Communication in the CICU is an often intimidating blend of efficient abbreviations and stubborn history.  Here is a non-comprehensive list to get you started.  Think of one that we forgot?  Please email it to us!  

And click here to find some of the original papers that describe these findings and procedures.

AAAortic atresia, a disorder in which the aortic valve orifice is atretic (does not open).
AAIA common mode of atrial pacing in which the pacemaker senses the only the atrium and paces it at the set rate unless inhibited by a sensed P wave.
AfterloadPurely defined as ventricular wall stress. Factors affecting wall stress include the thickness of the ventricle, the transmural gradient (including ventricular systolic pressure and intrathoracic pressre), and the diameter of the ventricle. Afterload is often used in the vernacular to refer to blood pressure (e.g. ‘afterload reduction’ often implies lower blood pressure)..
ALCAPAAnomalous origin of the left coronary artery arising from the pulmonary artery.
APAccessory pathway
APCAortopulmonary collateral. Abnormal vessel arising from the aorta and perfusing the lung (or airway).
Apex-formingA ventricle that reaches the true apex of the heart. Generally considered as one factor in assessing whether a ventricle is of adequate size to sustain a biventricular circulation.
AR or AIAortic regurgitation or insufficiency
ARCAPAAnomalous origin of the right coronary artery arising from the pulmonary artery.
ARTAntidromic reciprocating tachycardia, a reentrant tachycardia in which conduction down the accessory pathway is antegrade (atrium to ventricle) and AV nodal conduction is retrograde. Results in a wide-complex tachycardia.
ASAortic stenosis
AsAoAscending aorta
ASDAtrial septal defect. A defect between the left and right atrium. This is a physiologic term and does not specify where the defect in the atrial septum is anatomically. When used colloquially, it is often refers to ASD2.
ASD1Ostium primum atrial septal defect. A defect in septum primum which forms from endocardial cushions; commonly associated with atrioventricular canal.
ASD2Ostium secundum atrial septal defect. Defect in (usually) ostium primum that creates one or more fenestrations in the fossa ovalis.
ASOArterial switch operation. Modern treatment of dTGA in which the coronaries and aorta are translocated to the native pulmonary root (becoming the neo-aortic valve), and the MPA brought anterior to the aortic root (LeCompte maneuver).
ATW‘Around the world’ drain, typically Blake drain. Contacts left and right pleura and mediastinum.
Automatic tachycardiaA tachycardia caused by repetitive discharges (automaticity) from outside the SA node, distinct from a reentrant tachycardia. Examples include JET, EAT.
AVCAtrioventricular canal defect. May be transitional (i.e. not all components of a complete defect) or complete AVC.
AVNRTAtrioventricular nodal reentry tachycardia. A re-entry tachycardia with 2 pathways, one of which is in or around the AV node.
AVVRAtrioventricular valve regurgitation
Azygos veinA vein that originates from the venous plexus around the renal veins (or even the renal vein itself), courses superiorly adjacent to the spine, passes over the ipsilateral bronchus and pulmonary artery and terminates in the superior vena cava. Classically right sided, but may be left sided or even rarely bilateral. Clinically important because it provides a connection between SVC and IVC circulations, therefore is commonly ligated in BDG procedure.
BACHBoston Adult Congenital Heart program, a group of subspecialists with expertise in CHD across the age spectrum.
BaffleAs a verb, it means to direct blood to a certain place (e.g. ‘the LV was baffled to the aorta’ means that a patch was placed that directs blood from the LV to the aorta). As a noun, a baffle is a sheet (or tube graft) of material used to divert blood to a single location where it previously did not (exclusively) go.
BASBalloon atrial septostomy. Procedure used to increase the size of a PFO to improve atrial level shunting, typically in dTGA.
BBBBundle branch block
BentallOperative procedure in which the aortic root and ascending aorta are replaced with homograft and a prosthetic valve.
BDBalloon dilation, the act of inflating a balloon filled with saline or contrast to widen a narrowing within a valve or vessel.
BDGBidirectional Glenn. See Glenn. Classic Glenn shunt was SVC to RPA anastamosis (i.e. unidirectional).
Bovine trunkA common pattern of aortic arch anatomy in which the left carotid artery arises from the base of innominate artery (which also gives off the right subclavian and right carotid artery).
BTS or mBTS(Modified) Blalock-Taussig shunt. Classically, a right subclavian to RPA anastamosis used to palliate patients with TOF with severe cyanosis.. Now always ‘modified’ to use a 3-3.5 mm GoreTex tube graft. May be part of S1P. Also credit Vivien Thomas who taught Blalock how to do the operation.
BVFBulboventricular foramen. Anatomic connection between a single LV and the outflow chamber, leading to either the PA or Ao (in transposition). May become restrictive over time.
