EKG artifact

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This would have been reported as tachycardia if Channel III was not available! (Not sure what the reason for this artifact is. Recording was auto-triggered by the event monitor. Patient does not know; was probably sleeping).

Conduction system in VSD

Course of His bundle in VSD: Figure below shows the relationship for membranous VSD and inlet-muscular VSD (Note: Inlet-muscular VSD is different from inlet-VSD in AVSD.

Inlet-muscular VSD has a rim of myocardium separating the VSD margin from the tricuspid valve annulus; whereas, in inlet-VSD in AVSD, AV valve annulus itself if part of the VSD margin.

(See also separate posting for relevant images).

Image from Anderson RH, Wilcox BR. J Card Surgery. 1992;7:17-34.

Oxygen Consumption in Children - Normal values

From Jim Lock's Green book (2nd ed) 2000. page 60.
Also see earlier posting on this subject.

Cardiac Index in Children (Normal values)

(Click on the image to enlarge)

From Jim Lock's Green Book (Cath book) 2nd edition. 2000. page 58.

Data reportedly pooled from several previous publications (listed below) - Data from 140 patients of age range 12 day to 16 yrs.

1) Sproul & Simpson. Stroke volume and related hemodynamic data in normal children. Pediatr 1964;65:327-33.
2) James & Rowe. The pattern of response of pulmonary and systemic artery pressures in newborn and older infants to short periods of hypoxia. J Pediatr 1957;51:5-11.
3) Lucas R.V. Jr. et al. Maturation of pulmonary vascular bed. Am J Dis Child 1961;101:467-75.
4) Rowe and James. The normal pulmonary arterial pressure during the first year of life. J Pediatr 1957;51:1-4.
5) Kjellberg S.R. et al. Diagnosis of congenital heart disease. Chicago: Year book publishers. 1955.
6) Cummings GR. Hemodynamics of supine bicycle exercise in "normal" children. Am Heart J. 1977;93:617-22.
7) Lock, Einzig and Moller. Hemodynamic responses to exercise in normal children. Am J Cardiol. 1978;41:1278-84.

Van Praagh's terminology

Birth defects 1972;8:4-23.

AJC 1964;13:510-28.

&

Heart disease in infancy and childhood. Ed. Keith JD, Rowe RD and Vlad P. 1978.

See posting on this subject: Van Praagh's segmental terminology

Heterotaxy

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Prognosis:

80% mortality for asplenia in first year. Slightly better in the past 2 decades.

Ref:

Phoon. AJC 1994;18:581-7

m,f,o-anisosplenia. AJC 1986;58:1113-4 & Surgery 1972;71:125-9.

Phoon. Where is the spleen? Cardiol Young 1997;7:347-357.

Risk of Cardiovascular Disease (by Framingham Scoring System)

Grundy et al. Circulation 1999;100:1481-82.

(Click on the image to enlarge)

TEE - Basic Views & terminology

(From TEE for CHD Ed. by Wong PC & Miller-Hance WC. Springer-Verlag 2014)

(Click on the image to enlarge)

TEE - Probe position terminology

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Transesophageal echocardiography - Terminology of probe positions.

(From TEE for CHD. Ed. by Wong PC &Miller-Hance WC. Springer-Verlag 2014)

VSD enlargement (Surgery)

To enlarge the VSD without causing AV block...

D-loop ventricles - Raise the roof (Enlarge VSD in anterior-superior direction)

L-loop ventricles - Lower the floor (Enlarge VSD in posterior-inferior direction)

Without injuring the aortic valve in the process!