Congenital heart disease

Question 1

How do you manage VSD?

Answer 1

⅓ will close spontaneously

Severe w/ HF signs: diuretics + digoxin

Surgery if no response to decongestion

Question 2

How do you manage ASD?

Answer 2

Symptomatic - surgical or catheterization closure

Asymptomatic - elective closure at 3 years of age

Question 3

How do you manage PDA?

Answer 3

Asymptomatic = watchful waiting

Symptomatic = IV indomethacin – promoting closure

surgical closure

Question 4

How do you manage coarctation of the aorta?

Answer 4

Prostaglandin E1 (alprostadil) to keep ductus arteriosus open in preoperatively

Neonates = anastomosis

Balloon angioplasty for older kids

Question 5

How do you manage tetralogy of fallot?

Answer 5

Treat spells with oxygen + knee-chest position

IV Morphine to relax pulmonary infundibulum + sedation
Consider phenylephrine to increase vascular resistance
Prostaglandin therapy to maintain ductal patency
Beta blockers to decrease risk of Tet spells until surgery

Surgical repair
Birth - 2 years
Close VSD + repair stenosis
Bacterial endocarditis prophylaxis indicated until 6 months or until VSD repaired

Question 6

Tetralogy of fallot patients usually need later in life a

Answer 6

pulmonary valve replacement

Question 7

How do you treat transposition of the great vessels?

Answer 7

Prostaglandin E1 (alprostadil)
Balloon atrial septoplasty

Arterial switch operation performed w/n 2 weeks of life