Structural Heart Defects

Question 1

Four characteristics of tetralogy of fallot

Answer 1

1. Ventricular Septal Defect
2. Pulmonary Stenosis
3. Hypertrophy of RV
4. Overriding Aorta

Question 2

Pathophysiology of tetralogy of ballot

Answer 2

1. Stenosis of RV outflow leads to Rv being higher pressure than left
2. Blue blood passes from RV to LV

Question 3

Symptom of patients with tetralogy of ballot

Answer 3

Patients are BLUE

Question 4

How is tetralogy of fallot repaired

Answer 4

Black-Taussig Shunt - 1944

Question 5

When is surgical intervention of tetralogy of fallot done

Answer 5

Before the age of two years

Question 6

Side-effect of tetralogy of fallot surgery

Answer 6

Pulmonary valve regurgitation in adults life - redo surgery

Question 7

What is seen in an ECG in tetralogy of ballot

Answer 7

1. WRS duration - 142 msec

Question 8

Symptoms of tetralogy of Fallot

Answer 8

None

Echo every pulmonary regurgitation

Question 9

What is ventricular dental defect

Answer 9

Abnormal connection between two ventricles

Question 10

How common are VSDs

Answer 10

20% of all congenital heart defects

Question 11

Pathophysiology of VSDs

Answer 11

1. High pressure LV
2. Low pressure RV
3. Blood flows from high pressure chamber to low pressure chamber
4. Increased blood flow through the lungs

Question 12

What is the large VSD physiology

Answer 12

1, Breathless, poor feeding, failure to thrive

2. Require fixing in infancy

Question 13

What can large VSD lead to

Answer 13

Eisenmengers Syndrome

Question 14

Surgical procedure to fix VSD

Answer 14

PA band, complete repair

Question 15

Does minor VSD need intervention

Answer 15

No, it’s asymptomatic

Question 16

Clinical signs of large VSD

Answer 16

1. Small breathless skinny baby
2. Increased respiratory rate
3. tachycardia
4. Big heart on CXR
5. Murmur varies in intensity

Question 17

Clinical signs of small VSD

Answer 17

1. Loud systolic murmur
2. Thrill (buzzing sensation)
3. Well Grown
4. Normal HR
5. Normal Heart Size

Question 18

What is Eisenmengers Syndrome

Answer 18

1. High pressure pulmonary blood flow
2. Damages pulmonary vasculature
3. Reisstance to blood flow through lungs increase
4. Rv pressure increases
5. Shunt direction reverses

PATIENT IS BLUE

Question 19

What is an atrial septal defect

Answer 19

Abnormal connection between the two atria

Question 20

How common are atrial septal defects

Answer 20

Common

Question 21

When do ASDs present

Answer 21

Adulthood

Question 22

ASD pathophysiology

Answer 22

Slightly higher pressure in the LA than the RA

Shunt is left to right

Therefore not BLUE patient

Increased flow into right heart + lungs

Question 23

Large ASD physiology

Answer 23

1. Significant increased flow through the night heart and lungs in childhood
2. Right Heart dilation

Question 24

Signs of Large ASD

Answer 24

Chest infections

Question 25

Intervention for ASD

Answer 25

Right heart should be closed

Question 26

Is right heart dilation seen in small ASD

Answer 26

No

Question 27

Intervention for minor ASD

Answer 27

None, leave alone

Question 28

What happens to the shunt in small ASDs as age increases

Answer 28

Shunt increases in gradient size

Question 29

ASD clinical signs

Answer 29

1. Pulmonary flow murmur 2. Fixed split second heart sound (delayed closure of PV because more blood has to get out) 3. Big pulmonary arteries on CXR 4. Big heart on CXR

Question 30

What inheritable condition are Atrio-ventricular septal defects seen with

Answer 30

Downs Syndrome

Question 31

What is AVSD

Answer 31

Hole in the very centre of the heart

Question 32

What structures does AVSD involved

Answer 32

Ventricular and atrial septum, mitral and tricuspid valves

Question 33

What happens to the AV valves in AVSD

Answer 33

Instead of two skepearet valves, there is one big malformed one, causing greater leaks