CACommon atrium. A right and left atrium not separated by an atrial septum. This can occur natively (e.g. large ASDs) or be surgically created (e.g. following S1P).
CAPDCornell Assessment of Pediatric Delirium. An established screening tool for delirium.
CAVCComplete (or common) atrioventricular canal defect.
CCHDCritical congenital heart disease, defined as heart disease that is PGE-dependent at birth.
Circumflex aortaRight ascending aorta, aorta crosses the spine posterior to the trachea and esophagus, with left descending aorta.
Clear primeIndicates that no donor blood was used to prime the CPB pump, such that the patient may not have been exposed to donor blood products if it was not administered for other reasons (e.g. post-CPB bleeding).
CMACA video laryngoscope used for tracheal intubation.
CMRCardiac MRI, often used to define 3D anatomy, flow, ejection fraction, regurgitant fractions, and ventricular volumes with confidence in operative planning.
CoACoarctation of the aorta
CPBCardiopulmonary bypass
Critical ASCritical aortic stenosis. A disorder in which the aortic valve is thought (or rarely, known to be if the patient presented in shock) to be too small to sustain a circulation and is PGE-dependent until an intervention is performed. Colloquially, the term is generally reserved for situations in which the aortic valve is thought to be the primary limiter (i.e. patients with HLHS are not referred to as having critical AS although most do).
Critical PSCritical pulmonary stenosis. A disorder in which the pulmonary valve is thought to be too small to sustain adequate oxygenation, and is PGE-dependent until intervention is performed.
CRTCardiac resynchronization therapy. Pacing strategy in which ventricular leads are placed on both the right and left ventricle to decrease interventricular condution delay.
CRRTContinuous renal replacement therapy.
CVPCentral venous pressure - a mean pressure measured in a central vein (e.g. IJ, SVC)
CVRCardiotomy venous reservior. A critical component of CPB that allows for the collection of venous return from various cannulae.
CWContinuous wave Doppler. A specific echo technique used to assess for a gradient anywhere along the sound pathway.
DAoDescending aorta
DCCVDirect current cardioversion (i.e. shock). Often performed synchronously with the QRS to avoid R on T.
DDDA common synchronous pacing mode in which the pacemaker senses both the atrium and ventricle, and paces the atrium when it falls below the lower rate limit and paces the ventricle when it does not contract in time.
DHCADeep hypothermic circulatory arrest. A strategy in which all circulating blood is stopped under deep hypothermia (usually 18C). Typically now used only for <5 minutes for brief atrial interventions sans cannula interference.
DILVDouble inlet left ventricle
DKSDamus-Kaye-Stansel. An anastamosis between the pulmonary artery and aorta proximally. Part of S1P, which also includes distal aortic arch reconstruction. These 3 men all described the same operation in separate papers in 1974 for treatment of dTGA., hence the triple eponym. Can also be called a ‘Stansel’, occasionally a ‘Damus,’ but almost never a ‘Kaye.’
DOOAn asynchronous pacing mode in which both the atrium and ventricles are paced without regard to native rhythm or conduction. Often used for internal pacers during electrocautery.
DORVDouble outlet right ventricle. Defect in which both great arteries are associated with the RV. Clinical pathway depends on relation of the VSD to aorta, size of aorta, and size of LV. Classified as subpulmonary, subaortic, doubly committed based on position of VSD relative to the great arteries.
Double runA 1 mEq/kg dose of potassium chloride, double the usual dose.
Double switchAn operation in which the IVC and SVC are baffled to the left side of the heart (usually via Mustard) and the LV is directed to the aorta, either via ASO or Rastelli. Often used in L-TGA patients.
DSCDelayed sternal closure. The practice of closing the sternum in a separate (delayed) operation following an index operation, typically several days later.
dTGAD-looped transposition of the great arteries, can occur with (dTGA/VSD) or without (dTGA/IVS) a VSD. There have been many historical treatments of this defect: DKS, Mustard, Senning, and now ASO.
DuctSee PDA
EATEctopic atrial tachycardia. An automatic tachycardia originating from the atrium but outside the SA node. Often a marker of severe heart disease.
ECMOExtracorporeal membrane oxygenation
ECPRExtracorporeal cardiopulmonary resuscitation. The use of ECMO to resuscitate during CPR.
EFEEndocardial fibroelastosis. A rubbery, fibrous lining of the endocardium found in patients with left heart obstructive lesions thought to restrict LVEDV.
ERASEnhanced recovery after cardiac surgery. A QI program to standardize many aspects of care following an operation. For example, ERAS-A patients have a target extubation within 2 hours of arrival to ICU, ERAS-B within 8 hours.
EtCO2End tidal CO2. Partial pressure of carbon dioxide at end of expiration. Informative of ETT position and pulmonary blood flow.
ETTEndotracheal tube.
