Chd

Question 1

Success of fontan procedure for tricuspid atresia depends on

Answer 1

HIGH systemic venous pressure and maintaining both low PVR and low left atrial pressure

Question 2

For triscuspid atresia failed fontan procedure what may be necessary

Answer 2

Heart transplant

Question 3

What is Tricuspid atresia surgical management

Answer 3

Fontan procedure

Question 4

Tricuspid atresia -babies are cyanotic at birth and require “this” to survive

Answer 4

Prostaglandin E1 infusion with or without other palliative procedure

Question 5

For tricuspid atresia- what is necessary for blood to flow from the left ventricle into the pulmonary circulation

Answer 5

PDA or VSD

Question 6

Tell me exactly what is the problem with tricuspid atresia

Answer 6

Absence or permanent closure of the tricuspid valve

Question 7

Tricuspid atresia-what is the left ventricle and right ventricle

Answer 7

Small right ventricle large left ventricle

Question 8

Tricuspid atresia can have transposition of the great vessels

Answer 8

Dextrotransposition

Nondextransposition

Question 9

What is the flow of blood for tricuspid atresia

Answer 9

Blood goes from RA- asd or pfo to LA- through mitral valve to vsd- to pulmonary artery

If no VSD- blood flows through pda

Question 10

Signs of symptoms of tricuspid atresia

Answer 10

Clubbing in older children
Tachypnea
Prominent a waves
Abnormal pulses
Hepatic enlargement
Heart failure

Question 11

What is ebstein anomaly

Answer 11

Downward displacement of the valve because of abnormal attachment of valve leaflets

Question 12

What is the most common type of ASD

Answer 12

Ostium secundum at the level of foremen ovale

Question 13

What ASD is associated with mitral regurgitation

Answer 13

Located low in atrial septum

Question 14

What ASD is located high in atrial septum

Answer 14

Sinus venous

Question 15

What type of shunt is ASD

Answer 15

Left to right shunt b/w the 2 atria

Question 16

For ASD what can air bubbles lead too

Answer 16

Paradoxical Emboli that can lead to heart attacks and strokes

Question 17

Treatment of ASD

Answer 17

Early repair is advocated

Banding of pulmonary artery to reduce the magnitude of left to right shunt

Question 18

What infection can occur with ASD

Answer 18

Recurrent pulmonary infections

Question 19

What should be avoided in ASD

Answer 19

Increase in SVR-worsen left to right shunting

Question 20

ASD what is commonly seen post op

Answer 20

Svt and about conduction is common

Question 21

In ASD what will volatiles and positive pressure ventilation do to shunting

Answer 21

Decrease svr

Ppv will increase pvr and decrease the shunt

Question 22

What may present post op with VSD

Answer 22

3rd degree heart block may present

Question 23

What shunt has Recurrent pulmonary infections and CHF are common

Answer 23

VSD left to right

Question 24

True or false

Small VSD close during childhood spontaneously

Answer 24

True

Question 25

Large VSD s usually produce large left to right shunts that vary directly with____ and indirectly with___

Answer 25

Directly with SVR | Indirectly with PVR

Question 26

VSD are mostly a symptomatic what type of murmur do they have

Answer 26

Loud pan systolic murmur along left stern also border

Question 27

Name the most common VSD

Answer 27

Membranous VSD

Question 28

Name the 4 types of VSD

Answer 28

Membranous VSD Muscular VSD Supra-cristal VSD Av canal type VSD

Question 29

For a VSD WHAT DO YOU SEE ON THE CXR

Answer 29

Biventricular hypertrophy | Pul HTN

Question 30

Transposition of the great arteries must include which holes in the heart for blood to mix

Answer 30

Survival is only possible through mixing of blood through foramen ovale-PDA AND SOMETIMES A VSD

Question 31

Transposition of the great arteries includes what medication for survival

Answer 31

Prostaglandin E1

Question 32

What ventricle does transposition of the great vessels effect

Answer 32

Mimics tof- when a VSD and pulmonic stenosis occurs. Obstruction effects the left ventricle NOT the right

Question 33

Describe total anomalous venous return

Answer 33

Pulmonary veins do not connect to the left atrium. Instead blood returns to the right atrium or prior to the ra- and mixes with the deoxygenated blood

Question 34

How does the baby survive total anomalous venous return

Answer 34

Blood reaches the left side of the heart via an foramen ovale or an ASD.

Question 35

For total anomalous venous return - why does venous congestion begin to occur.

Answer 35

Severe pulmonary congestion occurs when the ductus venous begins to close.

Question 36

How is total anomalous venous return corrected

Answer 36

The pulmonary venous trunk is reanastomosed into the left atrium and the asd is closed

Question 37

Describe truncus arteriosus

Answer 37

Single arterial trunk supplies the pulmonary and systemic circulation

Question 38

What accompanies truncus arteriosus

Answer 38

A VSD to allow both ventricles to eject into it

Question 39

During truncus arteriosus- PVR gradually decreases after birth but pulmonary blood flow increases resulting in what

Answer 39

Heart failure

Question 40

Patients with cyanotic heart disease have what response to hypoxemia

Answer 40

Blunted response

Question 41

Patients with cyanotic heart disease have what response to hyper apnea

Answer 41

Normal response

Question 42

What does methergine do to parturients

Answer 42

Increases svr

Question 43

What does oxytocin do to parturients

Answer 43

Decreases svr and increases HR and PVR

Question 44

Normal aortic valve area

Answer 44

2.5-3.5cm

Question 45

Severe aortic stenosis is when the valve is less than or equal to

Answer 45

1cm2

Question 46

Hr for AS

Answer 46

60-90 Nsr Maintain preload, after load, contractility

Question 47

AS treatment for bradycardia Treatment for tachycardia

Answer 47

Atropine | Esmolol

Question 48

AS when is spinal and epidural tolerated

Answer 48

Mild to moderate stenosis | Epidural is better tolerated

Question 49

When are spinal and epidurals contraindicated in aortic stenosis

Answer 49

In severe aortic stenosis

Question 50

In AS- what medication is effective for treating svt and ventricular dysrhythmics

Answer 50

Amiodarone and lidocaine

Question 51

What medication do we use to treat hypotension in AS

Answer 51

Small doses of neo

Question 52

Describe coarctation of the aorta

Answer 52

Obstruction located in the descending aorta

Question 53

Describe preductal coaractation of the aorta

Answer 53

Narrowing occurs proximal to the opening of the ductus- marked differences occur between the lower and upper half of the body-lower half is cyanotic

Question 54

Coarctation of aorta with or without left ventricular failure=

Answer 54

HTN in upper body with bounding pulses and hypotension of lower extremities with weak or absent pulses

Question 55

Which cardiomyopathy is genetically transmitted

Answer 55

Hypertrophic cardiomyopathy

Question 56

The most common cause of sudden death in pediatric and young adult population

Answer 56

Hypertrophic cardiomyopathy

Question 57

What are the 4 major changes in hypertrophic cardiomyopathy

Answer 57

Ventricular hypertrophy Decreased ventricular chamber size Increased ventricular wall thickness Impaired ventricular relaxation

Question 58

What is described as the rapid acceleration of blood traveling through a narrow outflow tract

Answer 58

Venturi effect

Question 59

The presence of “this makes the coronary artery walls narrowed in hypertrophic cardiomyopathy

Answer 59

Collagen

Question 60

What happens to the left ventricle in hypertrophic cardiomyopathy

Answer 60

Asymmetric hypertrophy of inter ventricular septum of LV CAUSES LEFT OUTLFOW TRACT OBSTRUCTION - hemodynamics consequences are similar to AS