6/30/2012

Echo: Tissue Doppler Imaging of MV

(Extracted from JASE 2010;23:465-95)


3 cursor locations for AV valves:

Lateral Mitral Annular Tissue Doppler Tracing:


s' - Ventricular Systole

e' - Ventricular recoil during early diastole

a' - Atrial systole

IVCT' - Isovolumic contraction time (Note: Apostrophe)

IVRT - Isovolumic relaxation time (Note: Apostrophe)





Echo: 3D Mitral Valve (s/p AVSD repair, MR)



SVT from Holter - Onset and Termination

An ectopy initiates the re-entry circuit.

(Click on the image to enlarge)

6/13/2012

EKG

Right axis deviation, Tall R waves in right precordial leads, Strain pattern (ST depression & T wave inversion) in the leads showing tall R waves. This is RVH with pressure overload (as opposed to volume overload that will lack the strain pattern).

Click here for the source: ECG of the Month at Heart.Org. Posted by Dr. Kyuhyun Wang. June 2012.



6/07/2012

Pleural effusion after Fontan Operation

Am J Cardiol 2005;96:130-3
Millwaukee. 2000-2005, n=25 (on protocol) vs. Historic controls from 1997-2000 (n=33). Median duration of pleural effusion decreased (6 days vs. 15 days).

Protocol:
80% maintenance fluids
Lasix 1 mg/kg/dose Q8 hrs, changed to Diuril + Spironolactone Q12 hrs when PO intake starts
Captopril when PO intake starts
Nasal cannula oxygen, at least 0.5 LPM
Low fat diet (30% calories from fat)

(Nitric oxide/Sildenfil)

Other papers:
Curr Opin Pulm Med 2010;16:392-6 (by E. Austin III) - summarizes several recent studies. No signficant conclusions. Highlights the uncertainty of etiology and aproach.

6/06/2012

RACHS Score categories

Jenkins, KJ et al. JTCVS 2002;123:110-8

Risk Adjusted Congenital Heart Surgery Score

RACHS category 1:

1. Secundum ASD

2. Aortopexy

3. PDA (> 30 days of age)

4. Coarctation (> 30 days of age)

5. PAPVR repair



RACHS category 2:

1. Aortic valvuloplasty (> 30 days of age)

2. SubAS resection

3. Pulmonary valvuloplasty or replacement

4. RV infundibulectomy

5. RVOT augmentation

6. Coronary fistula repair

7. ASD & VSD repair

8. Primum ASD repair

9. VSD repair

10. Tetralogy repair

11. VSD closure with PA band removal

12. Repair of unspecified septal defect

13. TAPVR repair (> 30 days of age)

14. Glenn shunt

15. Vascular ring surgery

16. A-P window repair

17. Coarctation repair (≤ 30 days of age)

18. PA stenosis repair

19. Common atrium closure

20. LV-RA shunt repair



RACHS category 3:

1. AVR

2. Ross procedure

3. LVOT patch

4. Ventriculomyotomy

5. Aortoplasty

6. Mitral valvuloplasty or replacement

7. Tricuspid valvuloplasty or valvectomy or replacement

8. Tricuspid valve repositioning (Ebstein’s) (> 30 days of age)

9. Anomalous coronary artery repair with or without intrapulmonary tunnel (Takeuchi)

10. Closure of semilunar valve (aortic or pulmonary valve)

11. RV-PA conduit

12. LV-PA conduit

13. DORV repair with or without RV obstruction

14. Fontan

15. AVSD (complete or transitional) repair with or without valve replacement

16. PA banding

17. Tetralogy with Pulm. Atresia repair

18. Cor triatriatum repair

19. Systemic-Pulmonary artery shunt

20. Atrial switch operation

21. Arterial switch operation

22. Pulmonary artery reimplantation

23. Annuloplasty

24. Coarctation & VSD repair

25. Cardiac tumor excision



RACHS category 4:

1. Aortic valvuloplasty (≤ 30 days of age)

2. Konno procedure

3. Complex defect (Single ventricle) repair with VSD enlargement

4. TAPVR repair (≤ 30 days of age)

5. Rastelli procedure

6. Atrial switch with VSD closure

7. Atrial switch with subpulmonary stenosis repair

8. Arterial switch with PA band removal

9. Arterial switch with VSD closure

10. Arterial switch with subpulmonary stenosis repair

11. Truncus repair

12. Repair of … or interrupted aortic arch with or without VSD repair

13. Unifocalization … Tetralogy-PA

14. …



RACHS category 5:

1. Tricuspid valve repositioning for neonatal Ebstein’s (≤ 30 days of age)

2. Truncus with Interrupted aortic arch repair



RACHS category 6:

1. Norwood operation

2. …