FenestrationA surgically created hole in a patch or tube graft that allows blood to cross an otherwise intact pathway. Often, fenestrations are left in a Fontan baffle to permit blood to pass from the Fontan to the common atrium, or in an ASD to allow blood to pass from RA to LA as a ‘pop-off.’
Flow accelerationA change in Doppler flow velocities on echo that generally indicates a relative narrowing of a vessel at location being interrogated.
FontanConnection between inferior vena cava and pulmonary artery. May be performed using a lateral tunnel (through the body of the right atrium) or extracardiac conduit. Historically, anastamosis between RA and PA.
Fossa ovalisThin fibrous region within the center of the atrial septum. If open, it is the site of PFO.
GlennConnection between one (or both) SVCs and the pulmonary arteries. May be a second stage of single ventricle palliation.
Hammock valveMitral valve pathology with multiple closely spaced papillary muscles with attachments from both anterior and posterior leaflets. Results in severe MS.
HCM (or HOCM)Hypertrophic (obstructive) cardiomyopathy. A pathologic state in which the thickness of the ventricles is excessive. Although commonly heritable, obstructive lesions can also cause ventricular hypertrophy. These patients are susceptible to subendocaridal ischemia and dynamic outflow tract obstruction (e.g. with hypovolemia or vasodilation).
Hemiazygos veinVein that originates from a venous plexus near the renal vein, courses superiorly adjacent to the spine, and crosses to the opposite side just above the diaphragm and joins the azygos vein. Classically left sided, but may be variable.
HFJVHigh frequency jet ventilation
HFNCHigh flow nasal cannula
HFOVHigh frequency oscillatory ventilation
Holmes heartDouble inlet LV with normally related great arteries and pulmonary valve arising from an outflow chamber. Significant as first recorded clinical description of a single ventricle in 1824.
HomograftTissue from a human donor. Typically a segment of the ascending aorta and aortic valve or PA and pulmonary valve. May be used as a conduit or as tissue to augment small structures.
HTXHeterotaxy. A complex constellation of defects that involve the heart, great vessels, lungs, thoracic and abdominal viscera.
HybridProcedure in which branch PA bands are placed (surgical) and PDA stent (cath) are placed. Palliative single ventricle procedure.
IARTIntraatrial reentrant tachycardia, a reentrant tachycardia that resides within an atrial structure. Atrial flutter is a prototypical IART.
ImpedanceAn complex expression of the opposition to pulsatile blood flow in an arterial circulation, including the effects of elasticity, inertia, and viscosity in the vessels beyond, as well as the effects of arterial reflection. Differs from resistance, which is a more simplified concept of opposition to flow at a constant rate.
InfundibulotomyA linear incision placed in the infundibulum, often used to patch augment the RVOT in TOF.
InfundibilumTube-like, muscular connection between the body of the right ventricle and the pulmonary valve.
Innominate arterySegment of artery that connects the transverse aorta to the right subclavian and right carotid artery. Commonly discussed around placement of a BT shunt, which can be taken off the innominate artery or more distally off of the subclavian artery, a higher resistance vessel.
Innominate veinThe left innominate vein drains the left subclavian and jugular veins. The right innominate vein drains the same vessels on the right; the two join to form the SVC. Also called brachiocephalic veins.
Isolated CoACoarctation of the aorta in which there are no additional defects, notably the absence of a VSD.
Isolated LPA/RPAAnatomic situation in which one of the branch PAs becomes anatomically disconnected from the pulmonary trunk and blood supply becomes dependent on patency of the ipsilateral ductus arteriosus. Typically there is echocardiographic concern for this prior to ductal closure and is an indication for PGE and operative correction.
IsthmusPortion of the aorta between the most distal brachiocephalic artery (normally the left subclavian) and the insertion of the PDA. Typically the most hypoplastic portion of the arch in patients with CoA.
IVCInferior vena cava. Vein carrying venous return from the lower half of the body to the right atrium; partially covered by the eustachian valve that directs blood towards the PFO.
JateneSee ASO, first described by Jatene in 1975.
JETJunctional ectopic tachycardia. An exclusively postoperative automatic tachycardia originating from the junction between the AV node and the bundle of His. Common arrhythmia following cardiac surgery with a regimented treatment protocol.
KawashimaCirculation in which a superior cavopulmonary anastamosis (unilateral or bilateral) exists in the setting of an interrupted IVC with azygos continuation. Except for hepatic venous drainage, all systemic venous return passes through the pulmonary circulation. At risk for pulmonary AVMs if hepatic veins or arterial flow is not incorporated into the pulmonary circulation.
LA HTNLeft atrial hypertension. May be caused by left ventricular or mitral valve disease and results in pulmonary edema, impaired lung mechanics and gas exchange.
