Cardiovascular

Question 1

Two examples of right to left shunt

Answer 1

1. Tetralogy of fallot

2. Transposition of the great arteries

Question 2

Four features of Tetralogy of fallot

Answer 2

1. Stenosis of the right ventricular outflow tract (makes it difficult for deoxy blood to get to pulmonary circulation)
2. Right ventricular hypertrophy (as a result of the difficulty in pumping blood out to the pulm circulation)
3. Large ventricular septal defect (allows shunting of blood from right to left as pressure in the right side can exceed that of the left due to the stenosis)
4. Aorta overrides septal defect (this is variable)

Question 3

Baby with hypercyanotic spells, loud harsh ejection systolic murmur and a small heart on CXR.

What is the likely diagnosis?

Answer 3

Tetralogy of fallot

Question 4

Life-threatening cyanosis on day two of life, ‘egg on side’ cardiac contour on CXR and loud single second heart sound.

What is the likely diagnosis?

Answer 4

Transposition of the great arteries- presents when the ductus arteriosus closes.

Mgmt:
Establishing prostaglandin infusion to maintain patency of the ductus arteriosus is essential.
Balloon atrial septostomy (a balloon is pulled through the atrial septum from left to right atria in order to increase the size of the atrial defect) may be life saving. This allows mixing of oxy and deoxy blood to be compatible with life.