Rapitful Shqip

What are the complications of Fallot's tetralogy ?   • Cyanotic and syncopal spells.   • Cerebral abscess (in 10% of cases).   • Endocarditis (in 10% of cases).   Strokes - thrombotic secondary to polycythaemia.   • Paradoxical emboli.

What are the constituents of Fallot's tetralogy ?   • VSD with a right-to-left shunt. • Pulmonary stenosis (infundibular or valvular). • Right ventricular hypertrophy. • Dextroposition of the aorta with it overriding the ventricular septal defect.

What are the complications of Eisenmenger syndrome ? • Haemoptysis. • Right ventricular failure. •Cerebrovascular accidents (as a result of paradoxical embolization, venous thrombosis of cerebral vessels, or intracranial haemorrhage). •Sudden death. •Brain abscess. •Bleeding and thrombosis (patients at increased risks for both as a consequence of an abnormal haemostasis secondary to chronic arterial desaturation). •Paradoxical embolization. •Infective endocarditis. •Hyperuricaemia. •Recurrent haemoptysis.

What is the age of onset of Eisenmenger syndrome ?  In the case of patent ductus arteriosus and VSD, about 80% occur in infancy, whereas in the case of ASD over 90% occur in adult life.

Mention some cyanotic heart diseases of infancy.   • Tetralogy of Fallot. • Transposition of the great vessels. • Tricuspid regurgitation. • Total anomalous pulmonary venous connection.

What do you understand by the term 'Eisenmenger complex' ? Eisenmenger complex is a VSD with a right-to-left shunt in the absence of pulmonary stenosis. The onset of Eisenmenger syndrome is often heralded by a softening of the murmur, a decrease in the left heart size and an increase in the second pulmonic sound.

What do you understand by the term 'Eisenmenger syndrome' ?  Pulmonary hypertension with a reversed or bidirectional shunt.  It matters very little where the shunt happens to be (e.g. VSD, ASD, patent ductus arteriosus, persistent truncus arteriosus, single ventricle or common atrioventricular canal).

What are the fundal findings in coarctation of aorta ?  Hypertension due to coarctation of aorta causes retinal arteries to be tortuous with frequent 'U' turns; curiously, the classical signs of hypertensive retinopathy are rarely seen.

What are the complications of aortic coarctation ? •Severe hypertension and resulting complications: • Stroke. • -Premature coronary artery disease. • Left ventricular failure (two thirds of patients over the age of 40 years who have • uncorrected aortic coarctatioh have symptoms of heart failure). • Rupture of aorta. • Infective endocarditis endarteritis (at the site of the coarctation or on a con-genitally bicuspid aortic valve). • Intracranial haemorrhage (combination of hypertension and ruptured berry aneurysm). • Three quarters die by the age of 50, and 90% by the age of 60 (Bt Heart J 1970: 32: 63340).

Mention a few conditions in which rib notching is seen. • Coarctation of aorta. • Pulmonary oligaemia. • Blalock-Taussig shunt. • Subclavian artery obstruction. • Superior vena caval syndrome. • Neurofibromatosis. • Arteriovenous malformations of the lung or chest wall.

What conditions are associated with coarctation of aorta ?  It may occur in conjunction with gonadal dysgenesis (e.g. Turner's syndrome), bicuspid aortic valve, ventricular septal defect, patent ductus arteriosus, mitral stenosis or regurgitation, or aneurysms of the circle of Willis.

Is aortic coarctation more common in men or women ?  This condition is two to five times as frequent in men and boys as in women and girls.

What do you understand by the term 'levoversion' ?  Left-sided apex, right-sided stomach and right descending aorta.

What do you understand by the term 'dextroversion' ?  Right-sided cardiac apex, left-sided stomach and left-sided descending aorta.

What do you understand by the term 'situs inversus' ?  Right-sided cardiac apex, right stomach, right-sided descending aorta. The right atrium is on the left. The left lung has three lobes and the right lung has two.

Which other abnormality has been associated with dextrocardia ?  Asplenia (blood smear may show Heinz bodies, Howell-Jolly bodies) (Br Heart J 1975; 37: 840).

What is Kartagener's syndrome ?  A type of immotile cilia syndrome in which there is dextrocardia or situs inversus, bronchiectasis and dysplasia of the frontal sinuses (Beitr Kiln Tuberk 1933; 83: 489; N Engl J Med 1953; 248: 730).

What is Erb's point ?  The third left intercostal space adjacent to the sternum is Erb's point. The murmur of infundibular pulmonary stenosis is best heard in this space and in the left lourth intercostal space.

What is the role of balloon valvuloplasty in pulmonary stenosis ?  Relief of valvular stenosis can be accomplished easily and safely with percutaneous balloon valvuloplasty (Am J Cardiol 1990; 65: 775) and a delay in intervention offers no advantage. Balloon valvuloplasty, the procedure of choice, is usually successful, provided the valve is mobile and pliant; its long-term results are excellent. The secondary hypertrophic subpulmonary stenosis that may occur with valvular stenosis usually regresses after successful intervention. In a series of 100 patients, balloon dilatation resulted in a significant reduction in the transvalvular gradient. which was maintained at 12 months' follow-up (lnt J Cardio11988; 21: 33542).

How would you manage a patient with pulmonary stenosis ?  • Mild valvular pulmonary stenosis: these patients are usually asymptomatic. Survival among such patients is excellent (94% are still alive 20 years after diagnosis) and therefore they do not require surgical correction. It is important that patients with mild valvular stenosis who are undergoing elective dental or surgical procedures should receive antibiotic prophylaxis against infective endocarditis. • Severe stenosis: the stenosis should be relieved, since only 40% of such patients do not require any intervention by 10 years after diagnosis. • Moderate pulmonary stenosis has an excellent prognosis with either medical or interventional therapy, lnterventional therapy is usually recommended, since most patients with moderate pulmonary stenosis eventually have symptoms requiring such therapy. Valve replacement is required if the leaflets are dysplastic or calcified or if marked regurgitation is present.