Cardiac 21-23

Q21) Most common site for traumatic aortic rupture is 

a) Distal to the origin of left subclavian artery

b) Point of entry of aorta above the diaphragm

c) Root of aorta

d) Point distal to Left carotid artery

Q22) Total anomalous pulmonary venous drainage (TAPVC) is associated with 

a) Endocardial cushion defect

b) Sinus Venosus ASD

c) Defects in Fossa ovalis

d) Completely separate entity

Q23) Endocardial cushion defects seen with:

a) Mitral stenosis

b) Pulmonary stenosis

c) Mitral regurgitation

d) Aortic regurgitation



a) Distal to origin of subclavian artery

Traumatic aortic rupture leads to sudden death after high impact automobile accident or fall from height. Aorta is relatively fixed distal to ligament arteriosum just distal to the origin of subclavian artery and this is the most common site of traumatic rupture especially partial rupture in which adventitia is intact.

Specific clinical findings are 

  1. Asymmetry of BP in upper limbs or upper and lower limbs
  2. Widened pulse pressure
  3. Chest wall contusions

Bailey page 355


Ans 22 b

Sinus Venosus ASD constitutes 15% of all ASD.

TAPVD is associated with sinus venosus ASD. It is a  condition in which pulmonary veins instead of opening in the Left atrium open in the systemic circulation such as IVC or SVC

IT presents with in 7 days with cyanosis. If TAPVD is associated with ASD then cyanosis is less.

Sinus Venosus ASD

Sabiston page 1627



Normal area of orifice  of aortic valve is 3-5 sq cm.  Pathological changes start to occur when it is reduced to half. Severe symptoms develop when it is 1 sq cm.

Natural history of aortic stenosis

  1. Severe stenosis leads to Trans valvular pressure gradient

Increased left ventricular hypertrophy

Myocardial ischemia seen in 2/3rd and finally cell death leading to heart failure.

2. 2nd outcome is Myocardial hypertrophy and delayed diastolic function of Left ventricle leading to back pressure changes with  pulmonary hypertension and right  heart failure eventually

3. Atrial arrythmias can develop because of LA dilatation

4. Impaired forward flow can lead to decreased cerebral perfusion and syncope

Symptoms develop

  1. In cases of exertion or sudden standing from recumbent position
  2. Angina  30-40%
  3. Syncope 15%
  4. Dyspnea

Murmur- Cresendo Decresendo ejection murmur at left sternal border.

Forceful apical impulse

Indications of Surgery

  1. Asymptomatic severe AS with LVEF less than 50%
  2. Asymptomatic with rapid disease progression
  3. Symptomatic

Ref: Sabiston page 1708


Endocardial cushion defects are a range of defects in in the atrial septum, ventricular septum and AV valves.  It can be complete or partial. 

The endocardial cushions are two thicker areas that develop into the walls (septum) that divide the 4 chambers of the heart. They also form the mitral and tricuspid valves.

Endocardial cushion defects

ECD is strongly linked to Down syndrome. Several gene changes are also linked to ECD. However, the exact cause of ECD is unknown.

ECD may be associated with other congenital heart defects, such as:

  • Double outlet right ventricle
  • Single ventricle
  • Transposition of the great vessels
  • Tetralogy of Fallot