IAS
ASVD/IVS
Other Heart Defects
Operative Assessment
Pictures/Video
100
A coronary sinus ASD is associated with this rare vascular arrangement?
What is a persistent left SVC. Identified using bubbles via left arm IV. Retrograde cardioplegia contraindicated. Suggested by enlarged >1cm CS but not required. Technically unroofing... not ASD. LA drains to CS then RA http://www.anesthesia-analgesia.org/content/107/4/1163.full http://simplelink.library.utoronto.ca/url.cfm/367530
100
TEE evaluation of a muscular VSD should include the following highlights
Size. Number (often multiple – difficult repair). Margin. Magnitude/direction of flow. Cavitary dimensions. Associated AVSD/PS/AS. Eisenmengers.
100
Spectral doppler of a persistent ductus arteriosus would demonstrate this pattern.
What is diastolic flow reversal. Depending on relative pressures, continual flow reversed through PDA into pulmonary circulation. Associated RVF.
100
Following repair of coarctation of the aorta, resolution is best demonstrated using this imaging modality.
What is colour flow doppler and variance. Potentially unreliable alignment with Doppler gradients.
200
The most common form of ASD is associated with varying degrees of this valvular abnormality.
Mitral valve prolapse or MR related to myxomatous degeneration. Ostium secundum or fossa ovalis defect (75% of ASD)
200
Classification often involves the terms restricted and unrestricted. These terms describe what pressure gradient?
What are right and left ventricular pressures. Restricted = R < L. Unrestricted = R ~ L or R = L. Restrictive = limited flow. Unrestricted flow = flow related to PVR/SVR ratio.
200
TEE evaluation of Fontan circulation requires careful evaluation to identify these complications associated with low flow.
What are obstruction of venous pathways and thrombus. Conventional vs fenestrated/lateral tunnel vs extra cardiac. http://img.medscape.com/fullsize/migrated/503/663/card503663.fig1.gif Anastamosis not always visible. Glenn = ModBiCav/RPA
200
A ToF patient undergoes revision surgery, and intraoperative TEE is unremarkable. However, postoperative TTE evaluation identifies a significant stenosis. This limitation explains the discordance.
What is visualization of branch PAs. ToF associated with RVOTO PS/PA hypoplasia. Left PA most common. TEE able to identify most RVOTO/conduit/valve problems however.
300
Demonstration of a positive shunt using a bubble study requires passage in this many cardiac cycles.
Within 3 to 5. In ventilated patients, echo contrast is given with and without the release of 20 to 30 cm H2O positive airway pressure. Release of positive airway pressure provokes a transient increase in RAP (RAP ?> left atrial pressure), which forces contrast across the defect.
300
Aortic cusp herniation or deformity is most commonly associated with this type of VSD.
What are membranous and subarterial/supracristal/doubly committed VSD. Results from lack of valvular support by outlet septum. Venturi effect sucks down R cusp. Reoperations for AI
300
Supravalvular aortic stenosis (ie. stenosis at the STJ) is associated with these pathologies.
What are coronary artery dilation, accelerated CAD, LVH narrowing of abdominal aorta, renal artery stenosis. Usually defined at STJ. Distinct disease from Coarctation. Coronary below level of obstruction = subject to systolic pressures. Associated with elastin disorder. Possible Schone complex (LVOT obstruction with inflow obstruction - MV/Annulus/Ring disease)
300
Following correction of Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA/Bland-White-Garland), these valvular lesions may be present.
What are: AVR from reimplantation injury PVR from explant/PA mobilization MR ischemia pap/myocardium Also check WMA, ostial flow.
400
Sinus venosus defects are most often associated with abnormal return of this pulmonary vein.
What is the RUPV. Draining directly into SVC just superior to SVC/RA junction. Note close proximity to RPA. Best seen in ME Bicaval.
400
The complete form of AVSD is distinguished from the partial form of AVSD by these findings.
What are single (complete) vs two functionally distinct AV valves (partial). http://www.chd-uk.co.uk/wp-content/uploads/2012/04/AVSD-partial-and-complete.jpg Partial also associated with cleft mitral. Both have inferior atrial septal defect/ostium primum. Variable AV valve competency and outflow tract obstruction.
400
Following transannular patch/VSD closure for TOF, these problems may be identified in late follow-up.
What are PI with RVF, potential aortic root dilation with resultant AI, and restrictive defect. RV size measured in AP4C. http://ehjcimaging.oxfordjournals.org/content/7/2/79/F12.expansion.html RVF - Tapse/MPI/FAC etc. Intervene (repeat surgical) before decrease RVF/dilation... If off-pump planned, need to rule out potential for paradoxical embolism. http://simplelink.library.utoronto.ca/url.cfm/367556
400
Following a difficult repair of a perimembranous VSD, TEE may demonstrate these findings.
What are TV damage/removal/resuspension, RV dysfunction, arrhythmia, and residual leak. Classical approach through RA. Retraction of TV. RV approach if poor windows through RA. PA/LV less common.
500
Placement of an ASD percutaneous closure device requires a minimum of 4-5mm of clearance from these structures.
What are the AV valves, superior and inferior caval veins, and entry of pulmonary veins. Ostium secundum defects only; <38mm. No uniform guidelines. http://circimaging.ahajournals.org/content/2/2/141.full.pdf+html
500
Small, Moderate, and Large VSD are defined by these pulmonary:systemic pressures and these Qp:Qs.
What are: Small <0.3 and <1.4 Medium >0.3 and >1.4-2.2 Large >0.3 and >2.2 Small - adult presentation (minimal hemodynamic/structural changes) M/L in pediatric. VSD closure high risk (RVF) if PVR:SVR > 0.7 (Eisenmengers)
500
In congenitally corrected TGA (aka LTGA), 3 of these pathologies are often identified concomitantly.
What are pulmonary outflow obstruction, VSD, or tricuspid abnormalities. Left AV valve (systemic side) = tricuspid. Can be 'Ebstein-ized' Right AV valve (pulmonic side) = bicuspid. Aorta anterior vs normal posterior to PA. http://1.bp.blogspot.com/_cdAl6ByImOw/TMC1dNqwXyI/AAAAAAAAAAM/Aa3BhuQKP78/s1600/cctgapic.jpg
500
Following ASD/PFO closure using a percutanous device, short and long-term TEE evaluation may include these notable complications. 9....
Erosion. Tamponade. Embolization. Valvular impingement. Arrhythmia. Clot/thrombus. IE. Device fracture/failure. Residual shunt.
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