LAPLeft atrial pressure, typically measured by an indwelling catheter inserted through the left atrial appendage or pulmonary vein. Normal <8-10 mmHg.
LdCAVCLeft dominant complete atrioventricular canal
LeCompte maneuverA maneuver performed while the aorta is transected in which the RPA, which normally passes through the underside of aortic arch, is brought anterior to the aorta, often as part of ASO. This is performed to allow a primary anastamosis of the MPA (which is typically shorter in dTGA since it arises from the posterior aorta) to the more anterior neo-pulmonary valve. A mild degree of stretch-related flow acceleration (obstruction) at the branch PAs is typical.
LLPA/LLPVLeft lower pulmonary artery/vein
LMALaryngeal mask airway. Device used for airway support during anesthesia or to aide in difficult intubation.
LPALeft pulmonary artery
LPA slingLeft pulmonary artery sling
L-TGALevo-tranposition of the great arteries, an anatomy in which the RA-->LV-->PA and LA-->RV-->aorta. Patients are at increased risk for TR, systemic RV failure and heart block.
LtR shuntLeft to right shunt. A physiologic state in which an anatomic defect causes a net shunting of blood from the left (i.e. LA, LV or aortic) to right (RA, RV or PA) side of the circulation. An ASD is typically a left to right shunt because LV compliance is less than RV compliance. A VSD is typically a left to right shunt if SVR (or really, systemic impedance) is higher than PVR (pulmonary impedance). The effect of a left to right shunt is always increased pulmonary blood flow. If it occurs above the AVV, it is a RV volume load; otherwise, it is a LV volume load.
LUPA/LUPVLeft upper pulmonary artery/vein
LVDCCLV dependent coronary circulation. Anatomic situation in which coronary perfusion is dependent upon fistulous connections between the coronary arteries and the LV cavity; present in some cases of MS/AA HLHS.
LVEDVLeft ventricular end diastolic volume. Volume of blood in the LV at the end of diastole, an important determinant of stroke volume. Functionally synonymous with preload.
LVOTLeft ventricular outflow tract. Depending on the situation, a gradient of >30 mmHg may be considered significant.
LVOTOLeft ventricular outflow tract obstruction
LVVOLeft ventricular volume overload. A physiologic state in which the LV pumps more volume than otherwise required for the aorta to receive 1 cardiac output. A typical VSD (if blood flows left to right) is an LV volume load because the LV performs the stroke work that pumps all of the blood through the aortic valve (1 cardiac output) plus the shunt fraction (what flows through the VSD and into the PA); in this case, the RV acts as a passive conduit. Other examples of LV volume loading lesions are MR, AR, PDA, and APCs.
MAMitral valve atresia
MABPMean arterial blood pressure, measured either by arterial line or by non-invasive cuff.
ManougianOperative technique for enlarging a narrow aortic annulus by incising the non-coronary cusp of the aortic valve and extending it onto the anterior leaflet of the mitral valve.
MSMitral valve stenosis. A gradient >5 mmHg is often clinically significant.
MUFModified ultrafiltration. A post-CPB strategy used to concentrate, filter, and return blood from the venous reservior to the patient.
MustardVenous baffle of SVC and IVC across the atrium to the left side of the heart, typically to a left sided TV. May be performed as part of biventricular repair. The large atrial patch typically equalizes RAP and LAP even without fenestration. Long-term sequelae include atrial arrhythmias.
MVrMitral valve repair
MVRMitral valve replacement
neo-AIReurgitation (or insufficiency) of the neo-aortic valve.
neo-AoVNeo-aortic valve. Called ‘neo’ as the valve in the aortic position (i.e. connected to the aorta) was not the native aortic valve (i.e. connected to the aorta and coronary arteries at birth). For example, the valve in the aortic position following ASO is the morphologic pulmonary valve in the aortic position, so is called the neo-AV. This communicates both that we are talking about the valve in the aortic position (i.e. connected to the aorta) and that it is non-native, which is important because the morphologic PV has different mechanical properties than the morphologic AV.
NikaidohOperative procedure in which the aortic root is translocated to the site of the pulmonary root to be closer to an otherwise remote VSD, usually for the purpose of ventricular septation.
NIPPVNon-invasive positive pressure ventilation (e.g. BiPAP), typically with a set rate.
NIRSNear infrared spectroscopy. A light-based technology that uses absorbance spectroscopy (like a pulse oximeter or co-oximeter) to provide a surrogate for volume-averaged tissue oxyhemoglobin saturation. Can be monitored on the forehead (cerebral) or flank (somatic). Although sometimes considered a surrogate for SvO2, it is known to be very insensitive to low SvO2 and should not be considered reassuring if normal. rSO2>50 is normal.
NIVNon-invasive ventilation, used more broadly than NIPPV to any modality (e.g. HFNC, CPAP, BiPAP).
