Congenital questions Flashcards
(200 cards)
Understand how to calculate the estimated left to right shunt for an ASD
Aortic Saturation - SVC saturation/ Pulmonary venous saturation - Pulmonary artery saturation
A 2:1 shunt should be repair with elevated PA pressure
What are two most appropriate or preferred repair techniques for coarctation in the neonatal age group
Extended end to end anastomosis
left subclavian flap
What are the 3 most appropriate or preferred repair techniques for coarctation in the adult age group
Interposition graft
resection and end to end anastomosis
balloon dilation with intralumenal stent
List 5 complications of coarctation surgery
paraplegia chylothorax hemorrhage phrenic nerve injury/palsy Horner's syndrome post operative/residual hypertension recurrent coarctation Postcoartecomy syndrome/abdominal pain/mesenteric arteritis
Describe 3 features that preclude percutaneous ASD device closure
Location of ASD primum defect sinus venosus defect deficient spetal rim Size of ASD a defect over 2.5 cm Associated anomalies azygous continuation partial anomalous venous return pulmonary hypertenion
List 5 complications of ASD closure
Residual shunt migration of shunt obstruction of coronary sinus obstruction of pulmonary veins thromboembolic event cardiac chamber performation
List 6 potential causes of hypoxemia folllowing bidirectional cavopulonary anastomosis
pulmonary artery stenosis stenotic anastomosis elevated pulmonary vascular resistance cardiac tamponade left ventricular dysfunction, pulmonary edema anemia atrioventricular valve dysfunction/mitral regurgitation runoff through venous collaterals- azygos vein hemo/pneumothorax hypovolemia excessive PEEP Vq.Q mismatch, atelectasis
Describe the anatomical features/locations of the following types of ventricular septal defects: Perimembranous subaortic ASD Inlet VSD Muscular VSD Doubly comitted subarterial VSD
Perimembranous VSD: located in perimembranous septum under the commissure of the anterior and septal leaflet of the tricuspid valve.
Inlet VSD: located in the inlet of the tricuspid valve, under the commissure of the septal and posterior leaflets.
Muscular VSD: defect is completely surrounded by muscular rim and can be located anywhere in the interventricular septum
Doubly comitted subarterial VSD: there is fibrous continuity between the leaflets of the pulmonary and aortic valves because of the absence of the infundibular septum
Describe the pathophysiology of subvalvular subaortic stensosis
Fixed fibromuscular discrete membrane. Tunnel diffuse subarotic stenosis Hypertrophic cardiomyopathy (IHSS) Abnormal insertion of mitral valve chordae Hypoplastc aortic valve ring
List 4 complications of subaortic stenosis repair
Residual obstruction
heart block
ventricular septal defect
aortic valve tearing
What is natural history of perimembranous VSD if left unoperated
Progressive RV enlargement Congestive heart failure prolapse aortic valve and aortic valve insufficiency risk of endocarditis adult pulmonary hypertension
Patient wishes to have device closure of VSD . What anatomtomicl structures are importance to assess before closure
Tricuspid valve
aortic valve
size of defect
distance from aortic valve to superior edge of defect
What are complications following closure of perimembranous VSD device closure
Left ventricular outflow tract obstruction
residual shunt
device embolization/migration
tricuspid/mitral/aortic valve regurgitation
Arrhythmia/heart block
List the 5 complications or pitfalls specifically associated with surgery for Ebstein’s anomaly
Injury to the AV node or heart block
Injury to the right coronary or posterior descending coronary artery
residual right ventricular outflow tract obstruction
residual atrial septal defect
tricuspid stenosis
residual tricuspid regurgitation
3 year old presents with a right sided effusion 4 weeks post Fontan procedure
List 4 criteria that would strongly suggest the effusion represents a chylothorax
presence of chylomicrons
WBC > 1000
Lymphocyte > 80%
Triglyceride > 1mM
List 4 treatment options in the sequence that normally would be employed for chylothorax
Pleural drainage NPO or low fat or medium change triglyceride diet total parenteral nutrition surgical ligation of thoracic duct octreotide treatment
List 5 complications of unrepaired congenital ventricular septal defect
Congestive heart failure
Aortic insufficiency
Endocarditis
Pulmonary hypertension (Eisenmenger’s syndrome)
right ventricular outflow tract (RVOT) obstruction
severe failure to thrive
Start CPB and the PA pressure remain high? What is this? what can be done?
Likely a patent ductus arteriosus, so quickly gain control of the ductus and ligate it.
Alternatively, clamp the distal left and right pulmonary arteries and then ligate ductus
Classify interrupted aortic arch
Type A: Interruption distal to left subclavian
Type B: interruption between left subclavian and left common carotid (most common)
Type C: interruption between innominate and left common carotid artery
What are associated lesions with interrupted arch
Isolated VSD (most common) Truncus arteriosus transposition of great arteries with VSD including taussig-bing anomaly aortopulmonary window single ventricle subaortic obstruction
What is DiGeorge Syndrome? What 2 things must be done postop?
No thymus. Watch of this when doing sternotomy.
Monitor Calcium level
Blood products must be irrigated
In a 30 year adult should you close an ASD?
Yes, reduces the risk of paradoxical embolism but this controversial.
Yes, because of mortality benefit if closed before age of 40?
New born presents with extreme cyanosis (arterial saturation 45%) that occurs 2 hours after birth. ET and positive pressure ventilation with an FiO3 of 1.0 results in minimal improvement in oxygenation. What are 4 likley diagnosis?
Transposition of Great Arteries
Pulmonary artery atresia with or without VSD
Obstructed total anomalous pulmonary venous drainage
tricuspid atresia
What is immediate pharmacological treatment for a new born in extreme cyanosis
PGE1 infusion should be started immediately to restore ductal patency. Most important thing regardless of diagnosis!