Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds > 9. ASD/VSD- Exam 3 > Flashcards

9. ASD/VSD- Exam 3 Flashcards

1
Q

normals BP: <40 weeks gestation

A

48-63 / 25-35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

normals BP: <36 hours old full term

A

62 / 39

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

normals BP: >36 hours old full term

A

68 / 43

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

normals BP: 1 year

A

98-104 / 55-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

normals BP: 2 year

A

101-107 / 59-64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

normals BP: 5 year

A

107-114 / 69-72

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Normal BF per 0-3 kg

A

200 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Normal BF per 3-10 kg

A

150 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal BF per 10-15 kg

A

125 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Normal BF per 15-30 kg

A

100 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Normal BF per >30 kg

A

75 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Normal BF per >55 kg

A

65 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common ASDs occur where?

A

septum primum within the fossa ovalis (secundum ASD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Less common ASDs occur where?

A

Defect can involve the septum secundum near SVC (sinus venosus defects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what will an ASD cause

A

Will cause pressure mediated shunting L->R *compliant right heart R->L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are Cyanotic shunts?

A

right to left shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are Acyanotic shunts?

A

left to right shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What shunt is of the most concern you?

A

Cyanotic shunts R->L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How may shunts be quantitated?

A

PULMONARY BLOOD FLOW (Qp) SYSTEMIC BLOOD FLOW (Qs) –Qp/Qs –1:1 is a normal ration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the general rule for shunts that do NOT require treatment

A

The general rule is shunts that DO NOT cause an INCREASE in right heart size (Qp:Qs < 1.5) do NOT require treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pulmonary over circulation=

A

left to right shunt that causes an increase in right heart size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

with a left to right shunt- what will the Qp/Qs ratio look like

A

over 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Qp/Qs less than 1.5=

A

small shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Qp/Qs over 2=

A

large shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Qp/Qs= [formula]

A

(SatAO − SatMV) / (SatLA − SatPA) -SatAO is the aortic blood oxygen saturation -SatMV is the mixed venous blood oxygen saturation, -SatLA is the left atrial blood oxygen saturation -SatPA is the pulmonary artery blood oxygen saturation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the 4 types of ASDs and which is most common

A

Ostium Secundum (the most common) Patent Foramen Ovale Ostium Primum Sinus Venosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Ostium Secundum anatomy=

A

formed by failed growth of the septum secundum or rapid reabsorption of the septum primum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Ostium Secundum occurs where on the atrial septum

A

Middle of atrial spetum Only ASD suitable for percutaneous closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Ostium Secundum causes what kind of mixing and sats

A

even distribution of mixing higher sats in RV starts out as a L->R shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Patent Foramen Ovale anatomy=

A

-small channel that has little hemodynamic consequence -it is a remnant of the fetal foramen ovale. -In some cases the PFO can be larger and require treatment -Normally closes due to pressure changes very early in life -“flap valve”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

describe how Patent Foramen Ovale are supposed to close

A

–The initial inflation of the lungs causes changes: –Decreases PVR= in increased BF from PA. –That increased amount of BF from the RA to the RV and into the PA’s and less BF through the foramen ovale to the LA. –Q= P/R such that decreased R = increased flow –In addition, more blood returns from the lungs which increases the pressure in the LA. –The increased LA pressure and decreased RA pressure (due to PVR) forces blood against the septum primum causing the foramen ovale to close. –This action functionally completes the separation of the heart into two pumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Ostium Primum anatomy=

A

located low in the septum and can be considered a type of AV septal defect –Could have RA saturations lower than RV without a VSD

33
Q

Sinus Venosis anatomy=

A

located high in the septum where the vena cava intersects with the right atrium, frequently associated with partial anomalous venous return (PAPVR) –May be inferior and/or superior

34
Q

Embryonic/fetal circulation is _____ to the neonatal circulation

A

different

35
Q

________ forms separate chambers

A

Embryonic septation –Several septal defects of heart septation may only become apparent on this transition

36
Q

what atrial septal defect occurs in all of us

A

the foramen ovale (between the 2 atria) which in general closes in the neonate over time.

37
Q

Cardiac Septation [atrial and ventricular] occurs on what day? last how long?

A

Occurs at Day 27 Lasts 10 days -The formation of the cardiac septa occur simultaneously -During this time, no major changes in external appearance

38
Q

Atrial Septation=

A

At day 27-28, the paired atria fuse together to form a common atrium. -Atrial septation occurs simultaneously and in cooperation with ventricular septation -Atrial septation also lasts approximately 10 days

39
Q

in normal patients left heart pressure is ____ than right heart pressure. Why?

A

higher -This is because the thick LV has to produce enough pressure to pump blood throughout the entire body, while the thin RV only has to produce enough pressure to pump blood to the lungs

40
Q

In the case of a large ASD (>9mm), which may result in a __________________ shunt

A

clinically remarkable left-to-right

41
Q

with an ASD, Blood will shunt from the LA to the RA. what will this cause

A

This extra blood from the left atrium may cause a volume overload of both the RA and the RV (RA dilatation-> RA fibrosis) .

42
Q

if an ASD that causes vol overload to the right heart goes untreated, what happens

A

If untreated, this condition can result in enlargement of the right side of the heart and ultimately right heart failure

43
Q

describe the full effects of an ASD (the pathway)

A

ASD present -> Increased right sided volume -> Right atrial and ventricular dilatation -> Tricuspid annular dilatation (TR) -> Pulmonary congestion -> Pulmonary hypertension/Over circulation/Hypertrophy

44
Q

With ASDs, Any process that increases the pressure in the LV can cause worsening of the ____ shunt. It also works on the ____ heart. Included are?

