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- 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
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 __________________.
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
What is Lutenbacker?
ASD + MS = small LA d/t shunt
The Qp/QS would be _________________ in a patient with significant ASD?
What does Qp/Qs mean?
SV RVOT / SV LVOT
The average velocity of an ASD is ____________________m/sec.
- 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:
A small VSD would have a low velocity? T/F
- 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
- 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?
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?
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?
What is a hypoplastic Lt Ventricle?
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)
lies immediately above the Pulmonary valve
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 _____________________
PA systolic pressure = ?
VSD is seen in __________________ only. Why?
- High Lt sided pressure
Why is ASD flow lower than VSD flow?
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)?
Swirling of ventricular contrast is seen when volume of injection rate is too (high / low)?
Detection of intracardiac shunts, enhancement of doppler signals, LV opacification, and myocardial perfusion are 4 indications to perform _____________________ ____________________.