Congenital disease and fetal circulation

Question 1

true/false - lungs are fluid filled in foetus

Answer 1

true

Question 2

describe blood flow in the foetus

Answer 2

blood from placenta goes to right of heart, crosses to left and pumped out to body

Question 3

function of ductus venosus

Answer 3

connects umbilican vein to IVC in the liver

Question 4

function of foramen ovale

Answer 4

connects RA to LA
allows blood to enter LA and ascending aorta
will close on high LA pressure

Question 5

function of ductus arteriosus

Answer 5

connects pulmonary bifurcation to descending aorta to allow excess blood into aorta

Question 6

what maintains patency of ductus arteriosus

Answer 6

prostaglandin E2
blood flow
relative hypoxia

Question 7

neonatal breathing drains fluid from lungs, where does it drain to?

Answer 7

lymphatics and circulation

Question 8

how is normal cyanosis reversed at birth

Answer 8

oxygen increase causes vasodilation in the lungs so less pulmonary resistance and better blood oxygenation

Question 9

what does the ductus arteriosum become

Answer 9

ligamentum arteriosum

Question 10

what causes ductus arteriosum to constrict

Answer 10

increased oxygenation
decreased flow
decreased prostaglandins

Question 11

in what neonate would ductus arteriosum fail to close

Answer 11

preterm infants

Question 12

what is a congenital heart disease when the ductus arteriosum is keeping neonate alive

Answer 12

duct dependent circulation

Question 13

when would you give IV prostaglandin E2

Answer 13

when duct dependent circulation is only solution temporarily until surgical plan devised

Question 14

diagnositc of PPHN

Answer 14

sats probe on right finger and toe. toe will be worse oxygenated due to more venous blood from ductus arteriosus

Question 15

treatment of PPHN

Answer 15

inhaled nitric oxide to improve pulmonary circulation

ECMO

Question 16

what is congenital heart disease?

Answer 16

abnormality of heart structure at birth

Question 17

where can congenital heart disease present

Answer 17

18-22 week USS - 33%
24 hour baby check - 50%
day 3-7
4-6 weeks by GP

Question 18

what is neonatal cyanosis

Answer 18

deoxygenated blood bypasses lungs to enter systemic circulation or where oxygenated and deoxygenated blood mix

Question 19

treatment of great artery transposition

Answer 19

surgery to repair

Question 20

what are the features of HLHS

Answer 20

LVH
enlarged ductus arteriosus
Stenosed aorta
ASD

Question 21

treatment of HLHS

Answer 21

3 stage complex surgery

fails over time and requires transplant

Question 22

4 duct dependent issues in systemic circulation

Answer 22

HLHS
critical aortic stenosis
critical coarctation of aorta
interrupted aortic arch

Question 23

2 duct dependent issues in pulmonary circulation

Answer 23

tricuspid atresia

pulmonary atresia

Question 24

treatment of small VSD

Answer 24

none

Question 25

when does cardiac failure present

Answer 25

after few weeks

Question 26

signs of moderate/large VSD

Answer 26

pansystolic murmir after weeks 
fail to thrive 
slow breathing/SOB
sweaty 
crepitations