Aortic arch anomalies - Vascular ring (Developmental basis)

Images are from Freedom's CHD Textbook of Angiography Vol. II (1997) p.948.

Based on Edwards Hypothetical Double Arch.

Numbers in lower diagram indicate possible sites of regression. Vascular anomalies occur according to the site of regression.

Normal left arch - 1, 7 regress.

Right arch with mirror-image branching - 2,8 regress.

Left arch with aberrant RSCA - 1, 3 regress.

Right arch with aberrant LSCA - 2,6 regresss.

Figure out other vascular anomalies...similarly:

   Double arch - both arches patent

   Double arch with atresia of a segement of left arch

   Double arch with atresia of a segement of right arch

   Left arch with right descending aorta

   Left arch with isolation of RSCA

   Right arch with left ductus (retroesophageal)

   Right arch with isolation of LSCA

   Right arch with aberrant left innominate artery

   Right arch with isolation of left innominate artery

Anti-Arrhythmic Sickness Video (+playlist)

Coarctation Prediction: Carotid-Subclavian Artery Index

Images are from Eur J Cardiothorac Surg 2008;34:1051-6.
CSA index was proposed in Dodge-Khatami et al. Ann Thorac Surg 2005;80:1852-7.
CSA index = Diameter of distal transverse aorta/Length of distal transverse aorta.

TPA (Alteplase) for Femoral Pulse Loss after Cardiac Catheterization

Am J Cardiol 2003;91:908-910

Alteplase:
Bolus 0.1 mg/kg over 5-10 min, followed by 0.5 mg/kg/hr x 2 hrs.
Resume Heparin at 17 Units/kg/hr for at least 4 hrs after Alteplase infusion completes.
(Heparin infusion may be continued without interruption during Alteplase infusion).

If there is no improvement at about 4-6 hrs from first dose of Alteplase, repeat dose may be given. Important to give heparin infusion for at least 4-6 hrs after completion of any dose of Alteplase. (To deal with increased thrombotic tendency after Alteplase therapy.

Normal Values for Term, Newborn

Click on the image to enlarge

Prosthetic Valve - Valve orifice area (St Jude Valves)

St Jude valve (Regent AGFN-756) Specifications:

Valve orifice area (cm2):
17 mm - 1.87
19 mm - 2.39
21 mm - 2.9
23 mm - 3.45
25 mm - 4.02
27 mm - 4.69
29 mm - 5.44

3DRA protocol

General rule: Inject into chamber or vessel proximal to area of interest.
All injections are over 5 secs. (4 sec acquisition starts after 1 sec delay to allow for uniform opacification from the beginning of image acquisistion)
Contrast: Isoview

Great arteries: (Aorta, PA, RV-PA conduits)
    (i) Contrast:Saline dilution = 2:1
    (ii) Total volume of injection: 3 ml/kg over 5 seconds
    (iii) Generally, need to inject prior to segment of interest. May inject in MPA or aortic root for distal vessels

Central systemic veins: (SVC, IVC)
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 0.75 - 1.5 ml/kg
   (iii) Inject into proximal vein

Glenn anastamosis & Branch PAs:
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 1.5 ml/kg
   (iii) Inject into high SVC or Innominate vein
   (iv) Note: Wash-out from A-P collateral flow into branch PA may interfere with 3D reconstruction.

Fontan:
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 1.5 ml/kg (Divided for simultaneous SVC/IVC injections. Usually, 50/50. But, this may vary based on flow characteristics of SVC/IVC flow into each branch PAs).
   (iii) Note: Wash-out from A-P collateral flow into branch PA may interfere with 3D reconstruction.

Pulmonary veins:
   (i) Undiluted contrast
   (ii) Total volume of injection: Varies depending upon vein size, degree of stenosis, collateralization, etc.
   (iii) Inject as PA wedge angiogram. Begin injection, but wait until contrast appears in pulmonary veins before initation of rotation.

Selective Coronary Artery:
   (i) Undiluted contrast
   (ii) Total volume of injection: Inject enough to opacify vessel during the entire acquisition. Amount varies based on vessel size, stenosis, etc.

Surgical shunts (e.g. BT shunt):
   (i) Undiluted contrast
   (ii) Total volume of contrast: Enough to opacify the vessels during the entire acquisition. Amount varies depending on anatomy.
   (iii) Inject using a end-hole catheter with proximal balloon occlusion (if possible)

(Adapted from Denver Children's Hospital Protocol. Courtesy: Dr. Tom Fagan).


 

ASD schematic diagram

(Click on the image to enlarge)

From "Congenital Malformations of the Heart" by Helen B. Taussig. Harvard Univ. Press, Cambridge, MA 1947. Page 355.

(Reference quoted in the diagram is: Patten, B.M. Developmental defects at the foramen ovale. Am J Path 1938;14:135-162)

Gradient measurement difference between echo vs. cath (Aortic Stenosis)

LV and Ascending Aorta pressure traces are provided below.

From J.T.Bricker & D.G. McNamara Paediatric Cardiology: Its current practice. Edward Arnold, London 1988. Page 45.

Coronary Angiography - For anomalous aortic origins

All images are from The Cardiac Catheterization Handbook. by Morton J. Kern. Third edition 1999. p.311-317.