Question 34

Physiology of complete AVSD

Answer 34

1. Breathlessness as neonate 2. Poor weight gain 3. Poor feeding 4. Torrential pulmonary blood flow 5. Needs repair or PA band in infancy 6. Repaire is surgically challenging

Question 35

Physiology of partial AVSD

Answer 35

1. Can present in late adulthood 2. Presents like a small VSD/ASD 3. May be left alone if there is no right heart dilation

Question 36

What is patent ductus arterioles

Answer 36

Ductus arterioles does not close

Question 37

Symptoms of patent ductus arterioles

Answer 37

Big heart, breathlessness Continuous murmur

Question 38

What can patent ductus arterioles lead to

Answer 38

Eisenmenger's syndrome

Question 39

How is Eisenmenger's syndrome caused by patent ductus arterioles different from other caused eisenmenger's syndrome

Answer 39

Cyanosis of toes not fingers (fingers remain pink)

Question 40

Physiology of patent ductus arteriosus

Answer 40

1. Torrential flow from aorta to pulmonary arteries in infancy 2. Breathlessness 3. Poor feeding 4. Failure to thrive

Question 41

Intervention for PDA

Answer 41

Surgically closed

Question 42

In what babies is PDA more of a concern

Answer 42

Premature

Question 43

What condition can patent ductus arterioles increase the risk of

Answer 43

Endocarditis

Question 44

How is PDA surgically closed

Answer 44

1. Venous approach

Question 45

What is coarctation of aorta

Answer 45

1. Narrowing of aorta at the site of inception of ductus arteriosus

Question 46

Consequence of sever coarctation

Answer 46

1. Complete obstruction to aortic flow

Question 47

What can happen to the to the aorta heart failure and coarctation

Answer 47

Collapse

Question 48

What does mild coarctation of the aorta present with

Answer 48

1. Hypertension | 2. Mild murmur

Question 49

Should mild coarctation of the aorta be repaired

Answer 49

Yes

Question 50

Clinical signs of coarctation

Answer 50

1. Right Arm hypertension 2. Buzzes (bruits) over scapular and back from collateral vessels 3. Murmur

Question 51

What are long-term problems of coarctation

Answer 51

1. Hypertension (early strokes, CAD, sub-arachnoid haemorrhages) 2. Re-coarctation requiring repeat intervention 3. Aneurysm at site of repair

Question 52

Surgical vs percutaneous repair

Answer 52

1. Surgical - subclavian flap repair | 2. End-to-end repair

Question 53

How many cusps does normal AV have

Answer 53

Three

Question 54

How common are bicuspid AV valves

Answer 54

Common (more in males)

Question 55

Effect of Bicuspid AVs on function

Answer 55

Stenotic in infancy or childhood

Question 56

Properties of bicuspid valves vs normal valved

Answer 56

1. Degenerate faster 2. Become regurgitant earlier 3. Associated with coarctation and dilatation of ascending aorta

Question 57

What is pulmonary stenosis

Answer 57

1. Narrowing of the outflow of RV

Question 58

Three types of causes for pulmonary stenosis

Answer 58

1. Valvular 2. Sub-valvular 3. Supra-valvular

Question 59

Consequences of severe pulmonary stenosis

Answer 59

1. RV failure as a neonate 2. Collapse 3. Poor pulmonary blood flow 3. RV hypertrophy 5. Tricuspid regurgitation

Question 60

Moderate pulmonary stenosis consequences

Answer 60

1. Well-tolerated for many years | 2. RV hypertrophy

Question 61

How is pulmonary stenosis treated

Answer 61

1. Balloon valvuloplasty 2. Open valvotomy 3. Open trans-annular patch 4. Shunt (bypass blockage)