Basics of hemodynamic evaluation – 3
Basics of hemodynamic evaluation – 3
While evaluating intracardiac shunt lesions by cardiac catheterization, an easy way is to look at the step up or step down in the oxygen saturation between two chambers. For example, in case of left to right shunts, step up is noted between superior vena cava (SVC) and right atrium in case of atrial septal defect (ASD). Among the atrial septal defects, step up is noted in high right atrium for sinus venosus ASD, mid right atrium for secundum ASD and low right atrium for primum ASD. Step up from right atrium to right ventricle is noted in ventricular septal defect. In case of paten...
Source: Cardiophile MD - December 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Basics of hemodynamic evaluation – 2
Basics of hemodynamic evaluation – 2
Click here to see Part 1
This is the article in the series on basics of hemodynamic evaluation. As mentioned earlier, pressure measurement in each chamber is an important aspect of hemodynamic evaluation. Two types of catheter based pressure measurements are possible. One is using a catheter tipped manometer, which is more ideal, but expensive. Second, more commonly used method is using fluid filled systems with an external transducer. While using fluid filled systems, care has to be taken to avoid air bubbles in the connecting tubings to avoid damping of pressure wave transmissio...
Source: Cardiophile MD - December 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Basics of hemodynamic evaluation
Though invasive hemodynamic evaluation was pushed to the backstage with the development of Doppler echocardiography, it is again coming to centre stage with newer therapeutic options being available in pulmonary hypertension and heart failure. A basic knowledge of the principles of hemodynamic evaluation is essential to understand cardiac physiology.
Hemodynamic evaluation usually includes both right and left heart catheterization, though in some cases only one may be done. While writing a report of hemodynamic evaluation, it is customary to note the catheter course as it gives valuable complementary information. Catheter...
Source: Cardiophile MD - December 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Mural endocarditis
Vegetations in infective endocarditis are usually situated on the valves. If they are located on the walls of the cardiac chambers, it is known as mural endocarditis [1]. When mural endocarditis occurs without any cardiac structural abnormalities like ventricular septal defects, it is called primary mural endocarditis [2]. Primary mural endocarditis is extremely rare.
Left atrial mural endocarditis usually occurs due to the jet lesion of mitral regurgitation [1,3]. Left atrial mural endocarditis is usually picked up by trans esophageal echocardiography. Vegetations are mostly located just distal to the mitral orifice betw...
Source: Cardiophile MD - October 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
Segmental approach to congenital heart disease
Segmental approach is used routinely in the echocardiographic evaluation of congenital heart disease. It is also useful in other cardiac imaging modalities used for evaluation of congenital heart disease like computed tomography and magnetic resonance imaging. Chest X-ray is useful in evaluating the cardiac position and visceral situs as it gives an overview of cardiac position in the thorax, position of left and right bronchi, aortic arch, liver and stomach air bubble [1].
Here is a chest X-ray in mesocardia with levo transposition of great arteries:
X-ray chest PA showing mesocardia with L-TGA and L-posed aorta seen as ...
Source: Cardiophile MD - July 17, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiography Source Type: blogs
Cardiology MCQs
Which of the following is an innocent murmur?
Gibson’s murmur
Roger’s murmur
Still’s murmur
Dock’s murmur
Correct answer: 3. Still’s murmur
Still’s murmur was described by George Frederic Still in 1909. This is a low pitched murmur heard in the lower left sternal area. It is best heard with the bell of the stethoscope. Still’s murmur is a mid systolic murmur, loudest in supine position and diminishes in intensity on sitting and standing as venous return decreases [Doshi AR. Innocent Heart Murmur. Cureus. 2018 Dec 5;10(12):e3689]. Gibson’s murmur is the train-in-tunnel murmur or ma...
Source: Cardiophile MD - July 5, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Congenitally corrected transposition of great arteries
Congenitally corrected transposition of the great arteries (CCTGA or cTGA) is a condition in which there is atrioventricular and ventricular arterial discordance so that the circulation is physiological. Congenitally corrected transposition of great arteries is also known as l-transposition of great arteries (l-TGA) because of the levo transposition of aorta. Levo posed aorta forms a hump along the left upper heart border on chest X-ray.
The right atrium connects to the morphological left ventricle, which in turn connects to the pulmonary artery so that systemic venous blood reaches the pulmonary circulation. The left atr...
Source: Cardiophile MD - June 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Paradoxical splitting of second heart sound
Normal split of second heart sound is due to the delay in pulmonary valve closure compared to aortic valve. This is mostly contributed to by the pulmonary hang out interval. Hang out interval is the time taken for the actual valve closure after the pulmonary artery and right ventricular pressure tracings crossover. Normal split of second heart sound closes in expiration as the reduced venous return shortens right ventricular ejection. When the split closes in inspiration and becomes audible in expiration, it is called paradoxical splitting of second heart sound. Please note that a wide split of second heart sound as in ri...
