Ch 17 (Cardiac Surgery Anesthesia)

Question 1

Cyanotic children compensate for chronic hypoxia with increased …

Answer 1

• erythropoiesis
• increased circulating blood volume
• vasodilation
• metabolic adjustments of factors such as the circulating concentration of 2,3-diphosphoglycerate (2,3-DPG)

Question 2

which 4 defects are associated with R ➔ L shunting

Answer 2

• TOF
• pulmonary atresia
• tricuspid atresia
• ebstein anomaly

Question 2

which 4 defects are a/w L ➔ R shunting

Answer 2

• 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)

Question 3

what happens to pulmonary blood flow in a L ➔ R shunt

Answer 3

pulmonary blood flow ↑

Question 4

what happens to pulmonary blood flow with a R ➔ L shunt

Answer 4

↓ pulmonary blood flow with cyanosis

Question 5

Complex Shunts: Mixing of Pulmonary and Systemic Blood Flow With Cyanosis (5)

Answer 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)

Question 6

Simple left-to-right shunts increase ____________

Answer 6

pulmonary blood flow

Question 7

what is Eisenmenger syndrome

Answer 7

• 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.

Question 8

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

Answer 8

VSD

Question 9

DiGeorge Syndrome Clinical Features

Answer 9

Question 10

most common cyanotic CHD defect accounting for 6% to 11% of all CHD

Answer 10

TOF

Question 11

4 features of TOF

Answer 11

• VSD
• Overriding aorta
• Right ventricular outflow tract obstruction (RVOTO)
• Right ventricular hypertrophy

Question 12

Management of a tet spell

Answer 12

• 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

Question 13

TGA refers to..

Answer 13

the situation in which the aorta arises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle

Question 14

what is truncus arteriosus

Answer 14

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

Question 15

Truncus arteriosus has a known association with ____________ syndrome

Answer 15

DiGeorge

Question 16

hypoplastic left heart syndrome

Answer 16

Question 17

aortic stenosis pathophysiology

Answer 17

• 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.

Question 18

what is coarctation of the aorta

Answer 18

• discrete narrowing of the aorta, and it accounts for about 5% of CHD.
• lesion is often isolated with no other associated abnormalities

Question 19

The most common form of coarctation of the aorta presenting in the neonatal period is the ____________ type.

Answer 19

preductal