Ch 17 (Cardiac Surgery Anesthesia) Flashcards
Cyanotic children compensate for chronic hypoxia with increased …
- erythropoiesis
- increased circulating blood volume
- vasodilation
- metabolic adjustments of factors such as the circulating concentration of 2,3-diphosphoglycerate (2,3-DPG)
which 4 defects are associated with R ➔ L shunting
- TOF
- pulmonary atresia
- tricuspid atresia
- ebstein anomaly
which 4 defects are a/w L ➔ R shunting
- Atrial septal defect (ASD)
- Ventricular septal defect (VSD)
- Patent ductus arteriosus (PDA)
- Endocardial cushion defect (e.g., atrioventricular septal defect [AVSD]) - Aortopulmonary window (AP window)
what happens to pulmonary blood flow in a L ➔ R shunt
pulmonary blood flow ↑
what happens to pulmonary blood flow with a R ➔ L shunt
↓ pulmonary blood flow with cyanosis
Complex Shunts: Mixing of Pulmonary and Systemic Blood Flow With Cyanosis (5)
- Transposition of the great arteries (TGA)
- Truncus arteriosus
- Total anomalous pulmonary venous connection (TAPVC)
- Double-outlet right ventricle (DORV)
- Hypoplastic left heart syndrome (HLHS)
Simple left-to-right shunts increase ____________
pulmonary blood flow
what is Eisenmenger syndrome
- Severe pulmonary hypertension that leads to suprasystemic pulmonary artery pressures that cause the shunt to reverse, leading to cyanosis.
- The previous left-to-right shunt reverses to become a right-to- left shunt.
- At this point, the child’s condition becomes inoperable.
most common congenital defect in children, occurring in 1.5 to 3.5 of 1000 live births and accounting for more than 20% of CHD
VSD
DiGeorge Syndrome Clinical Features
most common cyanotic CHD defect accounting for 6% to 11% of all CHD
TOF
4 features of TOF
- VSD
- Overriding aorta
- Right ventricular outflow tract obstruction (RVOTO)
- Right ventricular hypertrophy
Management of a tet spell
- Simple measures (e.g., morphine to reduce infundibular spasm, Valsalva maneuver or legs-to-knee chest position to increase SVR) may be effective.
- Early and aggressive use of a vasoconstrictor is essential (e.g., metaraminol or phenylephrine).
- Phenylephrine should be premixed and in a syringe for immediate use
TGA refers to..
the situation in which the aorta arises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle
what is truncus arteriosus
The basic lesion is that of a common arterial outlet for the aorta and pulmonary artery associated with a single valve with variable morphology (called a truncal valve) and a VSD
Truncus arteriosus has a known association with ____________ syndrome
DiGeorge
hypoplastic left heart syndrome
aortic stenosis pathophysiology
- There is an increasing imbalance between myocardial oxygen supply and demand.
- Coronary blood flow is impaired due to low coronary perfusion pressure, while workload on the left ventricle is increased, leading to subendocardial ischemia, left ventricular hypertrophy, and a risk of left ventricular failure.
what is coarctation of the aorta
- discrete narrowing of the aorta, and it accounts for about 5% of CHD.
- lesion is often isolated with no other associated abnormalities
The most common form of coarctation of the aorta presenting in the neonatal period is the ____________ type.
preductal
