Acyanotic Defects

Question 1

What direction does blood shunt when there are holes in the heart?

Answer 1

Left to right!

PVR

Question 2

What is the most common type of ASD?

Answer 2

Secundum type 
(at the site of foramen ovale)

Question 3

What are the effects of an left to right shunt ASD?

Answer 3

Volume overload of RA, RV, and Lungs

Question 4

What determines the magnitude of the shunt?

Answer 4

Size of the defect
Relative compliance of ventricles
-RV more compliant

Question 5

What are the Physical findings in ASD?

Answer 5

Soft Pulmonary Ejection murmur -flow across normal valve
Soft Diastolic Murmur– flow across tricuspid valve
2nd Heart sound is widely split, fixed
No murmur from flow across defect

Question 6

What are the EKG findings in ASD?

Answer 6

RA enlargement
R Axis Dev
RV Hyp

Question 7

What are the CXR findings in ASD?

Answer 7

Inc Pulm Vascularity
Enlarged Heart size
Large Pulm Artery segment

Question 8

What is the Intervention for ASD?

Answer 8

Open heart surgery
-prosthetic patch
-Patients own pericardium
Device closure in cardiac cath lab
-Amplatzer Septal Occluder

Question 9

What are the features of a VSD?

Answer 9

Most common form of congenital HD
Can co-exist with other defects which may dominate the physiology
Septum divided into parts 
-small membranous portion
-large muscular portion

Question 10

What are the qualities of a Perimembranous VSD?

Answer 10

Most common
Located just below the Aortic Valve (left of septum)
Adjacent to septal leaflet of the tricuspid valve
Shunt may e limited by Tricuspid tissue

Question 11

What is unique about an inlet VSD?

Answer 11

Low chance of closing spontaneously

Posterior and inferior to perimembranous VSD

Question 12

What is the pathophysiology of a VSD?

Answer 12

Defects vary in size

L to R shunt at ventricular level (PVR

Question 13

What is used as a Pulm Artery Dilator?

Answer 13

O2 and Nitric Oxide

Question 14

What are history findings in VSD?

Answer 14

Small VSD Pt is asymptomatic
Large VSD
-delayed growth
-dec exercise tolerance
-freq pulm infections
-CHF
Long standing Pulm HTN Cyanosis may be present

Question 15

What murmurs can be heard in a VSD?

Answer 15

P2 heard more with a large VSD
Systolic Regurgitant murmur
Diastolic Rumble with large shunt

Question 16

What is the medical management of VSD?

Answer 16

Digoxin(more kick in the heart)
Diuretic
ACE inhibitor
High Cal formula

Question 17

What is the surgical management of VSD? Contraindications?

Answer 17

Growth failure not improved by meds
Not for long standing L to R shunt
Not if Cyanosis from R to L shunt (Eisenmenger: Deox blood to circulation)

Question 18

What kind of shunt if seen in a Patent Ductus Arteriosus?

Answer 18

Left to Right bc PVR

Question 19

Waht are EKG and CXR findings in PDA?

Answer 19

EKG:
Similar Findings as VSD
Small PDA-nothing
Large PDA- Possible LVH, LAE
CXR:
Small: normal
Large: Cardiomegaly and inc pulmonary vascularity

Question 20

What are the medical and surgical Tx of PDA?

Answer 20

Indomethacin to Constrict Vessels in Preterm infants
Device closure in cath lab

Litigation and division via left thoracotomy

Question 21

What pathology is associated with AVSD?

Answer 21

Down Syndrome

Question 22

Which shunt is dominant in AVSD?

Answer 22

Ventricular Shunt

Question 23

What are the EKG and CXR findings in ASD?

Answer 23

EKG: Left superior axis
CXR: Cardiomegaly
Increased Pulm Vascularity

Question 24

What are the causes of Pulmonary stenosis?

Answer 24

Valvar: Thick valve with fused or absent commisures, small orifice, associated with Noonan Synd.
Subvalvar, Supravalvar rare

Question 25

What are the EKG and CXR findings in Pulmonary Stenosis?

Answer 25

``` EKG: normal in mild cases RAD + RVH in mod to severe cases LVH CXR: Heart Size normal Vasc Normal ```

Question 26

What is the natural history of PS?

Answer 26

Mild does not progress Moderate DOES Progress Sudden death possible

Question 27

What is the Medical management of PS?

Answer 27

Baloon Valvuloplasty preferred to surgical repair | RV severely hypertrophied may develop 2ndary dynamic subvalvar obstruction

Question 28

What are the features and therapies associated with Aortic Stenosis?

Answer 28

LV Hypertrophy Avoid Sustained Strenuous activity Anti Congestives Baloon Valvuloplasty Aortic Valvotomy Aortic Valve replacement Excision of membrane or myectomy for subvalvar stenosis Patch Augmentation of supravalvar area.

Question 29

What is the Ross procedure?

Answer 29

Pulmonic valve replaces Vent valve | Cadaver valve replaces Pulm valve.

Question 30

What causes Coarctation of the Aorts?

Answer 30

Indenting of the Aorta by Ductus Arteriosus

Question 31

What are PE findings in Coartation of the Aorta?

Answer 31

Infants pale and dyspneic Weak peripheral Pulses Murmur is variable

Question 32

What is the natural history of Coarctation of the Aorta?

Answer 32

CHF by 3 months Renal Impairment Re-stenosis possible after repair HTN

Question 33

What is the Medical Management of Coarctation?

Answer 33

IV Prostaglandins to maintain ductal patency Anti Congestion meds Baloon angioplasty

Question 34

What is the Surgical Management for Coarctation?

Answer 34

Resection and end to end anastamoses Conduit insertion Fix Coarctation, VSD repair later