Pearls from YY
- Pulmonic stenosis in ToF (overriding aorta, VSD, pulmonic stenosis, RVH) can be protective of the pulmonary vasculature and prevent pulmonary HTN
- Patent ductus arteriosus
- causes LV volume overload first -> LV failure -> THEN pulmonary HTN and RV issues. So expect to see LV dysfunction as the first thing in PDA
- Differential cyanosis: in an uncorrected adult, there can be eventual difference in cyanosis, with the lower extremities more cyanotic than the upper extremities. This is because the PDA can deliver unoxygenated blood to the lower extremities since the connection to the aorta is after the takeoff of the left subclavian artery.
- Check out this amazing image from NEJM!. Shoutout to Ali Khaki for sending it our way!
Congenital Heart Disease in adults
Differential diagnosis congenital heart disease seen in adults (without corrective operation at birth). This list is different than the standard congenital heart disease list, since many defects are not compatible with survival into adulthood without correction.
- Stenotic lesions
- Aortic valve: bicuspid valve, unicuspid valve, subaortic membrane or hypertrophic cardiomyopathy
- Pulmonic stenosis
- Regurgitant lesions
- Ebstein’s anomaly of the Triscupid
- Myxomatous mitral valve disease
- Shunts
- ASD
- VSD
- PDA
- Abnormal connections:
- Anomalous origins of the coronary arteries (e.g. ALCAPA)
- Partial anomalous pulmonary venous return
- Congenitally corrected transposition of the great arteries (L-TGA, as opposed to D-TGA)
- Complex or combinations
- Tetralogy of Fallot
Further reading
- This chapter from a textbook
- A terrific review of acquired heart conditions (e.g. CAD) in adults with congenital heart disease (PMID 25099651) from Heart: http://heart.bmj.com/content/100/17/1317.long
- For a full list of management guidelines for adult congenital heart disease, check out the ACC/AHA guidelines from 2008
- Link: http://www.sciencedirect.com/science/article/pii/S0735109708033044 (PMID 19038677)
- Topics include: endocarditis prophylaxis, erythrocytosis and anemia, hemostasis, cardiac reoperation (super long list…)
Evernote link: https://www.evernote.com/shard/s248/sh/d3ef4331-447e-4a0d-a1dd-02e2baa84862/d59574fe5674017128edd007e24f30f4
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