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Congenital Defects & Pediatrics COPY > VSD > Flashcards

VSD Flashcards

1
Q

CPB Normorthermic Blood Flow

A

0-3 kg = 200 cc/kg/min 3-10 kg= 150 cc/kg/min 10-15 kg= 125 cc/kg/min 15-30 kg= 100 cc/kg/min >30 kg= 75 cc/kg/min >55 kg= 65 cc/kg/min

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2
Q

At what day does cardiac septation occur?

A

Day 27

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3
Q

How long does cardiac septation last?

A

10 days

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4
Q

When do the formation of cardiac septa occur?

A

Simultaneously

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5
Q

During cardiac septation, how does the external appearance change?

A

No major changes in external appearance

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6
Q

What could cause worsening of a left-to-right-shunt?

A

Any process that increases the pressure in the LV can cause worsening of the left-to-right shunt; also works on the right heart Systemic hypertension, increases pressure that the LV has to generate in order to open the aortic valve

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7
Q

What could cause worsening of a left-to-right-shunt?

A

Any process that increases the pressure in the LV can cause worsening of the left-to-right shunt; also works on the right heart Systemic hypertension, increases pressure that the LV has to generate in order to open the aortic valve

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8
Q

If there is a L to R shunt, which ventricle has to push our more blood? What does this result in?

A

Right ventricle; constant overload of the right side of the heart will cause an overload of the entire pulmonary vasculature (pulmonary over-circulation)

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9
Q

If there is a L to R shunt, which ventricle has to push our more blood? What does this result in?

A

Right ventricle; constant overload of the right side of the heart will cause an overload of the entire pulmonary vasculature (pulmonary over-circulation)

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10
Q

Qp/Qs > 1.5/1.0

A

Problem!! Eventually pulmonary hyptertension will develop

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11
Q

What does pulmonary hyptension cause for the RV?

A

Increased afterload (PVR) In addition to increased preload that the shunted blood form the LA to RA caused RV will be forced to generate higher tension/pressures to try to overcome the pulmonary HTN Could lead to RV failure (dilatation and decreased systolic function of the RV)

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12
Q

If Left to Right shunt is left uncorrected….

A

Pressure in right heart> pressure in left heart RA pressure > LA pressure Pressure gradient reverses across the ASD Shunt reverses (R to L shunt)= Eisenmenger’s syndrome Oxygen-poor blood gets shunted to the left heart Cyanosis

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13
Q

Eisenmenger’s Syndrome

A

Reversal of a L to R shunt to become a R to L shunt Oxygen-poor blood gets shunted to the left heart Causes cyanosis

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14
Q

Surgical Closure of VSD: Cardioplegia

A

Antegrade; usually a single dose will suffice

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15
Q

Surgical Closure of VSD: Case Notes

A

Very, very quick (5-10 min pump run) Will XC, Stay warm “ drift down temp “ Can be challenging: (on CPB, XC, CPG, warm, correct Ca++, lytes, ABG’s off CPB-MUF)

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16
Q

VSD

A

defect in the ventricular septum, the wall dividing the left and right ventricles of the heart

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17
Q

What does the ventricular septum consist of?

A

Inferior muscular portion Superior membranous portion

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18
Q

Common Regions of VSDs

A

Inlet Outlet (supracristal) Peri-membranous septum Muscular septum

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19
Q

What is the #1 type of VSD we will see? (What percent)

A

Per-membranous septum (75%)

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20
Q

What percent of VSDs are muscular?

A

20%

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21
Q

What percent of VSDs are supracristal (outflow)?

A

5%

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22
Q

Muscular VSDs are found in what four locations?

A

Anterior Mid-ventricular Posterior Apical

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23
Q

Muscular VSDs are found in what part of the septum?

A

lower part of the septum (they’re surrounded by muscule)

24
Q

The membranous portion of the ventricle is close to what?

A

AV node

25
Q

Membranous VSDs are located near what?

A

Heart valves

26
Q

What is the #1 type of VSD we will see? (What percent)

A

Peri-membranous septum (75%)

27
Q

Membranous VSDs are located near what?

A

Heart valves; can close at any time

28
Q

Supracristal VSD

A

outflow tract VSD sub-valvular in nature

29
Q

Crista Supraventricularis can be considered synonymous with what?

A

Infundibular (or conus) ventricular septum

30
Q

Outflow VSDs are found in what part of the ventricle?

