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Did I just read that right that the echo was the LAST test ordered vice the first?

 

OMFG!!! if that's true.

 

SK

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Obviously I'm late on the response; but, from the HPI you gave the first thing I was thinking was " Septal Defect >> Shunting >> Eisenmengers" and then was looking to see if there was an echo listed. I felt like the crazy last minute stressful rapid-fire associations we used to do right before walking into the myriad of testing during PA school.  Glad to know my brain stored something it can use.  Now if I could only clear some of the song lyrics out so I can have more functional space.   

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To me the TEE was the important bit and would have been a slam dunk but I didn't really think about a shunt being too open to cause the murmur.  Makes sense, though.

 

Bubble study is more specific and even better.

 

I also re-learned that you can...technically...calculate EF from ventriculogram in the cath lab, though cardiologists don't prefer this.  It's essentially eyeballing (or using a tool to measure) surface area of the systolic vs diastolic left heart, giving you the volumes you need.  

 

It's very rough though - measurement like that is ok for kidneys and babies but you can't see inside the heart (think dilation/hypertrophy affecting the interior volume)  and can't work the shape exact enough, fast enough.  It's a guess, at best.  

 

I did a lot of cards and spent a few afternoons "helping" to read echos (read: trying desperately to stay awake) and this was never mentioned.  

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GMOTM - The only indications I could find for prophylactic abx applied to time since surgery (definitely abx within first 6 months of repair, afterwards patient low risk).  I could not seem to find any quidelines that dictated abx based on location of patch.

 

Thanks for the brain exercise.   And the reminder that not all childhood murmurs that "resolve" are innocent! 

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AHA website (see last criteria). Unknown if residual defect:

Patient Selection

 

The current infective endocarditis guidelines state that use of preventive antibiotics before certain dental procedures is reasonable for patients with:

prosthetic cardiac valve or prosthetic material used for cardiac valve repair

a history of infective endocarditis

a cardiac transplant that develops cardiac valvulopathy

the following congenital (present from birth) heart disease:a

unrepaired cyanotic congenital heart disease, including palliative shunts and conduits

a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedureb

any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device (that inhibit endothelialization)

 

Disclaimer: ADA website taken from AHA website

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I was thinking was Septal Defect >> Shunting >> Eisenmengers

 Pre-PA here. As far as unicorns and zebras are concerned, I was thinking the same.

 

GMOTM, did she happen to say how the ablation was performed? Would a defect that large preclude percuntaneous septal closure?

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