Applied IV Endocardial Cushion Defects
RA pressure
0-5
ECDs have problems with what anatomy?
1. IVS 2. IAS 3. TV septal leaflet 4. AMVL
what window(s) can you find LSVC?
1. PSLAX 2. Ap4
defects associated with AVCD
1. TOF 2. DORV 3. D-transposition of great vessels 4. a/poly-splenia
4 examples of ECDs
1. TOF 2. Truncus arteriosus 3. DORV 4. transposition
surgery procedure for AVCD
1. close ASD (patch) 2. close VSD (patch) 3. reconstruct cleft AV valves 4. replace MV (patch)
types of coarctation of the aorta
1. preductal 2. ductal 3. postductal
anomalies also associated with partial AVCD
1. secundum ASD 2. persistent LSVC to CS 3. PS 4. TS or TV atresia 5. coarctation of Ao
LA pressure
10-12
LV pressure
120/10
Ao pressure
120/80
PA pressure
25/10 (mean 18)
RV pressure
25/5
complete AVCD subcategories
A: chordal attach to crest of IVS B: chordal attach to anomalous pap muscle C: free-floating leaflet w/ attach to pap muscles on both sides of IVS
ECDs also referred to as
AVCD or AVSD
large AVCD S/S
CHF, failure to thrive
T or F ECD is only partial
F can be partial or complete
how does blood flow?
HIGH TO LOW PRESSURE
normal shunt direction
L to R
Persistent left superior vena cava
LSVC drains to CS and causes dilation of CS
where is secundum ASD located? what can it be mistaken for?
MID of RA mistaken for PFO
where do you see a partial AVCD, and what will you see?
RA and LA primum ASD with L to R shunting, split valve (extra leaflet)
where is the volume overload with partial AVCD?
RA and RV (septum bow towards LV)
tricuspid atresia
TV missing or malformed; blocks flow from RA to RV
TOF
Tetralogy of Fallot
AVCD
atrioventricular canal defects
AVSD
atrioventricular septal defect
defect associated with Downs
complete AVCD
defect involving all 4 chambers of the heart and AV valves with large inlet VSD in posterior portion of IVS, large primum ASD and MV and TV are merged into 1 valve
complete AVCD
endocardial cushion defect (ECD)
failure of complete growth of endocardial cushion during development
what stage of life are AVCDs found?
fetus or children
S/S of complete AVCD
first weeks of life; 1. dyspnea 2. cyanosis 3. poor wt gain 4. edema
complete AVCD def
has all 3: 1. large primum ASD 2. VSD (inlet) 3. cleft MV
if shunt left unrepaired, what happens?
increase in pulm blood flow --> increase in pulm vasc resistance
if CS isn't fully developed, where does LSVC drain?
into LA, have R to L shunt
ductal coarctation of the aorta
narrowing at insertion of DA
Postductal coarctation of the aorta
narrowing distal to insertion of DA (dsc Ao)
preductal coarctation of the aorta
narrowing prox to DA (top of dsc)
S/S of partial AVCD
not until 20s, 30s (if small); 1. arrhythmias 2. pHTN 3. CHF
partial AVCD def
primum (floor) ASD w/ cleft MV or TV
goal for AVCD surgery
restore normal circ, close defects, restore AV valves (mainly MV)
if pulm vasc resistance increases over systemic resistance, shunting will
reverse to R to L (cyanosis, dyspnea)
Hypoplastic Left Heart Syndrome
severly underdeveloped L heart; LV can't pump out O2 blood to body
if AVCD has large atrial component and abnormal AV valves, there will be:
shunting and AV valve regurg (LV to RA)
what is the treatment for AVCD?
surgery
complete AVCD subcategories are categorized by
their attachment locations within the heart
T or F ECDs are a combined presence of several abnormalities
true
T or F with complete AVCD, shunting can be L to R OR bidirectional
true
partial AVCD is a __________ overload problem
volume