NorwoodSee S1P, an operation first performed at BCH.
NRGANormally related great arteries. The pulmonary artery arises anterior and leftward of the aorta, and the great arteries are normally aligned with and connected to the ventricles.
OHTOrthotopic heart transplant.
OzakiA technique used to replace one or more diseased aortic valve leaflets with leaflets made from native tissue or xenograft, cut from a template, and sewn into place. May also be used for pulmonary valve.
PA/IVSPulmonary atresia with intact ventricular septum. Spectrum of heart diseases which may result in a 1 or 2 ventricle circulation.
Pace terminationThe act of interrupting (terminating) a reentrant tachycardia through rapid atrial pacing, which creates a refractory period within a tachycardia circuit.
Papillary muscle of LancisiPapillary muscle that supports medial portion of the anterior leaflet of the TV. Significant as the point of bifurcation between the right and left bundle branches.
PaO2Partial pressure of oxygen dissolved in the plasma phase of blood. Useful in determining the A-a gradient in patients without oxyhemoglobin desaturation and without right to left shunting.
Partial anomalous pulmonary venous return (or connection). Connection of one or more, but not all, pulmonary veins to a systemic vein or the right atrium.
Parachute mitral valveMitral valve in which the chordae converge onto a single papillary muscle, taking the shape of a parachute’s harness. Blood must pass through chordal structures rather than, as is normal, between two widely spaced papillary muscles at the ventricular apex.
Partial AVCPrimum ASD and cleft mitral valve, with no VSD component.
PBFPulmonary blood flow
PCVPressure control ventilation, a mode of conventional mechanical ventilation in inspiratory pressure is controlled (set) and tidal volume varies with lung compliance.
PCWPPulmonary capillary wedge pressure. Measured from a catheter placed into a distal PA with an occluding balloon, creating a standing column from tip to LA. Surrogate for LAP unless significant PVS present.
PCWP-EDP gradientPulmonary capillary wedge pressure to end diastolic pressure (slang = ‘wedge to ED’) gradient, a cath lab measurement to assess gradients across the pulmonary veins (and mitral valve).
PDAPatent ductus arteriosus. Vascular connection between the proximal LPA and descending aorta. Patency maintained by PGE infusion. Colloquially called a ‘duct’ or ‘ductus’ for short. Plural (as in case of bilateral PDA) is ductus arteriosi.
PDAPosterior descending (coronary) artery; may be fed from the right (70-80%), left circumflex (5-10%), or both right and left (10-20%) coronary and supplies the posterior aspect of the interventricular septum. A ‘right dominant system’ is one in which the PDA is fed by the RCA, and a ‘hyper-right dominant’ is one in which a right dominant PDA reaches the ventricular apex.
PEEPPositive end expiratory pressure
PentalogySome cardiologists refer to TOF with the addition of an atrial level defect (ASD or PFO) as a Pentalogy (of Fallot). Should not be confused with Pentalogy of Cantrell.
Pentalogy of CantrellA congenital defect that includes a midline supraumbilical abdominal defect, a defectof the lower sternum, a deficiency of the diaphragmatic pericardium, deficiency of the anterior diaphragm, and a congenital heart defect. In some cases, this is TOF.
PFOPatent foramen ovale. Normal interatrial communication in fetal life (during which time it flows right to left). For left (atrial) to right (atrial) flow, the PFO must be distended or ‘sprung’.
PGE1Prostaglandin E1 (known as PGE), a naturally occuring hormone that is infused to maintain ductal patency in newborns with critical congenital heart defects.
pH STATA perfusion strategy for the maintenance of arterial pH near 7.40 during hypothermia, typically by adding CO2 to the sweep gas during hypothermic perfusion. This prevents alkalosis-induced cerebral vasoconstriction and improves hypothermic neuroprotection.
PigtailSpecific type of catheter used for angiography or to drain the pleura or pericardial fluid. So named due to its curved end.
PIPPeak inspiratory pressure. Maximum pressure during phasic ventilation
Plateau pressureInspiratory pressure in airways when inspiratory flow reaches 0. May differ from PIP in clinically important ways in VCV.
‘Plege’Cardioplegia, a cold, oxygenated, blood-containing solution used to arrest the heart during the aortic cross-clamp period.
PleurEvacA 3 chamber canister used to drain thoracic tubes, preventing entrainment of air and allowing adjustment of suction pressure.
Pop-offA term used to explain that an anatomic connection between two chambers if the pressure in one chamber becomes excessively high. Most commonly, this is used to refer to an atrial level defect that permits RA to LA (or Fontan to CA) flow, preserving cardiac output at the clinical cost of hypoxemia.
PottsOperative anastamosis between the descending aorta and LPA. First described to treat TOF.
PPMPermanent pacemaker. An indewlling pacemaker. May be epicardial or transvenous. May (or not) have 1 or 2 ventricular leads and/or atrial leads.
