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  #1  
Old 04-18-2011
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Heart Congenital Heart Disease Question

A 1-month-old girl undergoes cardiac catheterization for evaluation of a congenital cardiac disorder. She is adequately sedated and remains stable throughout the procedure. Her levels of oxygen saturation in various locations in and around the heart are shown.

Location Oxygen Saturation
Superior vena cava 71%
Right atrium 80%
Right ventricle 80%
Pulmonary artery 98%


Which of the following congenital heart defects is most likely in this patient?
A. Aortic insufficiency
B. Aortic stenosis
C. Atrial septal defect
D. Pulmonic stenosis
E. Transposition of the great arteries
F. Tricuspid insufficiency
G. Ventricular septal defect
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  #2  
Old 04-18-2011
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Can I choose both C and E?
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  #3  
Old 04-18-2011
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Quote:
Originally Posted by Mondoshawan View Post
Can I choose both C and E?
Yes. Agree. Both are good answers.

ASD alone though doesn't explain increased oxygenition in pulmonary artery. I'm more in favour of TGA!

Let us know the answer.

Thanks
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Old 04-18-2011
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i agree with mondoshowan ....but i am in favour of transposition of great arches..if i had to choose a single best answer
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Old 04-18-2011
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If ı have to choose one of them, ı prefer to choose 'G' ....As ı remember ıt is the most common congenital heart defect in children..And VSD explains this catherization results...
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Old 04-18-2011
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Answer--E (transposition of great vessels )
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Old 04-18-2011
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Answer is E because when you have defects like TGA , there Are accompaning defects like ASD , VSD so as to maintain life of the newborn which would otherwise die........
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Old 04-18-2011
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G) TGA, the pulmonary artery exits the left ventricle, that's why it's almost 100% oxygenated
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  #9  
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I think i will go with ASD


@Pnreddy

Why did u choose TGA ?? in tga Will RA n RV have the same oxygenation ? if so could u gimme the mechanism
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  #10  
Old 04-18-2011
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Default @ Noothan

Yes, the venae cavae return venous blood to right atrium, which in turn delivers it to right ventricle. So right atrial and ventricular oxygen pressures would be normal even in presence of TGA.
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Ok !!.....what was i thinking !
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  #12  
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I think....E ...
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  #13  
Old 04-18-2011
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seems like E to me too
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  #14  
Old 04-18-2011
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Default E,C,G ;)

patients with TGA may also have ASD, VSD, or PDA.
I will go with the options E, C and G, that is TGA+ASD+VSD.
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Old 06-09-2011
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So, what is the right answer here?
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Old 06-09-2011
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Quote:
Originally Posted by bebix View Post
So, what is the right answer here?
I bet it's TGA!
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Old 06-09-2011
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Oh he still hasn't posted the answer,

I think its E)

If it was VSD/ASD, then wouldn't the Right Atrial or Right Ventricular O2 Saturation be much higher? Since blood will shunt from Left to Right? In this case it's not, so I think we're left with only E) TGA.
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  #18  
Old 06-09-2011
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Quote:
Originally Posted by patelMD View Post
Oh he still hasn't posted the answer,

I think its E)

If it was VSD/ASD, then wouldn't the Right Atrial or Right Ventricular O2 Saturation be much higher? Since blood will shunt from Left to Right? In this case it's not, so I think we're left with only E) TGA.
(answer choice E)
The patient had a O2 step up between RV and PA and this can be only explained by TGA (transposition of great vessels)
I do not think that this question can appear on USMLE as it is extremely specific and specialized
I am working in the hospital now but I will give detailed explanation once I am free
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  #19  
Old 06-09-2011
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Quote:
Originally Posted by alaahoda2001 View Post
(answer choice E)
The patient had a O2 step up between RV and PA and this can be only explained by TGA (transposition of great vessels)
I do not think that this question can appear on USMLE as it is extremely specific and specialized
I am working in the hospital now but I will give detailed explanation once I am free
Differential diagnosis for this case is mainly PDA and TGA

TGA means that the freat vessels (PA and Aorta) have exchanged position meaning that now the PA comes out of the LV and Aorta comes out of the RV
If this case is complete, the baby will die on birth because the right side and the left side became completely separated circles

IVC/SVC --> RA --> RV--> Aorta --> arteries (bliss ha not become oxygenated in the lungs)

