Pediatrics - Lecture 2
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When was the first successful surgical correction of pediatric CHD?
1938, ligation of ductus arteriosus
What is the fundamental concept of segmental analysis?
Each component or segment of the heart is analyzed individually in a sequential fashion.
Veins/atria, ventricles, great arteries, AV canal, conus
Only conal septum, subaortic freewall usually absent, resulting in fibrous continuity between l. and non-cornary cusps and the AMVL
What are the steps to the segmental approach?
- 1) Thoraco-abdminal situs
- 2) Cardiac position/orientation
- 3) Segment - by - segment analysis
- 4) Atrial situs
- 5) Ventricular loop
- 6) AV canal analysis
- 7) Heart outflow analysis (ventriculo-arterial alignment)
- 8) Conus analysis
- 9) Semilunar valve relationship
- 10) All other anomalies
Describe the chain of segments and connections starting w/ the great veins.
Great veins - venoatrial - atria - atrioventricular - ventricles - ventriculoarterial - great arteries
Organs in the body are typically oriented assymetrically
____ - ______ situs provides the framework for the exam.
What are the different systemic venous drainages?
- Coronary sinus
- Hepatic veins
Normally, veins draining the liver empty into the ___, which enters the ___.
IVC, which enters the mRA.
Hepatic veins can connect to mRA independently.
Persistent l. SVC:
SVC is usually on r. side, however in persistent l. SVC there will be 2 great veins from upper body which connects to a dilated CS.
Situs abnormalities frequently result in abnl ____?
How does one identify the atrial situs?
By its morphologic features and intrinsic anatomy
(notecard in lecture 1 about mRA features)
Identifying the ventricles in 3 distinct chambers: LV, RV, and infundibulum
What are the two subchambers of the RV?
The RV is _____ shaped.
What are some morphological features of the RV?
- Septal attachments of chordae from TV
- Coarse trabeculations
- Moderor bands
Is the infundibulum well-defined?
No, because it has a different embryological orgin
How is the septal attachment of the AV valves in the cardiac crux useful?
The septal TV leaflet (in the mRV) is more apically placed than the MVL and helps to show the difference between the mRV and mLV.
What is the most reliable morphologic characteristic of the LV?
Smooth superior septal surface
The type of ventricular loop defines the pattern of _______ distribution, distribution of the c______ system, and organization of the ______ .
- Coronary artery
(barry said he probably won't drill us on this)
What is the simple description of AV connections?
If it's either biventricular (2 AV valves with concordant, discordant, or ambiguous connection) or univentricular (Single functioning ventricle; single, double, or common inlet)
How does one describe the dominant ventricular morphology and AV connection classification?
By assessing AV connection functionally (hypoplasia, obstruction, stenosis?)
Valves are associated with the _____, not the ______.
Ventricle, not the atria
What is the best method of description for ventriculo-arterial alignment?
Assigning a great artery to a specific chamber when it (nearly) completely is associated with that chamber. If nothing else, describe anatomy.
How are semilunar valves identified?
By the great vessel it's connected to e.g. aortic valve in aortic arch.
If a valve annulus overlies a cavity by more than ___% than is is assigned to that ____ cavity.
(Rule often n/a due to complex anatomy of great arteries)
Determination of the ventriculo-arterial alignment is based on the spatial relationships of _____ and underlying ______, not based on the type of inf___ present.
- valves and underlying ventricles
What are 3 types of conus abnormalities?
- Complete subaortic conus
- Bilateral conus
- Bilaterally absent conus
(Does NOT define ventriculo-arterial alignment)
What is the rarest conal abnormality?
Bilaterally absent conus (seen in double outlet LV)
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