Cardiology Lecture 2

Question 1

What happens to R side of heart in ToF?

Answer 1

• Right side - higher pressure due to pulmonary stenosis
• Right to left shunt occurs - cyanotic
• Tet spells can occur - spelling of cyanosis when distressed, dehydrated, unwell etc (higher metabokic demand)

Question 2

What happens to murmur during tet spells?

Answer 2

• Loses murmur - no flow through pulmonary stenosis

Question 3

Management of tet spell

Answer 3

Reduce metabolic demand:
* Keep baby as calm as possible - keep them with mum, relaxed
* Give O2
* Put legs up to knees - fluid bolus from legs, increases systemic vascular reisstance (L then exceeds R pressure, remove some shunt)
* Bolus of fluid
* Morphine
* Transfer to NICU - ?ventilation, support

Question 4

When is ToF repaired?

Answer 4

• Usually done at 6 months
• If having spells before this and not suitable for surgery yet can have prophylactic beta blocker
• RVO stent can be done - opens out stenosis of pulmonary artery, usually just below valve
• ToF repaired via opening stent, cut open, flap back and put patch over top to repair VSD

Question 5

Transposition of great arteries

Answer 5

• Parallel circuits - 2 seperate
• No mixing of blood - deoxygenated and oxytegnated sepearte

Question 6

How to babies originally survive with TOGA?

Answer 6

• Foramen ovale - allows mixing of oxygenated and deoxygenated blood
• Ductus arteriosus
• Often found on antenatal scans - prostin to prevent closure
• They can have septostomy after birth (allows mixing)
• Arterial swapping surgery done later on then have to swab coronary arteries over (early branch of aorta)

Question 7

Complications post TOGA procedure

Answer 7

• Coronary aretry problems later on - get a lot earlier than others
• Some compression can occur via pulmonary arteries straddling aorta

Question 8

What is truncus arteriosus?

Answer 8

• Large VSD
• Only one outflow tract - aorta and pulmonary artery combined
• Problem is get coronary steal - blood goes down pulmonary arteries during diastole when pressure is low - steals from when coronaries usually fill

Question 9

Management of truncus arteriosus if coronary steal

Answer 9

• Get CO2 high in baby - increases pulmonary pressures via ventilation
• Means that blood is not stolen by pulmonary artery

Question 10

What heart conditions are associated with DiGeorge?

Answer 10

• TOF
• Truncus arteriosus

Question 11

Univentricular heart types

Answer 11

• Hypoplastic left heart syndrome
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FINISH

Question 12

What happens in hypoplastic L heart syndrome?

Answer 12

• L atria and ventricle has not grown properly
• = Undeveloped aorta

No flow = no grow (if no blood flow, these don’t grow)

Question 13

Management of hypoplastin L heart

Answer 13

• Prostin dependent - keep duct open, allows flow
• You can get coromary steal syndrome too - can use high CO2 again (risk of death in first days of life)
• If high sats = lots of blood going to lungs = not a lot blood going to coronarys = very worrying, can arrest

Question 14

Management of hypoplastic L heart surgery

Answer 14

• Norwood operation - remove atrial septum, connect native aorta and pulmonary artery to make one large aorta
• BTT shunt - to connect aorta to pulmonary artery

Another type of shunt - finish this

Question 15

What is done after Norwood operation?

Answer 15

• Glenn / CP shunt - at 4-6 months old
• SVC plumbed straight into pulmonary arteries - passes into via gravity, lots of circulation from head in children
• When 4 years old, this stops as lower body more supply

Question 16

What happens after Glenn procedure?

Answer 16

• Fontan procedure
• IVC plumbed into pulmonary artery
• Need to be walking - calf muscles pump venous blood into pulmonary artery (new RA)
• Add fenestration into IVC - onto RA, if pressures are high, they can enter RA (risk of stroke, mixing of deoxygenated and oxygenated blood)