Blood in the lungs go back to pulmonary veins --> LA --> LV--> PA --> lungs once again (oxygenated blood never reaches tissues) (oxygenated blood is going through the PA --> high O2 saturation)


Fortunately, patients always gave another defect that stabilizes the condition and helps the passage of Oxyg. Blood to the other side like ASD, VSD, PDA

More to come on another post
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  #20  
Old 06-10-2011
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Quote:
Originally Posted by alaahoda2001 View Post
Differential diagnosis for this case is mainly PDA and TGA

TGA means that the freat vessels (PA and Aorta) have exchanged position meaning that now the PA comes out of the LV and Aorta comes out of the RV
If this case is complete, the baby will die on birth because the right side and the left side became completely separated circles

IVC/SVC --> RA --> RV--> Aorta --> arteries (bliss ha not become oxygenated in the lungs)

Blood in the lungs go back to pulmonary veins --> LA --> LV--> PA --> lungs once again (oxygenated blood never reaches tissues) (oxygenated blood is going through the PA --> high O2 saturation)


Fortunately, patients always gave another defect that stabilizes the condition and helps the passage of Oxyg. Blood to the other side like ASD, VSD, PDA

More to come on another post
When O2 saturation on a right sided chamber or vessel is increased compared to it's proximal chamber --> O2 step up --> defect with a left to right shunt
Examples: if RA > IVC or SVC --> ASD (ie oxygenated blood is coming from the LA to the RA increasing its O2 saturation more than the IVC)
Similarly if RV> RA --> VSD (oxygenated blood from LV to RV)
If PA> RV --> PDA (oxygenated blood from aorta to PA)

In this question the step up happened in the PA however PDA is not an option in the answers so that leads to thinking about another congenital anomaly defect which is (as described before) the TGA
In TGA the PA is carrying blood from the LV BACK AGAIN TO THE LUNG --> BLOOD STAYS IN A CLOSED CIRCUIT AND IS ALWAYS HIGHLY OXYGENATED

So the only reasonable answer is TGA

Last edited by alaahoda2001; 06-10-2011 at 02:01 AM.
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  #21  
Old 06-10-2011
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i think it is C
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  #22  
Old 06-10-2011
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Quote:
Originally Posted by earthpole View Post
i think it is C
It can never be C my friend
The O2 saturation in the, Despite showing mild step up, can never explain the super oxygenated PA BLODD
this saturation 98% can exist only in the pulmonary capillary blood as it is the most oxygenated blood in the body
If the PA oxygen is like that it means that either blood is shunting to it from a PDA Or it may have resulted from TGA (PA COMMING FROM LV)
All the best wishes

Last edited by alaahoda2001; 06-10-2011 at 07:16 PM.
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  #23  
Old 06-10-2011
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yup i think ur right with this
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  #24  
Old 10-12-2011
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E. Transposition of the great arteries
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  #25  
Old 10-13-2011
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G. VSD
the step up between SVC & RA is less than 10 therefore it shud be overlooked, but step-up b/w RV & PA is significant becuz >10

Plz let us know the correct answer & source of ur Q as there is no point in doing this except if u did!
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  #26  
Old 10-15-2011
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vsd
whats the answer!
Quote:
Originally Posted by harlesmd View Post
A 1-month-old girl undergoes cardiac catheterization for evaluation of a congenital cardiac disorder. She is adequately sedated and remains stable throughout the procedure. Her levels of oxygen saturation in various locations in and around the heart are shown.

Location Oxygen Saturation
Superior vena cava 71%
Right atrium 80%
Right ventricle 80%
Pulmonary artery 98%


Which of the following congenital heart defects is most likely in this patient?
A. Aortic insufficiency
B. Aortic stenosis
C. Atrial septal defect
D. Pulmonic stenosis
E. Transposition of the great arteries
F. Tricuspid insufficiency
G. Ventricular septal defect
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  #27  
Old 10-15-2011
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I'd go with 'E'.
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  #28  
Old 10-16-2011
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Default The answer is E

Sorry for neglecting this thread....I forgot I posted this question. The answer is E. TGA and some of you have explained the answer very well.
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  #29  
Old 11-10-2011
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think that TGA due to oxygenation 98% of right ventricle
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