Septal Defects - Right side of Heart

ASD stands for?

Atrial Septal Defect

What is an Atrial Septal defect?

Defect or discontinuity within the atrial septum

What are the different types of ASDs?

• Secundum

• Primum

• Sinus venosus

What is the ASD: Secundum?

Most common but most difficult one to see

• Located in central arterial septum and near the foramen ovale

  • Absence of foramen ovale flap is noted

What is the ASD: Primum?

• Found lower in the septum, near krux of the heart

  • Cleft in mitral valve is found which will cause mitral regurgitation

The ASD, Primum is associated with…

• Atrial ventricle septal defect malformation

• Other abnormalities of the arterial ventricular valve

• Trisomy 21

What is the ASD: Sinus Venosus?

Least common,

• Near entrance of SVC into the RA

The ASD, Sinus Venosus is associated with…

Parietal anomalis pulmonary venous return

ASDs are common in ______ _________ and associated with…

• Down Syndrome

  • PDA

  • VSD

  • Pulmonary stenosis

  • Transposition of great vessels

  • Tetralogy of flow

Label this image

1. Right atrium 

2. Absent septum secundum

3. Left atrium

4. Septum primum

ASD 

What does VSD stand for?

Ventricular Septal Defect

What is a Ventricular Septal defect?

Interruption of interventricular septum

• May be large or small

What is the most common CHD?

VSD

• 30% of structural heart defects

The ventricular septum may be __________ or ___________.

• Muscular 

• Membranous

What is a muscular VSD?

Found lower in septum and typically small, multiple holes

• Spontaneously close after birth

What is a membranous VSD?

Most common, just below aortic leaflets.

VSD

What is the best view to see VSDs in?

• Long axis

• Short axis

• 4-chamber

• 5-chamber

What are the US findings of a VSD?

• Found just below aortic leaflets

• Defects smaller than <2mm not normally detected on a fetal echo

  • May not see shunting of flow, pressure between ventricles are going to be similar

What is the prognosis of VSDs?

Pretty good unless associated with other anomalies. Can have surgery after birth

What does ASVD stand for?

Atrioventricular septal defect

What is the most common type of AVSD?

Endocardial cushion defect

Where is the Endocardial Cushion found?

Area where the valves, atria, and ventricles come together

• Central portion of heart, where the Cruz of the arterial and ventricular septum grow centrally together

What is the seen with an incomplete AVSD?

• Communication between LV & RA

• Membranous VSD & Primum ASD

• Abnormal Tricuspid valve

• Cleft Mitral valve

What is a cleft mitral valve?

Anterior part of leaflet is divided into 2 parts (medial & lateral)

What is the seen with a complete AVSD?

Single large AV valve stretching across both of the ventricles

Systole AVSD [different sizes of atrium]

Diastole AVSD

AVSD is associated with:

• Coarctation of the aorta

• Pulmonary stenosis

• Atresia

  • Increase incidence with Trisomy 21

What is the best view to see AVSDs in?

• Long axis

• Short axis

• 4-chamber view

Right ventricular inflow disturbance type is considered…

Tricuspid Atresia

Where is the Tricuspid valve located?

In between Right atrium and Right ventricle

Where is the Mitral valve located ?

In between the Left atrium and Left ventricle

What is Tricuspid Atresia?

• Interruption of growth of tricuspid leaflet

  • Causing valve to be hypoplastic or atresia

With Tricuspid Atresia, the ________ portion of the _______ ventricle has failed to form.

• Inflow 

• Right

  • Leading to Hypoplastic RV

What plane can Tricuspid Atresia be visualized in?

4-chamber view

The _____ and ____ will be diminished in size when looking at Tricuspid Artesia.

• RVOT

• PA

Ultrasound findings of Tricuspid Atresia.

• Large, left ventricles

• Small, underdeveloped right ventricle

• Echogenic tricuspid annulus & no valvular movement

  • Use color doppler

Tricuspid Atresia

When a small right ventricle is seen, what should the sonographer suspect?

• Pulmonary atresia

• Tricuspid atresia

• Aortic stenosis or insufficiency

  • Underdeveloped

Pulmonary and Tricuspid Atresia can be seen with and without any _______ ________.

Septal defects

What is Ebstein’s anomaly of Tricuspid Valve?

Abnormal displacement of septal leaflet of tricuspid valve toward apex of right ventricle creating malformed tricuspid valve

How does the heart function with Ebstein’s Anomaly of the Tricuspid Valve?

• Arterialized Chamber

• Reduced capacity of pumping action of the right ventricle

What does ‘Atrialized chamber’ mean?

Portion of the right ventricle that becomes a receiving chamber with the right atrium pressure

US findings found with Ebstein’s Anomaly of Tricuspid Valve.

• Apical displacement of Tricuspid valve leaflet

• Arterialized right ventricle

• Right ventricular dysfunction

• Right atrium is massively dilated

Ebstein’s Anomaly of Tricuspid Valve

Ebstein’s Anomaly of Tricuspid Valve

When an enlarged right atrium is seen, what should the sonographer suspect?

• Ebstein anomaly

• Tricuspid dysplasia

• Tricuspid regurgitation without inferior displacement of the valve

Summary describing Ebstein’s Anomaly.

• Malformation of tricuspid valve

• Valves are displaced inferiorly

• Enlarged right atrium

Right ventricular outflow disturbance type is considered…

Hypoplastic Right Heart

What is Hypoplastic Right Heart?

Underdeveloped right heart from obstructed RVOT

• Secondary to pulmonary stenosis

Hypoplastic Right Heart will have multiple structures that are small, what are they?

• Tricuspid valve

• Right ventricle

• Pulmonary artery

Hypoplastic Right Heart

Don’t confuse Hypoplastic Right Heart with….

Hypoplastic Left Heart

• Know situs & chamber locations

When something is found in the wrong place, what should the sonographer suspect?

Teratology of Fallot

Most common form of cyanotic heart disease [blue at birth] in infants and children.

Tetralogy of Fallot

What is the differential diagnosis for Tetralogy of Fallot?

Double outlet right ventricle

What is double outlet right ventricle?

Both great vessels, AO and PA arise from right ventricle

What is the prognosis of Tetralogy of Fallot?

Good with surgery after birth

• Pulmonary atresia or absent pulmonary valve may worsen prognosis

What 4 things are assoc with Teratology of Fallot?

1. High, membranous VSD

2. Overriding Aorta

3. Pulmonary stenosis

4. Hypertrophy of right ventricle

The severity of Tetralogy of Fallot depends on the ________ _________.

Pulmonary Stenosis

In utero the ventricles may still be _________, Hypertrophy of right ventricle happens over time.

Symmetrical

Tetralogy of Fallot is associated with…

Trisomy 21, 18, and 13

What is an Overriding Aorta?

Large, anteriorly displaced aorta, which overrides the septal defect

Form of RVOT obstruction?

Pulmonic Stenosis

Where is the Pulmonic valve found?

Between RV & PA has 3 semilunar cusps

When a pulmonic stenosis is present, what is seen on US.

• Cusps become thickened

• Less mobile

• Domed (in diastole)

When a Pulmonic Stenosis, what else may be seen?

• Hypoplastic or may have poststenotic dilation

• May see dilated RA & RV