A

left-to-right right systemic hypertension, which increases the pressure that the LV has to generate in order to open the aortic valve

45
Q

With ASDs, how does pulmonary over circulation occur

A

The RV will have to push out more blood than the left ventricle due to the L -> R shunt –Eventually pulmonary hypertension will develop

46
Q

With ASDs, how does right ventricular failure (dilatation and decreased systolic function of the right ventricle) occur after pulmonary over circulation is present

A

–The pulmonary HTN will cause the RV to face increased afterload (PVR) in addition to the increased preload that the shunted blood from the LA to RA caused. –The RV will be forced to generate higher tension/pressures to try to overcome the pulmonary HTN

47
Q

With ASDs, if the pulmoanry HTN and RV failure is left untreated what happens

A

the shunt will reverse!! –RA pressure > LA pressure –The pressure gradient reverses across the ASD –a right-to-left shunt (R->L) will now exist –This shunt reversal phenomena is known as Eisenmenger’s syndrome

48
Q

ASD shunt reversal phenomena is known as?

A

Eisenmenger’s syndrome

49
Q

What happens when Eisenmenger’s syndrome happens and the L->R shunts reverses to R->L?

A

oxygen-poor blood gets shunted to the left side of the heart. This will cause signs of cyanosis.

50
Q

what are the surgical corrections for ASDs

A
  1. Percutaneous closure (Amplatzer) 2. Surgical Closure –Primary Closure=Closure by direct vision suture –Patch Closure=Uses pericardial tissue or Gore-Tex patch for closure
51
Q

Percutaneous closure (Amplatzer) of the Ostium Secundum requires what to close the umbrella

A

ridged tissue

52
Q

Surgical Correction of ASD’s incision sites (3)?

A

–Median sternotomy –Right thoracotomy (going between the ribs on the right side) –Sub-mammary (under the breast tissue on the right front of the chest)-very difficult

53
Q

ASD cannulation sites: atrial+venous

A

Arterial: Aortic Venous: Bicaval (total CPB) –Single Atrial if the infant is small and DHCA is anticipated

54
Q

ASD venting:

A

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

55
Q

ASD cardioplegia:

A

Antegrade, usually a single dose will suffice 30ml/kg (maybe less- just enough to arrest the heart)

56
Q

ASD case notes:

A

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

57
Q

The ventricular septum consists of what portions

A

Inferior muscular portion Superior membranous portion

58
Q

what are the 4 common regions for VSDs

A

Inlet Outlet (supracristal) Peri-membranous Septum Muscular Septum

59
Q

what are the 3 common types of VSDs and the % occurrence for each

A

Membranous 75 % Muscular 20 % Supracristal (Outflow) 5 %

60
Q

Muscular ventricular septal defect is found in what 4 locations

A

anterior mid-ventricular posterior apical

61
Q

where are muscular VSDs found

A

lower part of the septum. They’re surrounded by muscle. (most close on their own during early childhood.)

62
Q

where are membraneous VSDs found? what is special about them?

A

The membranous portion, which is close to the atrioventricular node. located near the heart valves –These VSDs can close at any time

63
Q

what type of VSD is most common in adults and older children

A

Membraneous VSD

64
Q

describe supracrystal VSDs

A

-Outflow tract VSD sub-valvular in nature -Can be considered synonymous with the infundibular (or conus) ventricular septum

65
Q

where are supracrystal VSDs found? what is their occurrence

A

Outlet VSDs are found in the part of the ventricle where blood leaves the heart. T -These are the rarest type of VSD

66
Q

The infundibular (or conus) septum separates what and accounts for what?

A

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

67
Q

due to the location of the supracrystal VSD, what other bad things may happen

A

This portion of the septum also provides muscular rigid support for the aortic valve, especially the right coronary cusp—>which may cause a prolapse –cause poor right coronary flow and make it hard to deliver cpg

68
Q

During systole, some of the blood from the LV leaks into the RV, passes through the lungs and reenters the LV via the pulmonary veins and LA. This may cause what 2 effects

A
  1. the circuitous refluxing of blood causes volume overload on the LV 2. because the LV normally has a much higher systolic pressure (~120 mm Hg) than the RV (~20 mm Hg), a L–>R shunt persists
69
Q

with VSDs, the leakage of blood into the right ventricle causes what

A

elevates RV pressure and volume, causing pulmonary HTN

70
Q

VSD effects are more noticeable in what patients? what are the symptoms?

A

This effect is more noticeable in patients with larger defects, who may present with breathlessness, poor feeding and failure to thrive in infancy

71
Q

Patients with smaller defects may be?

A

asymptomatic

72
Q

Ventricular Septation - review –The ventricular septum is formed by the outgrowth of the muscular ridge at the ________. –The ventricular septum grows in what direction?

A

interventricular foramen upward from the apex of the heart to the base of the heart

73
Q

VSD cannulation: arterial + venous

A

Arterial: Aortic Venous: Bicaval (Total CPB) –Single Atrial if the infant is small and DHCA is anticipated

74
Q

VSD venting:

A

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

75
Q

VSD cardioplegia:

A

Antegrade, usually a single dose will suffice

76
Q

VSD case notes:

A

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

77
Q

why is Ventricular function may be related to of the length of time the VSD has been present

A

over time the ventricle may have compensated and hypertrophied

78
Q

VSD surgical correction options:

A
  1. Percutaneous closure (Amplatzer) [can be tough] 2. Surgical Closure –Primary closure [less common b/c VSDs are muscular] –Patch Closure

Peds (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions