4. Congenital Heart Disease Flashcards
1
Q
atresia
A
opening in the body that has been narrowed or closed of valves
2
Q
coarctation
A
narrowing
3
Q
cor pulmonale
A
right ventricular hypertrophy (RVH)
4
Q
infundibulum
A
muscle below the pulmonic valve
5
Q
what can infundibular spasm cause?
A
worsens pulmonic stenosis
6
Q
the infundibulum develops abnormally in what condition
A
tetralogy of fallot
7
Q
palliative surgery
A
operation intended to decrease severity of symptoms until pt can tolerate operation to fix condition
8
Q
when is palliative surgery particularly common?
A
pediatric heart operations
9
Q
palliative operation examples
A
BT shunt in order to keep child alive until they can tolerate open heart surgery for TOF correction
10
Q
BT shunt
A
blaylock-taussig shunt
artificial connection between aortic arch and pulmonary artery (artificial ductus arteriosus)
11
Q
infective endocarditis
A
infection of the heart chambers or valves
12
Q
what is a BT shunt
A
artificial connection between aortic arch and pulm artery
artificial patent ductus arteriosus
13
Q
what is necessary for pts with infective endocarditis?
A
prophylactic antibiotics have been recommended for patients who need to undergo operations
(unrepaired, palliated or corrected they all need it)
14
Q
common risk of CHD pts
A
infective enxocarditis
15
Q
compensating polycythemia
A
abnormally high Hct
-pts with congenital heart disease suffer from hypoxia and they make more red blood cells to compensate
16
Q
what are pts with compensating polycythemia more at risk for?
A
thrombosis
17
Q
pts with CHD suffer from
A
hypoxia
18
Q
pts with CHD compensate for hypoxia by
A
incr RBC
== incr Hct
19
Q
treatment for polycythemia
A
fluid replacement
brings Hct down towards normal
20
Q
paradoxical embolism
A
embolism that travels to the left side of the heart via ASD or VSD and is in arterial circulation (stroke!!)
21
Q
where does a normal embolism travel
A
travel to the lungs and stay on the right side of the heart/pulm artery
22
Q
what do anesthetists need to be very vigilant about when there is a risk for paradoxical embolism?
A
air bubbles in IV line
23
Q
cardiac shunt
A
abnormal blood flow pathways from one side of the heart to another
24
Q
which pts have an increased risk of paradoxical embolism with IV air injection?
A
pts w/ Right to Left shunt across ASD/VSD
25
what are the 4 possible cardiac shunts?
patent foramen ovale (PFO)
patent ductus arteriosus (PDA)
Atrial septal defect (ASD)
ventricular septal defect (VSD)
26
affect of increase SVR on cardiac shunt
more left to right shunt
| increase pulmonary blood flow
27
affect of decrease in SVR on cardiac shunt
more right to left shunt
| worsen hypoxemia
28
affect of increase PVR on cardiac shunt
more right to left shunt
| worsen hypoxemia
29
affect of decrease PVR on cardiac shunt
more left to right shunt
| increase pulmonary blood flow
30
are patients with right to left or left to right shunts more prone to have compensating polycythemia?
pts with right to left shunt because they have more hypoxia
31
problems with R-L shunt
1. decr pulm BF
2. hypoxia
3. paradoxic embolism
4. compensating polycythemia
32
R-L shunt anesthetic induction effects
inhalational slower
IV faster
33
R-L shunt worsened by
incr PVR
decr SVR
34
R-L shunt management
1. decr PVR
2. mx/incr SVR
3. prevent IV air bubbles
4. saline epidural LOR
35
what increases PVR?
hypoventilation
36
what can we do to decrease PVR?
higher FiO2
| modest hyperventilation
37
what decreases SVR?
anesthetic agents (regional and general) titrate slowly
38
what induction agent can be used to maintain SVR?
ketamine
39
can you do single shot spinal anesthetic with right to left cardiac shunt?
no it is contraindicated
40
in a right to left cardiac shunt how will the inhalational induction speed change?
slower
blood from R will enter L without picking up agent
dilutes vapor in arterial blood
41
in a right to left cardiac shunt how will the intravenous induction speed change?
faster
| drugs get to the L side of the heart faster
42
in a patient with right to left cadiac shunt what is the alteration to epidural catheter placement?
MUST use saline for loss of resistance
| for risk of air in vein getting into systemic circulation
43
what does the left to right cardiac shunt do to pulmonary blood flow?
promotes excessive pulmonary blood flow
44
what can excessive pulmonary blood flow lead to?
increase PVR
dyspnea
incr P on right side of heart
right ventricular hypertrophy
right heart failure
45
what can the L-to-R shunt/pulm congestion be worsened by?
decreases in PVR
increases in SVR
| increases in SVR
46
How is the anesthetic inhalation induction effected in the L-to-R shunt?
minimally (if any)
47
how is the anesthetic intravascular induction affected in the L-to-R shunt?
slightly prolonged
| it is slightly diluted
48
how should we change preload in a L-to-R shunt?
preload maintained to limit the amount of left to right shunting
49
L-R cardiac shunt management
1. mx/incr preload
2. mx/incr PVR
- low FiO2
- slight hypoventilation (PaCO2 40-50 mmHg)
3. decr SVR
4. prevent IV air bubbles
50
eisenmengers syndrome
eventually the pressure in the right heart becomes large enough that the shunt converts to a right to left shunt.
51
is eisenmengers syndrome more likely with high or low PAP?
higher PAP
52
which do you need to be extremely vigilant in preventing intravenous air bubbles? R-to-L shunt or L-to-R shunt?
BOTH
53
when managing a congenital heart disease patient what should you ask?
does this pt have too much pulm blood flow OR not enough pulm blood flow?
what can I do to correct that?
54
if the patient has too much pulm blood flow how can we decrease left to right shunting?
increase PVR
hypoventilate
lower fiO2
decrease SVR
55
if the patient doesnt have enough pulm blood flow how can we improve left to right shunting?
increase SVR
decrease PVR
hyperventilate
increase Fio2
56
patent ductus arteriosus
ductus arteriosus never closed after birth
| **some congenital heart disease having a PDA is necessary for survival
57
before birth how does the blood flow through the ductus arteriosus?
right to left shunt
58
after birth how does the blood flow through the ductus arteriosus?
left to right shunt
59
if no other defects are present how should blood flow through the PDA?
left to right
(from aorta to pulm artery)
increase pulmonary BF/congestion
| increasing pulm blood flow
60
right to left shunt acorss PDA
61
what is different about a patient with a PDAs blood pressure?
low diastolic blood pressure
62
anesthetic management of pt with PDA 3
1 measures to decrease left to right shunt and limit pulmonary congestion
2 up to 3 doses of indomethacin to close PDA
3 invasive monitoring is not essential in uncomplicated PDA
63
what should the fiO2 and PaCO2 be for a patient with a PDA?
low FiO2
| PaCO2 40-50mmHg
64
preductal circulation
blood flow to areas of the body proximal to the ductus arteriosus
65
postductal circulation
blood flow to areas of the body distal to the ductus arteriosus
66
if the ductal connection is distal to the subclavian then the preductal circulation includes 3
```
head (left common carotid)
right arm (brachiocephalic)
left arm (left subclavian)
```
67
if the ductal connection is distal to the subclavian then the postductal circulation includes
lower extremities and abdomen
68
if the ductal connection is proximal to the subclavian then the preductal circulation includes 2
head
R arm
| right arm
69
if the ductal connection is proximal to the subclavian then the postductal circulation includes
left arm
lower extremities/abdomen
| lower extremities and abdomen
70
is paradoxic air embolism more or less likely with ductus arteriosus porximal to subclavian
more risk ofr air embolism
71
where should you take a preductal blood sample from?
RIGHT radial artery
72
where should you take a postductal blood sample from?
artery in leg: femoral, dorsalis pedis, or posterior tibial artery
73
if preductal oxygen saturation is significantly different from postductal oxygen saturation what does that suggest?
a heart defect with right to left shunting across a PDA
74
aortopulmonary window
hole between aorta and pulm artery
75
aortopulmonary window shunt
Left to Right
76
aortopulmonary window symptoms
pulmonary congestion
77
Patient foramen ovale
foramen ovale never closed after birth
(10-25%)
78
how is blood expected to shunt in a PFO?
left to right
79
anesthetic management for patient with PFO 2
1 decrease left to right shunting to limit pulmonary congestion
2 should not allow any air in IV
80
atrial septal defect
ASD is hole between right and left atria
| LARGER PFO
81
anesthetic management of pt with ASD
higher preload
elevated PVR
lower SVR
82
ventricular septal defect
hole between left and right ventricles
83
anesthetic management of pt with VSD
higher preload
elevated PVR
lower SVR
84
Ebsteins Anomaly
malformation of tricuspid valve that results in tricuspid regurg= high right atrial pressure and right atrial enlargement
85
what other defect is more likely to occur when the pt has ebsteins anomaly
ASD (perforated foramen ovale)
| Right to left shunt
86
how does blood shunt with ebsteins anomaly and ASD?
right to left
87
anesthetic management of ebsteins anomaly
```
decrease PVR
-hyperventilate
- incr FiO2
increase SVR
avoid air bubbles in IV line
```
88
what will the patients SpO2 be for ebsteins anomaly with ASD?
lower b/c it is mixed venous/arterial blood
89
what would the hypoxemia in ebsteins anomaly cause?
compensating polycythemia
90
eisenmengers syndrome
left to right shunt reverses into a right to left shunt
91
why does flow reverse in eisenmengers syndrome?
pressure on the right side of the heart increases due to RV dilation/strengthening
92
clinical implication of eisenmengers syndrome
once it develops cyanosis ensures with varying degrees of heart failure and pulm congestion
HIGH RISK for surgery
93
anesthetic management for left to right shunts that have possible eisenmengers physiology 3
1 maintain SVR
2 maintain PVR
3 fine balance managing oxygenation
94
high FiO2 eisenmengers
leads to RHF
95
low FiO2 eisenmengers
leads to cyanosis
96
interrupted aortic arch
aorta isnt fully developed and there is a gap between ascending and descending aorta
97
in order for a pt with interrupted aortic arch to survive what two other defects must they have?
PDA
VSD
| ASD or VSD
98
what direction do you want blood flow through VSD in interrupted aortic arch?
L to R shunting through VSD
99
where does the oxygenated blood from the left ventricle perfuse? interrupted aortic arch pt
right upper extremity and part of the head
100
where does blood flow to the lower extremities come from in a pt with interrupted aortic arch?
right ventricle through PDA
| mixed venous/arterial blood
101
how do the blood pressure, pulse and spO2 differ from right arm to left arm
normally higher in the right because the interruption is usually proximal to the left subclavian
102
anesthetic management for interrupted aortic arch
```
keep ductus arteriosus patent
maintain preload
maintain SVR
```
103
what are the 4 defects of tetralogy of fallot?
1 pulmonic stenosis (right ventricular outflow tract obstruction RVOT)
2 right ventricular hypertrophy
3 VSD
4 overriding aorta
104
in tetralogy of fallot how does the blood shunt?
right to left across the VSD
105
what type of blood is perfusing the body through the overriding aorta in TOF patient
dexoy blood from RV
oxy blood from LV
106
SaO2 in pt with overriding aorta
Lower SaO2 due to mixed venous/arterial perfusion
107
what are the two ways for blood to get to the lungs in patients with TOF?
1. stenotic pulmonary valve
2. L - R shunting across PDA
**BF through both is limited**
| PDA (left to right shunt)
108
is a PDA necessary for life sustaining pulm blood flow in a patient with TOF?
YES
109
problems w/TOF
1. pulm BF is limited
2. R - L shunting causing hypoxia
3. PDA is necessary
110
indundibular spasm ______ hypoxia
worsens hypoxia symptoms
111
tet spell
sudden onset life threatening hypoxic spell in pts with TOF
112
what are tet spells caused by
infundibular spasm which triggers R - L shunting
| subsequent increase in right to left shunt
113
pt that is experiencing a tet spell can do what at home to help?
squat or use valsalva maneuver
114
causes of infundibular spasm 2
1. sympathetic stimulation (crying)
- tachycardia
- incr contractility
- hyperventilation
2. hypovolemia
115
why does spontaneous hyperventilation cause an infundibular spasm?
decreases intrathoracic pressure with increases venous return and increases right to left shunt
116
how does hypovolemia cause a infundibular spasm?
underfilled heart decreases diameter of RVOT = less blood to lungs for oxygenation
117
treatment for tet spell 7
1- 100% O2
2 - mod hyperventilation to decr PVR
3 - ketamine incr SVR
4 - phenylephrine incr SVR
5 - fluid bolus to incr preload
6- knee to chest
7 - beta blocker
8 - avoid beta agonists
118
why does knee to chest position help during tet spell?
incr SVR which forces blood into the pulmonary system
119
why does a beta blocker help during tet spell?
decr HR improves diastolic filling/preload
incr heart size
incr RVOT
120
why should you avoid beta agonists during tet spell?
incr contractility which worsens infundibular spasm
121
anesthetic managment for tetralogy of fallot 7
1- PDA kept open
2- R-L shunt managment
3 - avoid hypotension on induction
4 - consider phenylephrine/ketamine to treat hypotension
5 - minimize sympathetic stimulation
6 - mx or incr preload
122
what medicine is given to keep the PDA open?
PGE1 (prostaglandins)
123
how should you induce TOF pts?
IV induction with ketamine
124
why do we mx or incr preload in TOF pts?
to help keep the RVOT open
125
TOF surgical repair: initial surgery
palliative BT shunt to improve pulm BF and allow for PDA to close
126
TOF surgical repair: later surgery
close VSD
repair/replace pulmonic valve
127
Transposition of Great Arteries (TGA)
RV pumps into aorta
LV pumps into pulmonary artery
128
without shunts where is the deoxy and oxy blood in TGA
oxy blood in pulmonary system
dexoy blood in systemic systm
129
most common type of TGA
D-TGA
130
D-TGA
aorta positioned to the right and front of the pulmonary artery
131
L-TGA
aorta to the left and front of pulmonary artery
132
how many shunts must be present in TGA
at least 2
133
which shunts are present in TGA
R - L
L - R
134
TGA R-L shunt
shunt blood towards the lungs
(anatomy is reversed)
135
TGA L-R shunt
shunt blood away from lungs
(anatomy is reversed)
136
problems with TGA
1. decr BF to lungs
2. low SpO2
3. possible compensating polycythemia
4. air bubbles are catastrophic
137
TGA inhalational induction
slower
delayed
138
TGA IV induction
faster
more potent
139
TGA managment
1. keep PDA open w/PGE1
2. incr preload
3. mx/incr SVR
4. decr PVR
5. IV induction w/ketamine
6. TIVA mx
7. avoid air bubbles
140
which shunt do we want to favor in TGA
R - L shunting
(shunting blood towards the pulmonary system on the L)
141
which induction drug for TGA
ketamine to incr SVR
142
why is TIVA preferred for TGA
VA are cardiac depressants
inhaled anesthetics dont reach the brain as well in TGA
143
TGA surgical repair
baffle (atrial switch)
144
baffle
divers venous blood to L heart to be pumped out of LV to lungs
145
atrial switch
LA functions as normal RA
146
2 types of baffle/atrial switch procedures
mustard baffle
senning baffle
147
mustard baffle uses
synthetic material
148
senning baffle uses
pts own tissue
149
most common repair for TGA
arterial switch
150
arterial swtich
aorta and pulmonary artery are disconnected and reconnected to the proper ventricles
151
TAPVR
pulmonary veins empty into RA
(all blood returns to RH)
152
TAPVR pts have
ASD for R-L shunting
153
TAPVR problems
1. pulmonary congestion
2. R - L shunting
3. postop CO compromised
154
TAPVR has ________ pulmonary BF
increased pulmonary BF
(even though it has R-L shunting)
155
TAPVR R-L shunt does not cause
hypoxia
mixing of venous/arterial blood
156
why does TAPVR R-L shunt not incr hypoxia?
blood is mixed before the blood is shunted
157
what should you avoid in TAPVR?
air bubbles
158
what should you give post-op in TAPVR pts?
inotropes to prevent low CO and pulm HTN
159
pulmonary atresia
pulmonary valve is blocked
160
pulmonary atresia pts need
1. R-L shunt through ASD/VSD
2. PDA
161
pulm atresia problems
1. pulmonary BF limited
2. R-L shunting
3. ventricles become overloaded -- CHF symptoms
162
pulm atresia management
1. Keep PDA open w/PGE1
2. R-L shunt managment
3. Give inotropes (if CHF symtoms)
163
truncus arteriosus
aorta and pulmonary artery arise from same trunk
trunk acts like overriding aorta
164
trunk in truncus arteriosus is supplied by which ventricles
both RV and LV
165
truncus arteriosus shunts
L - R (LV -> pulmonary artery)
R-L (RV -> aorta)
166
in truncus arteriosus what is the body perfused with
mixed venous/arterial blood
167
which system receives the majority of the blood flow in truncus arterious
lungs
(excessive pulmonary blood flow)
168
truncus arteriosus management
limit pulm BF by mx an appropriate SVR:PVR ratio
169
incr flow to pulmonary system in truncus arteriosis will do what?
decr flow to systemic circulation
170
Atrioventricular canal defects
1. ASD
2. VSD
3. one atrioventricular valve
171
Atrioventricular canal defect AKA
endocardial cushion defect
common atrioventricular canal (CAVC)
septal defect
172
Atrioventricular canal shunts
R-L
L-R
173
which shunt is more prominent in atrioventricular canal defect?
L-R shunting
174
pulm BF in AV canal defect
excessive pulm BF
175
what blood is pt perfused with in AV canal defect?
mixed venous/arterial blood
- low SpO2
- compensating polycythemia
176
AV canal defect managment
1. limit pulm BF by incr PVR
2. avoid air bubbles
3. give inotropes for CHF symptoms
177
hypoplastic left heart syndrome (HLHS)
severely underdeveloped LH structures incapable of pumping blood to body
178
HLHS defects
1. underdeveloped LV
2. small/closed mitral/aortic valves
3. stenotic ascending aorta
179
what is required in HLHS?
ASD (L - R shunt)
PDA (RV - aorta)
180
if pulmonary BF increases in HLHS
CO decreases
higher % of blood goes to lungs instead of aorta
181
if pulmonary BF decreases in HLHS
CO increases
higher % blood through PDA to aorta
182
how do you incr CO in HLHS?
incr PVR
183
4 main problems in HLHS?
1. overworked RV (volume overload)
2. too much pulm BF
3. reduced CO
4. perfusion w/mixed venous/arterial blood (low Spo2) through PDA
184
management of HLHS
1. keep PDA open w/PGE1
2. limit pulm BF
185
what is controversial and contraindicated in pts with HLHS? Why?
supplemental O2
because it will decr CO and incr pulm congestion
186
what do HLHS pts need to stay alive?
immediate palliative surgery while waiting for heart transplant
187
norwood procedure treats
HLHS
188
norwood procedure
RV is attached to aorta
BT shunt placed
189
what does attaching the RV to the aorta do?
incr CO
decr BF to lungs (0 pulm BF)
190
what does a BT shunt do in norwood procedure?
allow pt to receive pulmonary BF
191
BT shunt blood flow in norwood
L - R from brachiocephalic artery to pulmonary artery
192
norwood procedure fixes what problems?
excessive pulm BF
CO
193
norwood procedure does not fix?
hypoxia
overworked RV
194
when does the norwood procedure take place?
during 1st week of life
195
sano shunt
modified norwood
connects RV and pulm artery
196
sano shunt benefits
possible improved survival
better coronary diastolic perfusion
197
BT shunt cons
lungs steal some blood from coronaries during diastole
198
Hemi-Fontan (Bidirectional Glenn) procedure for HLHS
1. SVC attached to pulm artery
2. BT shunt removed
199
hemi-fontan benefits
allows BF to lungs w/o BT shunt
reduced RV strain
200
problems after hemi-fontan
still have incr RV strain
still have hypoxia due to mixed perfusion
201
fontan procedure
IVC connected to pulm artery
(bypass RA)
202
blood flow after fontan
venous return bypass right heart
- no RV strain
blood flow to lungs is passive
203
what is the RV pumping after fontan
RV pumps arterial blood to body
204
management for pts w/fontan physiology
1. mx preload
2. slight hypoventilation
3. SV is preferred
4. arterial and central venous monitoring
205
why do you need to mx preload in fontan?
pulmonary BF is passive so its harder to get blood into lungs with hypovolemia
206
why is hypoventilation preferred in fontan?
incr pulm BF
incr CO
hypoventilation
= hypercarbia
= decr cerebral vascular resistance
= incr cerebral BF
= incr cerebral venous drainage
= incr pulm BF
207
which pts are impacted by protein losing enteropathy?
fontan pts
208
PLE
excessive loss of proteins across the intestinal mucosa
209
PLE etiology
unkown
210
PLE develops
5 years after fontan in 30% pts
211
PLE symptoms
peripheral edema
ascites
pleural
pericardial effusions
212
PLE treatment
digoxin
diuretics
parenteral albumin
SVR reduction
cardiac transplant
213
tricuspid atresia
blocked tricuspid valve
214
tricuspid atresia requires ____ for blood to get to lungs
ASD
and
VSD
215
tricuspid atresia problems
1. underdeveloped RV
2. overworked LV
3. hypoxia due to mixed perfusion
4. too much or too little pulm BF
216
which ventricle is doing all the work in tricuspid atresia
LV
217
what can pts die of if tricuspid atresia is not corrected?
LHF
218
when would tricuspid atresia have too much pulm BF?
large VSD
no pulm stenosis
219
when would tricuspid atresia have too little pulm BF?
small VSD
and/or
pulm stenosis
220
incr PVR in pulm atresia will
decr pulm BF
incr CO
221
decr PVR in pulm atresia will
incr pulm BF
decr CO
222
management of tricuspid atresia with reduced pulm BF
decr PVR
223
management of tricuspid atresia with incr pulm BF
incr PVR
224
tricuspid atresia surgical option with reduced pulm BF
palliative BT shunt
225
tricuspid atresia surgical option with incr pulm BF
palliative pulmonary artery banding
226
final surgical repair option for tricuspid atresia
fontan procedure
227
fontan procedure results in tricuspid atresia
1. decr LV strain
2. oxygenated perfusion
3. incr reliability of BF to lungs
228
double outlet right venticle
right ventricle supplies both the pulmonary artery and aorta
229
double outlet right ventricle needs
VSD to allow oxy blood to get to RH
230
problems with double outlet RV
1. RV overworked
2. hypoxia due to mixed perfusion
3. possible pulm stenosis
231
double outlet RV BF w/pulm stenosis
no excessive pulmonary BF
232
double outlet RV BF no pulm stenosis
excessive pulm BF
233
double outlet RV w/pulm stenosis managment
decr PVR
234
double outlet RV no pulm stenosis
incr PVR
235
decr SVR in double outlet RV will
decr pulm BF
236
coarctation of aorta
narrowing of aorta distal to left subclavian artery
237
problems with coarctation of aorta
1. decr CO
2. aortic dissection risk
3. BP different between lower and upper extremities
238
decr CO in coarctation of aorat causes
poor peripheral perfusion
metabolic acidosis
high afterload
CHF
aortic regurge
239
BP in coarctation of aorta in extremiteis
lower extremities will have lower BP compared to upper extremities
240
management of coarctation of aorta
1. mx preload (forward flow)
2. low-normal contractility
3. low-normal HR
4. avoid bradycardia
5. mx SVR
241
how is CO increased in coarcation of aorta
HR-dependent
242
why is hypotension bad in coarcation of aorta
perfusion will be seriously compromised
243
Shone's syndrome
Left-heart defects
1. coarctation of aorta
2. sub-aortic obstruction
3. supravalvular mitral ring (mitral stenosis)
4. parachute mitral valve (regurge)
244
Shone's syndrome problems
1. smaller LV
2. decr LV function
3. pulm HTN
245
Shone's syndrome surgical intervention
1. aortic arch repair
2. mitral valve replacement
3. aortic valve replacement (Ross procedure)
246
vascular rings
abnormal development of aortic arch that encircles trachea and/or esophagus
247
vascular rings leads to
tracheal compression
dyspnea
dysphagia
248
vascular rings AKA
double aortic arch
249
vascular ring surgery is typically
thoracotomy
(sometimes sternotomy w/bypass)
250
what size and type ETT w/vascular rings
smaller
armored (avoid compression)
251
can you extubate w/vascular rings?
if tracheomalacia and stenosis are not anticipated
252
vascular rings induction
inhalational w/spontaneous ventilation
253
what is avoided in vascular rings pts?
NMB agents
- only given when airway and PPV have been assessed
254
dextrocardia
heart is on right side of body
255
2 types of dextrocardia
situs inversus (most common)
situs solitis
256
situs inversus
reversal of normal positions of abdominal organs and heart
less comorbidities
257
situs solutus
normal abdonminal organs
reverse heart
more comorbidities
258
what should you change for dextrocardia pts?
ECG lead and defib paddles are reversed
259
Ross procedure indication
children w/diseased aortic valve
260
why are prosthetic valves bad in children
1. artificial valves not small enough
2. artificial valves dont grow w/child
3. incr risk of aortic stenosis w/aging
4. requires anticoags for life
261
Ross Procedure
aortic valve is replaced w/pts pulmonic valve
pulmonic valve is replaced with homograph from cadaver
262
Ross advantages
near-zero embolic risk
valve grows with child
263
Ross disadvantages
pulmonary homograft will develop regurge or stenosis in 15-20 years requiring another surgery
264
considerations in pts with repair CHD
tailor anesthetic to current heart function of pt as determined by diagnostic tests
265
ductal dependent systemic BF
PDA required for adequate systemic BF
266
ductal dependent systemic BF examples
interrupted aortic arch
HLHS
267
pts w/ductal dependent systemic BF typicall have
LVOT
268
ductal dependent pulmonary BF
PDA required for adequate pulm BF
269
ductal dependent pulm BF examples
TOF
pulmonary atresia
270
ductal dependedn pulm BF pts typically have
RVOT
