Buy Echo in Cardiac Shunt Lesions Assignment

Buy Echo in Cardiac Shunt Lesions Assignment
Buy Echo in Cardiac Shunt Lesions Assignment
1. Which of the following statements is most accurate?
A. Secundum ASD is a defect of the superior caval vein.
B. Secundum ASD is commonly associated with a
biatrial SVC connection.
C. Primum ASD is commonly associated with a biatrial
SVC connection.
D. Superior sinus venosus ASD is commonly associated
with an anomalous right pulmonary vein.
E. Inferior sinus venosus ASD overriding the IVC is
more common than is its superior counterpart.
2. Which of the following echocardiographic ndings is
most suggestive of a hemodynamically signicant ASD in
an adult with poor-quality transthoracic images?
Buy Echo in Cardiac Shunt Lesions Assignment
A. Color ow Doppler disturbance at the atrial septum in
the four-chamber or subcostal view.
B. 2D image in the parasternal short-axis image to look
for atrial septal tissue dropout.
C. A dilated RA and RV on apical four-chamber view.
D. A high-velocity CW Doppler at the tricuspid or
pulmonic valve.
E. A normal bubble study excludes the possibility of a
hemodynamically signicant ASD.
3. Which of the following statements is most accurate
considering the echo/Doppler technique used to obtain the
Qp/Qs ratio?
A. Normally, with no shunt, the Qp/Qs is 2.0 or less.
B. The parasternal SAX 2D echo view is the only
necessary view.
C. Continuous-wave Doppler is preferred over the pulsedwave Doppler to obtain the stroke volume since there is
a greater likelihood of obtaining the maximal velocity.
D. The ow within the main pulmonary artery (MPA)
can be used in place of the RVOT ow to calculate the
Qp, but the area used to measure the pulmonary stroke
volume must also be from within the MPA.
E. The ow across the ASD can be directly measured
by tracing the PWD VTI and adding this to the LVOT
VTI to determine the Qp portion of the Qp/Qs ratio.
4. Which of the following statements is most accurate
regarding the 2D echo investigation of a secundum
A. Despite the common echo “dropout” associated with
imaging the atrial septum from the apical fourchamber view, this window can rule out an ASD if the
septum is seen to be intact.
B. The absence of right ventricular dilation excludes a
hemodynamically signicant ASD.
C. Most ASDs are round, permitting a relatively simple
geometric approach to their investigation.
D. It would be rare for an individual to have more than
one ASD.
Buy Echo in Cardiac Shunt Lesions Assignment
E. With the use of an agitated saline bubble study,
injected in the lower extremity, a superior sinus
venosus ASD can be conrmed by the presence of
a lling defect (“negative shunt”) seen in the right
atrium adjacent to the right superior pulmonary vein
on the “other side” of an intact atrial septum.
5. Which of the following is considered the least important
parameter in determining the degree of shunt across an
intracardiac defect?
A. The blood viscosity, as estimated by the hematocrit
B. The size of the defect
C. The pressure gradient across the defect
D. The resistance to ow of the vascular bed on each side
of the defect
E. The heart rate
Chapter 34
Echo in Cardiac Shunt
Vincent L. Sorrell
(c) 2015 Wolters Kluwer. All Rights Reserved.
298 Section VIII Congenital Heart Disease and Fetal Echocardiography
6. A 24-year-old obese female patient presents for routine
checkup to the primary care physician’s ofce prior to
starting an exercise weight loss program. She is found to
have a systolic ejection murmur at the base of the heart
and a xed split S2. Vital signs were normal. An ECG was
obtained, and she was sent for cardiologic consultation
and an echocardiogram. The TTE was limited from poor
acoustic transmission and technically suboptimal quality,
but the sonographer thought the right heart was dilated.
As the reading cardiologist in the echo lab, which of the
following would be the most appropriate next step?
A. Perform an urgent TEE.
B. Calculate the Qp/Qs, and if this is normal, perform a
contrast echocardiogram to improve the quality of the
C. Perform an agitated saline bubble study.
D. Perform a carefully mapped pulsed-wave Doppler
examination of the right side of the ventricular septum
since you suspect a ventricular septal defect.
E. Search the aorta critically for a PDA from the
suprasternal window.
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