LV volume and area
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|
|
Term
| What is transposition of the great vessels. |
|
Definition
| Vessels arise from the wrong ventrical |
|
|
Term
| Another name for transposition of great vessels |
|
Definition
|
|
Term
| How does D-transposition occur |
|
Definition
| abnormal septation of truncus, failure of septation |
|
|
Term
| what is the meaning of dextro |
|
Definition
|
|
Term
| what is the blood path for a d-transposition case? |
|
Definition
SVC/IVC-RA-RV-Ao
LA-LV-PA |
|
|
Term
| What is the most common form of d-transposition? |
|
Definition
| Ao is anterior and to the right of the PA |
|
|
Term
True or False
D-transposition is fatal if not treated. |
|
Definition
|
|
Term
| Name 5 clinical features of TGA? |
|
Definition
- cyanotic at birth
- heart failure
- respiratory distress; pulmonary edema
- cardio megley (R heart dilates)
- intracardiac pressures abnormal
|
|
|
Term
| Surgery steps for TGA are? |
|
Definition
- pallative ASD, VSD
- jantene procedure
- coronary arteries reattached
- ASD, VSD closed
|
|
|
Term
|
Definition
L=Left
is when the heart tube convolutes to the left instead of the right resulting in abnormal reversal of the ventricals |
|
|
Term
| Waht are facts about L-Transposition |
|
Definition
MV, TV remain in there normal position
RV has moderator band, myocardium smaller
atria are usually normal
can go undetected
ventricular inversion (RV-Ao;LV-PA)
ASD,VSD |
|
|
Term
| What is Persistant Truncus Arterious |
|
Definition
| Venus and atrial mixing;VSD |
|
|
Term
| Number of PTA's and description |
|
Definition
3 types
Type I=single PA trunk, arise from common atrial trunk, w/R and L P. arteries originate from that trunk
Type II= L & R PA arise seperately from posterior portion. No PA just 1 large arterial vessel. Right Ao arch is common
Type III= L & R PA arise as seperate vessels very widly seperated. Ao should be normal |
|
|
Term
| Surgical treatments for PTA |
|
Definition
close VSD
Seperate PA from the atrial trunk which will be used fr Ao
make sure RVOT aligned w/ new PA
close ASD |
|
|
Term
| How many types of TAPVR are there |
|
Definition
|
|
Term
| What does TAPVR stand for |
|
Definition
| Total Anomalous Pulmonary Venous Return |
|
|
Term
|
Definition
| Partial Pulmonary Venous Return |
|
|
Term
| What is supra cardiac TAPVR |
|
Definition
| Pulmonary vein flow to an innominate to a vein above the heart |
|
|
Term
|
Definition
| Pulmonary flow to coronary sinus and empties into RA then to LA ( due to ASD) |
|
|
Term
|
Definition
| Pulmonary vein to IVC (RA-LA because of ASD) |
|
|
Term
| What are surgical treatments for TAPVR |
|
Definition
can be performed in 1-2 months
depends of number of pulmonary veins
ASD closed
pulmonary veins re-anastomosed to the LA
may put baffle/conduit in to help redirect flow in LA. you dont want turbulent flow |
|
|
Term
| Do they usually perform surgery with an anomaly where RCA arises from LMC artery? |
|
Definition
|
|
Term
| What is the most serious of coronary artery anomalies |
|
Definition
|
|
Term
| name three anomolies of the coronary arteries |
|
Definition
- RCA arising from LMC artery
- Left main from the PA
- Left main from thr RCA
|
|
|
Term
| Facts about anomaly where the Left Main arises from PA |
|
Definition
- most common defect; requires surgery
- LMC lies between PA and Ao, gets pinched with contraction, causes coronary spasm leading to ischemia
- have to reattach LMC to Ao
|
|
|
Term
| Facts about anomoly where Left main arises from RCA |
|
Definition
- Less serious defect
- coarse between Ao and PA
- Puts child or infant at risk for sudden death
- can go undetected
|
|
|
Term
|
Definition
| one pap. muscle, two leaflets; all chorde go to one pap. muscle |
|
|
Term
|
Definition
| Thick leaflets and stenotic; decrease MV area. |
|
|
Term
|
Definition
| one or both leaflets prolapse into LA, causes volume overload to LA; seen more in females; can go undetected |
|
|
Term
|
Definition
| Benign cardiac tumors, slow growing. predominatly in the LA for children typically they will grow in LV; can go undetected and mimic stenosis |
|
|
Term
| Facts about endocardial defects |
|
Definition
- ASD,VSD, cleft MV
- cushions partially fuse resulting in division of AV canal
- Is a R/L ostium; has R/L flow
- Primum ASD (partial ECD)
- cleft MV or TV
- volume overload to right heart
|
|
|
Term
| What are surgical repair and survival rate for ECD |
|
Definition
- if not repaired mortality rate is high @ 80% at 2 years due to increasing CHF and pulmonary disease
- restore normal circ. by closing ASD, VSD with patches
- Pulmonary band
- reconstruction of MV and TV
- repair additional defects like Pulmonary stenosis
|
|
|
Term
|
Definition
- fixed or split S2
- failure to thrive
- fatigue
- dyspnea
- PHTN
- large cardiac silhouette
- EKG
- sign of CHF
- RV enlargment, hypertrophy (RV)
|
|
|
Term
|
Definition
- High membranous
- Mid Septal
- mid muscular VSD, apical VSD, supra cristal VSD (shunted in RVOT)
|
|
|
Term
| Where are membranous VSD's located |
|
Definition
| high in the IVS at level of the Ao |
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|
