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LS CV Oral Review > Congenital 1-100 > Flashcards

Congenital 1-100 Flashcards

1
Q

What anomaly is associated with WPW ?

A

Ebstein’s Anomaly

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2
Q

Physiologic effect of ASD with shunt

A

Left to right shunt

RV failure

Pulmonary over circulation

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3
Q

Sequelae of ASD

A

symptoms from excess pulmonary blood flow and right-sided heart failure

  1. frequent pulmonary infections
  2. fatigue
  3. exercise intolerance
  4. palpitations.
  5. Atrial arrhythmias:
    • atrial flutter
    • atrial fibrillation
    • sick sinus syndrome
  6. Flow-related PAH accompanies large left-to-right shunts
  7. Paradoxical embolism
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4
Q

indication for closure of smaller ASD

A

Small ASDs with a diameter of less than 5 mm and no evidence of RV volume overload do not impact the natural history of the individual and thus may not require closure

unless associated with paradoxical embolism.

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5
Q

Class I indications for the closure of an ASD

A

Closure of an ASD either percutaneously or surgically is indicated for:

  1. right atrial and RV enlargement with or without symptoms. (Level of Evidence: B)
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6
Q

PAP and indications for the closure of an ASD

A

Closure of an ASD, either percutaneously or surgically, may be considered in the presence of:

net left-to-right shunting,

pulmonary artery pressure < 2/3 systemic levels,

PVR < 2/3 SVR

or when responsive to either pulmonary vasodilator therapy or test occlusion of the defect (patients should be treated in conjunction with providers who have expertise in the management of pulmonary hypertensive syndromes). (Level of Evidence: C)

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7
Q

Variants of DORV

A

Based on the location of the phenotypic large VSD

  1. Simple - Below the Aorta
  2. Taussig - Bing - below the pulmonic
  3. Doubly committed VSD
  4. Non-committed - remote to the great arteries
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8
Q

Taussig - Bing heart

A

DORV with VSD below the pulmonary artery

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9
Q

Ductal dependent cyanotic congenital heart diseases

A

Ductal-dependent lesions

  1. Tetralogy of Fallot
  2. Tricuspid atresia or Ebstein’s anomaly
  3. Pulmonic atresia or stenosis
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10
Q

Ductal independent cyanotic congenital heart lesions

A
  1. Truncus arteriosus
  2. Transposition of the great arteries
  3. Total anomalous PVR
  4. HLHS
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11
Q

Teleologic reason for prematurity and PDA

A

respiratory distress results in elevation of prostaglandin levels that may lead to persistence of the PDA

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12
Q

Indomethacin treatment of PDA

A

0.2mg/kg over 20 minutes at 12 and 24 hours

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13
Q

what % of premature infants will have a successful closure of a PDA with inodmethacin

A

80%

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14
Q

Indications for the closure of a PDA in adult patients

A

signs of LV volume overload

PAH but PAP <2/3 of systemic pressure or PVR <2/3 of SVR

Device closure is the method of choice where technically suitable PDA closure should be considered in patients with PAH and PAP >2/3 of systemic pressure or PVR >2/3 of SV but still net L–R shunt (Qp:Qs >1.5) or when testing (preferably with nitric oxide) or treatment demonstrates pulmonary vascular reactivity

III C PDA closure should be avoided in silent duct (very small, no murmur) PDA closure must be avoided in PDA Eisenmenger and patients with exercise-induced lower limb desaturation

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15
Q

Criteria for a “hemodynamically significant” pda

A

two or more of the following signs are present:

  • increased pulse volume or widened pulse pressure
  • hyperactive precordium
  • increased pulmonary vascular markings on chest radiograph
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16
Q

should all PDA in adults be closed

A

Yes, endocarditis

17
Q

What are the complications of PDA ligation (surgical)

A

Chyle leak (<2)

Vagus / recurrent laryngeal nerve injury (2-9%)

Hemorrhage (<1%)

Recanaliztion (@)

18
Q

pediatric cardioplegia dose (for at least ASD repair)

A

25cc/kg

19
Q

Types and prevalence of ASD

A
  1. Secundum (80%)
  2. sinus venosus (10%)
  3. Primum (10%)
  4. Coronary sinus (10%)
20
Q

potential complications of ASD ?

A

Bleeding

Residual ASD

Sinus node dysfunction

Baffle occlusion

21
Q

Patient with TAPVR

medical support

A

Low oxygen setting

High PEEP (decrease pulmonary blood flow / edema)

Inotropes

Avoid - Prostaglandins and pulmonary vasodilators

22
Q

what to look for on Echo for TAPVR

A
  1. Anatomic variant
    1. Supracardiac
    2. Cardiac
    3. Infracardiac
  2. Presence and location of the shunt
    1. Survival is dependent on RàL shunt
    2. Almost always due to non-restrictive PFO
  3. Evidence of RV Fluid overload
23
Q

Medical / preop management of TAPVR

A
  1. Patients requiring resuscitation should be intubated
    1. kept on low oxygen settings and high PEEP
    2. decrease pulmonary blood flow and limit pulmonary edema.
  2. Inotropes should be used as necessary.
  3. AVOID: Prostaglandins and pulmonary vasodilators should be avoided.
  4. TAPVR with obstruction: surgical emergency
  5. TAPVR without obstruction: may optimize with diuretics and supplemental oxygen, proceed with early elective repair
24
Q
  1. After TAPVR -, the baby has difficulty weaning from ventilator, CXR shows right pleural effusion and congestion.
A

likely has an obstruction at the anastomosis of the right veins.

  1. Obtain an echo (transthoracic) to evaluate the right sided pulmonary venous return.
  2. Consider contrast enhanced MRI, CTA of the heart, or possibly catheterization to look for obstruction.
  3. May need surgical revision with sutureless technique (see above).
25
Q

Shone complex

A

Shone complex

four obstructive left heart lesions

  1. supravalvular mitral membrane
  2. parachute mitral valve
  3. muscular or membranous subvalvular aortic stenosis
  4. coarctation of aorta.
26
Q

when is coarc significant

A

> 50% stenosis

27
Q

vent settings to prevent pulm overcirculation with coarctation of the aorta

A
  1. Ventilation (prevent pulm over circ)
    1. Low FiO2
    2. pCO2 > 45
28
Q

Indications for ASD repair in children

A

Children:

  • Large shunt, FTT
  • Evidence of RV / LV volume overload
  • Secundum – should be corrected at 3-5 years
  • TIA/stroke
29
Q

Indications for ASD repair in adults

A

Adults:

  • Pulmonary hypertension: ASD should be fixed to prevent
  • If PVR < 10 u/m2, good outcomes.
  • IF PVR > 15 à high mortality

LS CV Oral Review (6 decks)

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