Pediatric Echocardiography - Science topic

Multiple VSDs, to fullfill criteria of swiss cheese VSDs the VSDs must be spreaded in the muscular septum, inlet and outlet septum. here it seems to be only in the muscular septal parts. This echo is indicating still recirculation. But before any heart surgery should be performed, please perform a catherization to measure the pulmonary resistance. If the pulmonary resistance is above 50% of the systemic circulation consider a pulmonary banding before corrective surgery, PA Banding should reduce the PA pressure at least by 50% of preassure before. Do a re cath after a year after banding and see if the pulmonary resistance is reduced. If the resistance is below 30% of the systemic do a VSD closure and debanding of PA.

Speckle tracking 

Pacing induced cardiomyopathy is a concern, but in the first 10-15 years of life it's a rare occurrence. Nonetheless, we echo our PM kids annually. 

ARSA is a rare congenital anomaly that usually does not produce symptoms; Difficult to see in newborn , and is not part of echo  protocol . Only symptomatic patients would need to look for ARSA and operation is controversial 

The incidence of congenital heart disease in children with Down syndrome is between 40-60 percent. The most commons AVDs.

As someone who has managed these types of patients for 25 years, digoxin remains our first therapy, loaded mom, have not actually done fetal IM injection. We do this in part to mitigate some of the negative inotropic effect of all of the other options in anit-arrythmia therapy. In hydropic but premature fetus, we will quickly add flecainide. We have not actually delivered any fetus prematurely (i.e. <36 weeks) for SVT/hydrops, and have had no fetal loss in >15 years with this strategy. A few babies have been inadequately controlled on this combination and amio has been our 3rd line agent, though sotalol has also had more recent reports of efficacy (it has been more than 10 years since we have had to go beyond second line).

We use the attached scale based on weight or BSA for surgical valve work and have done so for the last 20+ years and have found it to be reasonably accurate. It is also used by our cardiologists in the cath lab.

Weight (kg) Pvringsize area(mm2) halfsize

< 2.5 4-5 13-20 0

< 3.5 & >= 2.5 6 28 4

< 4.5 & >= 3.5 7 39 5

< 5.5 & >= 4.5 7.5 45 5.5

< 6.5 & >= 5.5 8 50 6

< 7.5 & >= 6.5 9 64 6.5

< 8.5 & >= 7.5 9.5 72 6.5

< 9.5 & >= 8.5 10 79 7

< 11.0 & >= 9.5 11 85 7.5

< 13.0 & >= 11.0 12 113 8.5

< 15.0 & >= 13.0 13 133 9

< 17.0 & >= 15.0 13.5 144 9.5

< 19.0 & >= 17.0 14 154 10

< 22.5 & >= 19.0 15 177 11

< 27.5 & >= 22.5 17 227 12

< 32.5 & >= 27.5 18.5 270 13

< 37.5 & >= 32.5 20 314 14

> 37.5 20 314 14

Surface area mitral tricuspid aortic pulmonary

< 0.275 11.2 13.4 7.2 8.4

< 0.325 & >= 0.275 12.6 14.9 8.1 9.3

< 0.375 & >= 0.325 13.6 16.2 8.9 10.1

< 0.425 & >= 0.375 14.4 17.3 9.5 10.7

< 0.475 & >= 0.425 15.2 18.2 10.1 11.3

< 0.55 & >= 0.475 15.8 19.2 10.7 11.9

< 0.65 & >= 0.55 16.9 20.7 11.5 12.8

< 0.75 & >= 0.65 17.9 21.9 12.3 13.5

< 0.85 & >= 0.75 18.8 23 13 14.2

< 0.95 & <= 0.85 19.7 24 13.4 14.8

< 1.1 & >= 0.95 20.2 24.9 14 15.3

< 1.3 & >= 1.1 21.4 26.2 14.8 16.2

< 1.5 & >= 1.3 22.3 27.7 15.5 17

< 1.7 & >= 1.5 23.1 28.9 16.1 17.6

< 1.9 & >= 1.7 23.8 29.1 16.5 18.2

>= 1.9 24.2 30 17.2 18