PR or PIPulmonary (valve) regurgitation or insufficiency
PreloadPurely defined as end diastolic fiber length of a myocyte. Factors that decrease preload include bleeding and diuresis, but also venodilation. Removal of a volume loading lesion (e.g. VSD or AVVR) also acutely decreases preload, which may manifest as decreased ventricular excursion postoperatively.
PRSWPreload recruitable stroke work. The ability of preload to increase the stroke work of the ventricle, typically assessed based on changes in pulse pressure (surrogate for SV) and SBP with changes in preload (e.g. volume administration or venoconstriction).
PRVCPressure-regulated volume control, a mode of conventional mechanical ventilation in which tidal volume is set but is delivered in a pressure-regulated way; the decelerating flow pattern in this mode is favorable in small airways.
PVRPulmonary valve replacement, an operation in which a (usually) prosthetic valve is placed in the position of a previously native valve or within an RVPAC..
PVRPulmonary vascular resistance, computed as (mean PA pressure-LAP)/pulmonary blood flow. PCWP can be used as a surrogate for LAP in the absence of PVS.
PVSPulmonary vein stenosis. A disease of intimal hyperplasia of the pulmonary veins. Can cause pulmonary edema and lung disease.
PWPulse wave Doppler, a specific echo technique that uses rapid bursts (pulses) of sound to accurately measure the velocity of blood in a precise location Used to identify the precise location of flow acceleration (obstruction).
QpPulmonary blood flow. This can sometimes be estimated based on the Fick principle as Qp = VO2/(SpvO2-SpaO2). Dissolved oxygen should be considered when SpvO2 is >95%.
QsSystemic blood flow. This can sometimes be estimated based on the Fick principle as Qs = VO2/(SaO2-SvO2), so long as PaO2<100.
Qp/QsConceptual framework describing the ratio of pulmonary to systemic blood flow. Estimated based on Fick principle as Qp/Qs ≈ (SaO2-SvO2)/(SpvO2-SpaO2); makes many assumptions, including a single source of PBF and absence of streaming.
QTcCorrected QT interval. Generally, the 99th percentile QTc values are 460 ms (prepuberty), 470 ms in postpubertal males, and 480 ms in postpubertal females. Excessive prolongation increases risk for torsades de pointes, a life-threatening arrhythmia.
RAA (with MIB)Right aortic arch (with mirror image branching). A common abnormality in which the aorta courses over the right mainstem bronchus (rather than left); the dorsal (posterior) aorta lies to the right of the spine rather than left. Commonly has brachiocephalic branching that is mirror image of normal (i.e. a left innominate artery first, then right carotid, then right subclavian). Can create a vascular ring when combined with an aberrant left subclavian and a left ductus arteriosus from the left dorsal aorta or diverticulum of Kommerell.
RAARight atrial appendage.
RAPRight atrial pressure. Normal value 3-5 mmHg.
RastelliOperative technique in which the VSD is baffled to the aortic valve and RVPAC is placed. Originally developed for dTGA/VSD/PS.
RCPTRegional cerebral perfusion time. Represents a time of low flow to the brain (~40 mL/kg/min) used for aortic surgery. Spine is usually perfused via vertebral arteries.
RdCAVCRight dominant complete atrioventricular canal
Reentrant tachycardiaA type of arrhythmia characterized by the presence of abnormal conduction tissue (called a pathway) that allows the recirculation of electrical impulses that cause tachycardia. This causes abrupt onset tachycardias (i.e. in 1 beat), and in some cases can be terminated with adenosine or with rapid atrial pacing.
RESTORERandomized Evaluation of Sedation Titration for Respiratory Failure. A protocol used for the sedation of critically ill children, here modified for cardiac patients.
RLPA/RLPVRight lower pulmonary artery/vein
RmBTSRight modified Blalock-Taussig shunt. See BTS.
RPARight (main) pulmonary artery
RossOperation in which the native pulmonary root (and valve) are excised and transferred to the aortic position. Necessarily includes RVPAC placement.
Ross-KonnoRoss operation in which the aortic root is also enlarged by incising the annulus ± ventricular septum to enlarge the LVOT and aortic annulus.
RtL shuntRight to left shunt. A physiologic state in which an anatomic defect causes a net shunting of blood from the right (i.e. pulmonary) side of the circulation to the left (i.e. aortic). An ASD may be a right to left shunt if the RV compliance is less than LV compliance (as following TOF repair). A VSD may be a right to left shunt in the presence of RVOTO or PHTN.
RUPA/RUPVRight upper pulmonary artery or vein
RVOTORight ventricular outflow tract obstruction. A gradient of >30 mmHg may be associated with increased RVH or hypoxemia in the setting of a VSD.