Source: Cardiophile MD - June 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Chest X-ray in left to right shunts
Chest X-ray is a simple, cheap and easily available investigation for the evaluation of left to right shunts. But it is often avoided in pediatric age group due to concerns of radiation. Cardiac size and lung vascularity can be readily assessed and followed up serially [1]. Lung vascularity pattern is different in pre-tricuspid and post tricuspid shunts. Pattern changes with the development of pulmonary hypertension as the shunt decreases. Cardiac size also decreases when the shunt decreases. Cardiac chamber enlargements are also different according to the level of shunt.
Chest X-ray in atrial septal defect
Atrial septal ...
Source: Cardiophile MD - May 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Ebstein ’ s anomaly and pregnancy
Ebstein’s anomaly and pregnancy
Ebstein’s anomaly of tricuspid valve was first described by Wilhelm Ebstein in 1866 [1]. It is characterized by distal displacement of the septal and posterior leaflets of tricuspid valve. Anterior leaflet is elongated and sail like. A portion of the right ventricle is ‘atrialized’ due to the distal displacement of the tricuspid valve. Right atrium is often grossly dilated. Right to left shunting occurs across a patent foramen ovale producing cyanosis of variable extent. Ebstein’s anomaly is one of the cyanotic congenital heart diseases in which survival to adul...
Source: Cardiophile MD - May 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Fetal and transitional circulation
Fetal circulation is different from adult circulation. The changes occurring soon after birth constitutes transitional circulation. Respiratory gas exchange in the fetus occurs in the placenta rather than the lungs. Fetal cardiovascular system is designed so that the most saturated blood reaches the heart and the brain. Fetal circulation can be called a shunt dependent circulation because there are intracardiac and extracardiac shunts [1].
Cardiac output in the fetus is called combined ventricular output (CVO). Despite the low oxygen partial pressures in fetal blood, presence of fetal hemoglobin and high combined ventric...
Source: Cardiophile MD - April 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Major aortopulmonary collateral arteries
Major aortopulmonary collateral arteries (MAPCA) occur in cyanotic congenital heart diseases with decreased pulmonary blood flow (tetralogy of Fallot like physiology). They are a natural protective mechanism to improve pulmonary blood flow. MAPCAs are more likely to occur in pulmonary atresia than in simple tetralogy of Fallot.
MAPCAs can also occur in conditions other than the typical pulmonary atresia with ventricular septal defect. In a retrospective review of such cases, 33 had single ventricle anatomy while the rest had two ventricle anatomy. Among those with single ventricle, 15 had unbalanced complete atrioventricu...
Source: Cardiophile MD - April 23, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Fontan Circulation
Fontan repair of tricuspid atresia was initiated in late 1960s. Francis Fontan et al reported that surgical repair was carried out in three patients with tricuspid atresia of which two were successful [1]. Inferior venacaval blood was directed to the left lung and the right pulmonary artery received the superior venacaval blood through a cavopulmonary anastomosis. They mentioned that the size of the pulmonary arteries must be large enough and at sufficiently low pressure to allow flow in a cavopulmonary anastomosis.
The first step was a Glenn procedure in which distal end of right pulmonary artery was anastomosed to the ...
Source: Cardiophile MD - April 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs
Aortic erosion following ASD device closure : A reality check !
ASD device closure has become a de-facto modality for most ostium secundum defects(<35mm). The stupendous success of this procedure is attributed to careful pre and Intra-procedural Imaging, new generation hardware and of course the ever-improving expertise among Interventional cardiologists.
Still, there is one issue that is bothersome. It is the late complications of this device and the need for follow-up (Unlike surgery where close and forget option seems real and confer lot of comforts) The delayed mechanical complications are now extremely rare still follow up of these patients is advised.
What is the mechanism o...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized asd device closure and aortic erosion atrial septal defect closure by amplatzer ias dynamics late migration of asd device mechanism of of aortic erosion surgery vs device asd closure transverse sinus pericardium effuion ias asd Source Type: blogs
Innovation in pediatric Interventions: Device closure of sinus venosus ASD is not forbidden
Embryology
Sinus venosus ASD (also referred to as SVC ASD) is a defect in the failure of the sinoatrial orifice to lateralize completely to the right side during atrial septation.Left venous valve, as well as the septum secundum, fails to fuse with the roof of the atria creating interatrial communication. During this process, the developing pulmonary vein overshoot to the right side making PAPVD a mandatory add-on defect. (Harley ,Thorax 1958 ) It can be referred to as embryonal venous migration defect at the level of RA. In the same sense, it is not a true defect in IAS but a defect in septation between SVC/P...
Source: Dr.S.Venkatesan MD - January 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized SINUS VENOSUS ASD stenting for svc asd SVC ASD device closure Source Type: blogs