A

Where blood leaves the heart; these are the rarest types of VSD

31
Q

What are the rarest types of VSDs?

A

Outflow VSDs

32
Q

What separates the tricuspid and pulmonary valves and accounts for the more superior placement of the pulmonary valves relative to the aortic valve?

A

Infundibular (or conus) septum

33
Q

What separates the tricuspid and pulmonary valves and accounts for the more superior placement of the pulmonary valves relative to the aortic valve?

A

Infundibular (or conus) septum

34
Q

Infundibular (or conus) septum provides muscular rigid support for what valve?

A

Aortic valve, especially the right coronary cusp (think prolapse)

35
Q

VSD

A

defect in the ventricular septum, the wall dividing the left and right ventricles of the heart

36
Q

Infundibular (or conus) septum provides muscular rigid support for what valve?

A

Aortic valve, especially the right coronary cusp (think prolapse)

37
Q

VSD Blood Flow Pattern During Systole

A

some of the blood from the left ventricle leaks into the right ventricle, passes through the lungs and reenters the left ventricle via the pulmonary veins and left atrium

38
Q

VSD Blood Flow Pattern During Systole

A

some of the blood from the left ventricle leaks into the right ventricle, passes through the lungs and reenters the left ventricle via the pulmonary veins and left atrium Results: Overloads LV Because the left ventricle normally has a must higher systolic pressure (120 mmHg) than the right ventricle (20 mmHG) a left to right shunt persists Elevated RV pressure and volume –> pulmonary HTN

39
Q

VSD Symptoms when there is a larger defect

A

Breathlessness, poor feeding, failure to thrive in infancy (patients with smaller defects may be asymptomatic)

40
Q

Ventricular septum is formed by what?

A

Outgrowth of the muscular ridge at the interventricular foramen; ventricular septum grows upward from the apex of the heart to the base of the heart

41
Q

VSD Cannulation

A

Arterial: Aortic Venous: Bicaval (total Cpb) Single atrial if the infant is small and DHCA is anticipated

42
Q

VSD Repair: Venting

A

May use direct venting with a flexible since the heart is open

43
Q

VSD Repair: Cardioplegia

A

Antegrade, usually with a single dose

44
Q

VSD Repair: Case Notes

A

case is quick depending on VSD location Case may be 32C or DHCA if small infant Can be challenging, but usually you have more time with VSD Ventricular function may be related to the length of time the VSD has been present

45
Q

What could Ventricular function in a pt with a VSD be related to?

A

Length of time the VSD has been present

46
Q

Surgical Correction of VSDs

A

Percutaneous closure *can be tough with VSDs Surgical closure (Primary, patch) *probably not primary

47
Q

symptoms of CHF in a child

A
  1. tachypnea
  2. diaphoresis with feeding
  3. poor feeding
  4. growth failure
  5. failure to thrive
  6. Respiratory distress
  7. Cyanosis
48
Q

VSD murmur

A

Pan-systolic

49
Q

Gold standard for diagnosis of VSD

A

ECHO

50
Q

when do moderate to large VSD present

A

first two months of life as the PVR decreases and the left to right shunt increases

51
Q

when would you decide to take the baby with a VSD to the OR

A

with mild symptoms: treat with diuretics and nutritional support.

Indications for OR:

  1. persistent sx despite OMM
  2. Moderate to large VSD with PAH (PVR 4-8, or PAP > 50% systemic)
  3. Asymtomatic VSD with a Qp/Qs > 2.1
  4. VSD with a history of endocarditis.
  5. VSSD associated with aortic valve prolapse
  6. Moderate or large VSD with LV dilation
  7. All inlet or outlet VSD
52
Q

How would you address a 6-month-old child found to have multiple muscular defects with a >2:1 L to R shunt?

A

Swiss cheese defects

Treated with PA banding.

Many will close with time.

53
Q

How would you treat a 6 month old child with supracristal VSD?

A

Transpulmonary approach with patch closure

54
Q

How would you address a 1-year-old child with an outlet VSD and significant AI?

A

surgery is indicated before damage is done to the aortic cusp (Right coronary cusp)

55
Q

How would you handle a patient with a large VSD and cyanosis?

A

Cyanosis or Right to left shunting on echo requires RHC

check PAP / PVR / Qp:Qs

if PVR > 8 and QP/Qs < 1.3 –> check for reversibility with supplemental O2 or inhaled NO

If not reversible –> then contraindication to VSD closure

Congenital Defects & Pediatrics COPY (19 decks)

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