Fetal to Neonatal Transition; Acyanotic CHD - ASD

Question 1

___% of umbilical venous blood enters the hepatic circulation

Answer 1

50

Question 2

IVC –> right atrium –> ___ valve –> foramen ovale –> left atrium –> left ventricle –> ascending aorta

Answer 2

Eustachian

Question 3

SVC –> right atrium –> tricuspid valve –> right ventricle –> pulmonary artery –> ___

Answer 3

5% enters the lungs, majority goes through the ductus arteriosus –> descending aorta

Question 4

Total fetal cardiac output

Answer 4

~450mL/kg/min

Question 5

Descending aortic blood: ___% returns to placenta, ___% perfuses fetal organs and tissues

Answer 5

65, 35

Question 6

Bring about rapid decrease in pulmonary vascular resistance at birth

Answer 6

1) Mechanical expansion of lungs 2) Increase in arterial pO2

Question 7

Removal of low-resistance placental circulation at birth brings about

Answer 7

1) Increase in systemic vascular resistance 2) Closure of the ductus venosus

Question 8

Reverses blood flow through the ductus arteriosus at birth

Answer 8

Increase in systemic vascular resistance, decrease in pulmonary vascular resistance

Question 9

Constricts and eventually closes the ductus arteriosus during the neonatal period

Answer 9

High arterial pO2

Question 10

Remnant of the ductus arteriosus

Answer 10

Ligamentum arteriosum

Question 11

Functionally closes the flap of the foramen ovale

Answer 11

Increase in left atrial volume from increase in return of blood from the lungs

Question 12

Functional closure of the ductus arteriosus in the normal neonate

Answer 12

10-15 hours of life

Question 13

Newborn cardiac output

Answer 13

350ml/kg/min

Question 14

Foramen ovale functionally closes by

Answer 14

3rd month of life

Question 15

CHD associated with Holt Oram syndrome

Answer 15

ASD

Question 16

T/F An isolated valve-incompetent PFO is hemodynamically significant and is considered an ASD

Answer 16

F

Question 17

T/F An isolated PFO does not require surgical treatment

Answer 17

T

Question 18

PFO device closure is considered when

Answer 18

(+) history of thromboembolic stroke

Question 19

MC form of ASD

Answer 19

Ostium secundum defect in the region of the fossa ovalis

Question 20

T/F Secundum ASD is associated with structurally normal AV valves

Answer 20

T

Question 21

With large defects, ratio of pulmonary to systemic flow (Qp:Qs) is usually

Answer 21

2:1 to 4:1

Question 22

T/F Despite large pulmonary blood flow, pulmonary arterial pressure in cases of ASD is usually normal because of the absence of high-pressure communication between pulmonary and systemic circulation

Answer 22

T

Question 23

T/F A child with ostium secundum ASD is most often asymptomatic

Answer 23

T

Question 24

CHD: Widely split S2 with fixed splitting

Answer 24

ASD

Question 25

CHD: Systolic ejection murmur best heard at left mid to upper sternal border

Answer 25

ASD

Question 26

SEM heard in ASD is brought about by

Answer 26

Increased flow across the right ventricular outflow tract into the pulmonary artery

Question 27

T/F SEM heard in ASD is brought about by flow across the ASD

Answer 27

F, flow across the ASD is low in pressure

Question 28

Echo findings characteristic of RV volume overload

Answer 28

1) Increased RV end-diastolic dimension 2) Flattening and abnormal motion of the ventricular septum

Question 29

T/F Patients with classic features of a hemodynamically significant ASD on PE and chest radiography in whom echo shows an isolated secundum ASD need to undergo diagnostic cath before repair

Answer 29

T

Question 30

Surgical or transcatheter device closure of ASD is advised for

Answer 30

1) All symptomatic patients 2) Asymptomatic patients with Qp:Qs ratio of at least 2:1 3) RVE

Question 31

Timing for elective closure of ASD

Answer 31

After the 1st year and before entry into school

Question 32

Procedure of choice for ASD closure

Answer 32

Percutaneous catheter device closure

Question 33

T/F Small- to moderate-sized ASDs detected in TERM infants may close spontaneously

Answer 33

T

Question 34

T/F IE is common in ASD hence antibiotic prophylaxis for isolated secundum ASD is recommended

Answer 34

F, EXTREMELY RARE