RVPRight ventricular pressure. Typically, this refers specifically to the RVSP (RV systolic pressure), and may be represented as a fraction of systemic. The RV is generally less able to tolerate RV HTN due to its thin wall, which increases wall stress for a given pressure.
RVPACRight ventricular to pulmonary artery conduit. Most commonly a valved homograft.
RVVORV volume overload. A physiologic state in which the RV pumps more volume than normally required for the pulmonary circulation to receive 1 cardiac output. Can be caused by LtR atrial level shunts (e.g. ASD, PAPVR), TR, or PR.
RVPACRight ventricular to pulmonary artery conduit. A homograft (cryopreserved donor vessel, usually from donor aorta or prosthetic tube) used to connect the right ventricle to the pulmonary artery in a number of operations.
S1PStage 1 palliation (or Norwood procedure). Often the first step in the palliation of infants with single ventricles
SanoA conduit connecting the right ventricle and pulmonary arteries in S1P. May contain an interposition valved venous homograft.
‘Sat run’The practice of measuring SaO2 in the RA (or SVC) and PA to evaluate for a ‘step-up’. Commonly performed by direct stick during open chest procedure. See ‘step up’.
SAMSystolic anterior motion of the mitral valve. A phenomenon most often associated with septal thickening (e.g. hypertrophic cardiomyopathy) in which flow acceleration in the LVOT causes displacement of the distal portion of the anterior leaflet of the mitral valve into the LVOT, worsening obstruction and causing MR. Worsened by hypovolemia; can cause sudden circulatory collapse.
SaO2Arterial oxyhemoglobin saturation measured by co-oximetry.
Scimitar syndromeA disorder characterized by hypoplasia of the right lung and anomalous pulmonary venous drainage of most or all of the RPVs to the IVC. Often associated with secondary dextrocardia.
SCPCSuperior cavopulmonary connection. See Glenn.
SenningOperative technique in which the body of the RA is used to baffle SVC and IVC to left sided AVV and pulmonary veins to the right sided AVV. Now a rarely performed atrial switch procedure.
Shone’s syndromeA specific complex of parachute mitral valve, supramitral ring, subaortic stenosis, and CoA. Shone’s complex more loosely refers to patients with a variety of other left heart obstructive lesions.
SLSSSmall left sided (left heart) structures. Generally, patients with left heart obstructive lesions that include mitral and aortic stenosis, with or without left ventricular hypoplasia and aortic arch obstruction.
SpO2Oxygen saturation by pulse oximetry. This value correlates poorly with co-oximetry values in cyanosis (<90%).
StarnesAn operative approach that includes placement of a fenestrated patch over the TV orifice that excludes the RV from receiving preload in severe neonatal Ebsteins anomaly. PBF is through a mBTS.
STEMIST elevation myocardial infarction. An emergency requiring immediate intervention (i.e. heart attack).
Step upAn increase in oxyhemoglobin saturations from the RA (or SVC) to PA. Differences of more than 10% points indicates the presence of a significant left to right shunt. Commonly used to assess for residual VSD.
StreamingA clinically important phenomenon in which blood of different oxygen contact may co-flow within a vessel (or ventricle) without complete mixing. For example, in MS/AS, fully oxygenated blood ejected by a small LV into a DKS may enter the right arm fully saturated despite traveling in the ascending aorta alongside desaturated blood (from the RV).
Stroke workThe work required for the ventricle to eject the, stroke volume. Because the force applied is the ventricular systolic pressure, stroke work is estimated as the product of stroke volume and mean systolic pressure (and is conceptually the area within the PV curve).
SubASSubaortic stenosis, commonly occuring as a discrete mebrane in patients with CAVC.
‘Super-Glenn’A colloquial term used locally to refer to patients with both a SCPC (Glenn) and an aortopulmonary shunt (or BTS). Often includes a septation between the right and left PA.
Sutureless repairAn operation used to treat PVS in which the native pulmonary veins are incised and filleted open, and pericardium (which natively wraps around the outside of the pulmonary vein) is used to create a closed circulation. Called sutureless because no sutures are directly placed within pulmonary veins.
SVCSuperior vena cava. Vessel receiving blood from the head and neck. Blood often sampled for ‘SVC saturation’ to determine adequacy of cerebral oxygenation.
SvO2Venous oxyhemoglobin saturation, often used as a surrogate for the adequacy of oxygen delivery. Strictly speaking, drawn from the PA in a bivenricular circulation with no intracardiac mixing. When this is anatomically precluded, we often use the SVC saturation as a surrogate; beware of contamination from the atrium or PAPVC.
SVRSystemic vascular resistance. A conceptual term that is calculated by MABP/cardiac output and represents impendence to systemic blood flow. Increases with hypothermia or vasocontricting agents.
TAPTransannular patch. An operative technique used in repair of TOF in which the pulmonary annulus is incised and a patch placed acorss it.
