Pediatrics - Lecture 1

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Pediatrics - Lecture 1
2013-01-21 18:26:12
pediatrics echo325

Nomenclature and the Segmental Approach
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  1. Which 2 major organ groups affect the position of cardiovascular structures in congenital cardiology?
    abdominal viscera

    the atria
  2. The abdominal viscera and the atria are (symmetric/asymmetric) in structure.
  3. Situs solitus:

    • Liver and cecum on r.
    • Stomach, sigmoid colon, and spleen on l.
  4. Situs inversus:
    Opposite of normal

    • Liver and cecum on r.
    • Stomach, sigmoid colon, and spleen on l.
  5. Situs ambiguous:
    Any pattern other than normal or inverted

    (Bilateral liver, asplenia)
  6. Heterotaxy Syndrome:
    Partial or complete lack of lateralization of organs, splenic abnls, CHD, and other wrong stuff.
  7. What determines atrial situs (cardiac sidedness)?
    The position of the morphologic r. and l. atria (mRA and mLA)
  8. Describe atrial solitus, inversus, and ambiguous
    Solitus - nl, LA posterior and to the l. of RA

    Inversus - LA is posterior and to the r. of RA

    Ambiguous - cannot delineate RA and LA.  Rare.
  9. In which cases of ambiguous atria do both the chambers resemble the mRA?
    Frequently seen in pts. w/ asplenia
  10. What is the best landmark used to differentiate between the mRA and mLA? Which chamber is it seen in?
    The thicker limbus of the fossa ovale which is always on the same side as the mRA
  11. What are some morphologic criteria for the RA?
    • Crista terminalis
    • AV pectinate m.
    • Broad, triangular appendage
    • Limbus of fossa ovale
    • IVC, SVC, and carotid sinus
  12. What are some morphologic criteria for the LA?
    • Pectinate m. in appendage
    • Long, narrow appendage
    • Valve of foramen ovale
    • PVs (unreliable marker due to variation)
  13. AV concordance:
    • Assignment of AV connection
    • Concordant: RA to RV
    • Discordant: RA to LV
  14. Levoposition:
    nl. most of cardiac mass is l. of midline
  15. Dextroposition:
    most of cardiac mass is r. of midline
  16. Mesoposition:
    cardiac mass evenly divided around midline
  17. Cardiac orientation:
    Orientation of the base to the apex of the heart, not mediastinal position
  18. Levocardia:
    Base to apex from upper r. to lower l.
  19. Dextrocardia:
    Base to apex from upper l. to lower r. 
  20. Mesocardia:
    Base to apex almost directly superior to inferior (on midline)
  21. Primary dextrocardia:
    Heart is in r. chest due to CHD
  22. Secondary dextrocardia:
    Heart is pushed/pulled to the right by extracardiac anomalies (pneumothorax, hernia of the diaphragm)
  23. Ectopia cordis:
    Heart is positioned partially or completely outside the thoracic cavity
  24. What are the 4 main cardiac segments?
    • Atria
    • Ventricles
    • Great arteries
    • Great veins
  25. AV canal:
    • AV valves
    • IAS
    • IVS
    • Conus (infundibulum)
  26. Overriding:
    An annulus crosses the plane of VSD making itself more apparent in one ventricle. Could be any valve.
  27. Straddling:
    Chordae that cross a VSD and have attachments in opposite ventricle. Tough to surgically close VSD. Atrioventricular valves.
  28. Univentricular AV connection:
    All atria connected to single functioning ventricle
  29. Transposition:
    Semilunar valves only, great arteries are on opposite sides of IVS (aorta to mRV, PA to mLV)
  30. Malposition:
    Any abnl connection of semilunar valves and great arteries e.g. double outlet r. ventricle
  31. Conus:
    Infundibulum. Segment between the ventricles and great arteries. 
  32. What is the nl position of the conus?
  33. Endocardial cushion defect:
    AV canal defect, AV septal defect
  34. Truncus arteriosus
    Persistant arterial trunk
  35. Ductus arteriosus:
    Ductal artery: vessel between main PA and AO  artery so blood bypasses fetal lungs