Total anomalous pulmonary venous connection (or return). A defect in which all pulmonary veins return to a systemic vein or the RA. May be clinically obstructive (lung disease), constituting a surgical emergency.
Taussig-BingDORV with subpulmonary VSD. Aorta is separated from the VSD by obstructive subarterial conus.
TCPCTotal cavopulmonary connection. See Fontan.
TEGThromboelastography. A measure of clot strength. When performed with platelet mapping, also used to determine inhibition of two specific platelet receptors (AA and ADP).
TOFTetralogy of Fallot. A common heart defect including a ventricular septal defect over which the aorta sits and some degree of pulmonary outflow obstruction. Clinical pathway is primarily dependent on the size of the PV and pulmonary arteries. Desribed first by Steno of Denmark (1673), and named a tetralogy by Fallot of Marseilles (1888).
TOF/PSTetralogy of Fallot with pulmonary stenosis.
TOF/PA/MAPCASTetralogy of Fallot with pulmonary atresia and multiple aortopulmonary collaterals. The most severe form of TOF in which central pulmonary arteries are diminuitive or absent altogether.
TSTricuspid valve stenosis. Typically, a gradient of >2-3 mmHg may be clinically significant.
TRTricuspid valve regurgitation.
TR jetMeasured Doppler gradient across the TV, used to estimate RVP by echo (added to the RA v wave).
Transitional AVCPrimum ASD, cleft mitral valve, and inlet VSD that is made restrictive due to attachments of the AVV to the crest of the ventricular septum.
Transposition physiologyAny physiology in which the oxyhemoglobin saturation in the PA is higher than in the aorta. Typically, this occurs when the PA is closer to the LV (often with VSD) than is the aorta. Increasing arterial saturations requires an increase in left to right atrial level flow (e.g. via PGE) or raising SvO2, though the physiology remains until ASO is performed.
Triangle of KochAn anatomic location bounded by the the tricuspid valve annulus, ostium of the coronary sinus, and the tendon of Todaro. Important because it houses the AV node.
TVTricuspid valve
Unrestrictive VSDVSD without a pressure gradient across it. Generally defects that are the size of the aortic valve or larger are physiologically unrestrictive.
UVC/UACUmbilical venous catheter/umbilical arterial catheter.
VADVentricular assist device, including HeartWare, Berlin pump, or external centrifugal pump (RotaFlow).
VA ECMOVenoarterial ECMO. Blood is drained from systemic veins (or atrium), oxygenated, and pumped back into the arterial system.
VCVVolume control ventilation, a mode of mechanical ventilation in which tidal volume is controlled (set) and inspiratory pressures (peak and plateau) vary with lung compliance.
VerifyNowSpecialized test to determine the degree of blockade of thromboxane A2 by aspirin or P2Y12 ADP receptor by clopidogrel.
VSDVentricular septal defect. An anatomic connection between the right and left ventricle.
VSRValve-spring repair of TOF that includes (often) an infundibular and MPA patch augmentation and pulmonary valve commissurotomies.
VVCVenovenous collateral. An abnormal vessel between (often) a pulmonary artery to common atrium or pulmonary vein (in a Fontan) or IVC (in a Glenn). Causes cyanosis.
VV ECMOVenovenous ECMO. Blood is drained from systemic veins (or atrium), oxygenated, and pumped back into the venous system (RA or PA).
VVIA synchronous pacing mode in which only the ventricles are sensed and are paced when the ventricular rate falls below the set lower rate limit.
WaistFluoroscopically apparent Indentation on a balloon being used for catheter-based valvuloplasty or angioplasty indicating that a focal area of stenosis was balloon dilated. ‘Resolving’ a waist implies that the focal constriction was expanded.
WardenOperative procedure for treatment of PAPVC in which the SVC is transected and anastamosed to the RAA and anomalous pulmonary veins baffled to LA.
WATWithdrawal assessment tool. Possible total 19 points, greater than 3 is abnormal. Somtimes annoyingly used as a verb ‘patient is WATting high...’
WaterstonOperative anastamosis between the ascending aorta and RPA.
XCTAortic cross-clamp time. Represents the time during which the myocardium is ischemic, although protected by cardioplegia solution.
Z scoreThe number of standard deviations away from the median of age matched controls. A negative Z score indicates smaller than average, a positive indicates larger than average. The size of many anatomic features (e.g. mitral or aortic valve annulus, aortic isthmus) are assessed as a Z score. Generally, a Z score of <-3 typically has clinical implications.
ZBUFZero-balance ultrafiltration. A post-CPB strategy of ‘washing’ by UF and replacement with equal volumes of crystalloid. Practice around this strategy is variable, but is important to understand since it can significantly effect acid-base balance and serum lactic acid in the early postoperative period.
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