Congenital Heart Disease Flashcards
What type of shunt is associated with acyanotic
congenital heart disease?
Left-to-right intracardiac shunt. The result of this shunt is
pulmonary hypertension, right ventricular hypertrophy, and
congestive heart failure.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 49.
When should surgical correction of an ASD be
implemented?
ASDs should be surgically closed when pulmonary blood flow is
1.5 times the systemic blood flow.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 50.
Describe the three different types of atrial septal
defects (ASDs).
- Ostium Primum (also called endocardial cushion defect) is a
large opening located in the interatrial septum 2. Sinus venosus
is a form of ASD found in the upper atrial septum 3. Ostium
secundum (which is the most common type of ASD) is in the
region of the fossa ovalis and ranges from a single opening to a
septum that is fenestrated. They are frequently located close to
the center of the interatrial septum.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 49-50.
Regardless of where the shunt is located, what is the
end result of acyanotic congenital heart disease?
Increased pulmonary blood flow with pulmonary hypertension,
hypertrophy of the right ventricle, and after time, congestive
heart failure.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 49.
Describe the medical treatment of PDAs.
Nonselective cyclooxygenase inhibitors, both COX-1 and COX-
2 are used. These drugs inhibit prostaglandin synthesis. The
use of indomethacin (a nonselective cyclooxygenase inhibitor)
is the first line of therapy used for PDA, and has reduced the
need for surgical closure by 60%.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 53.
What risks are associated with the surgical closure
of PDAs in infants?
Infections, intracranial hemorrhage, and paralysis of the
recurrent laryngeal nerve
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 53.
What type of murmur accompanies a patent ductus
arteriosus?
A continuous systolic and diastolic murmur
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 52.
What determines the pulmonary/systemic blood flow
ratio in a patient with a patent ductus arteriosus?
- The length and diameter of the ductus arteriosus 2. The
pressure gradient that exists from the aorta to the pulmonary
artery 3. The pulmonary/systemic vascular resistance ratio
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 52.
What is Eisenmenger’s syndrome?
Eisenmenger’s syndrome is a reversal of a left-to-right
intracardiac shunt due to an increase in the pulmonary vascular
resistance. Once the pulmonary vascular resistance reaches a
level that is equal to or exceeds systemic vascular resistance,
the shunt reverses to a right-to-left shunt.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 59.
What is the principal indication for cardiac transplant?
Dilated cardiomyopathy is the primary indication for cardiac
transplantation. Patients who respond the most favorably to this
procedure are those younger than 60 years of age who were
formerly otherwise healthy and whose symptoms are now
worsening despite medical therapy.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 139.
What is the most common congenital cardiac
abnormality seen in children and infants?
Ventricular septal defects (VSD)
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 51.
What type of murmur is associated with aortic
stenosis?
A systolic murmur. It can be heard over the second intercostal
space on the right side and frequently radiates into the neck.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 53.
List possible postoperative complications
immediately following the surgical repair of
coarctation of the aorta.
Paraplegia, hypertension, aortic regurgitation, infective
endocarditis
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 55.
What are the clinical manifestations of a previously
undetectable coarctation of the aorta?
Dizziness, palpitations, headache, and epistaxis
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54-55.
What is the hallmark symptom of cyanotic congenital
heart disease?
Cyanotic congenital heart disease is comprised of a right-to-left
intracardiac shunt and a decrease in blood flow to the
pulmonary system, with resultant arterial hypoxemia.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56.
How do volatile anesthetics affect left-to-right shunts?
Volatile anesthetics cause a decrease in systemic vascular
resistance, thus decreasing the left-to-right shunt.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 50.
What are the four anomalies associated with
tetralogy of Fallot?
- Hypertrophy of the right ventricle 2. VSD 3. An overriding
aorta 4. Right ventricular outflow obstruction
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56.
Children with tetralogy of Fallot frequently assume a
squatting position. Why is this?
Squatting causes an increase in systemic vascular resistance,
creating an increase in pulmonary blood flow, and temporarily
relieving their symptoms.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56.
Pregnant women with coarctation of the aorta are at
an increased risk for what complication?
Aortic dissection
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54-55.
List complications associated with coarctation of the
aorta.
Aortic dissection, systemic hypertension, premature ischemic
heart disease, left ventricular failure, CVAs resulting from the
rupture of intracerebral aneurysms, and infective endocarditis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54-55.
Distinguish the difference beween postductal and
preductal coarctation of the aorta.
The two types of coarctation of the aorta are based upon the
location of the narrowed area in relation to the position of the
ductus arteriosus. Preductal coarctation of the aorta is located
proximal to the opening of the ductus arteriosus, whereas in a
postductal coarctation, the narrowing occurs distal to the ductus
arteriosus.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 478.
What type of murmur is associated with tetralogy of
Fallot?
An ejection murmur caused from blood flowing across a stenotic
pulmonary valve. This murmur can be auscultated along the
sternal border on the left side.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56.
Describe congenital aortic stenosis.
Congenital aortic stenosis develops from a deformed bicuspid
aortic valve. It is not stenotic at birth, but the valve leaflets
thicken and calcify with time.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 53.
How does an increase in pulmonary vascular
resistance or a decrease in systemic vascular
resistance affect the right-to-left intracardiac shunt in
patients with tetralogy of Fallot?
The right-to-left shunt is increased, which increases arterial
hypoxemia
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56-57.
List the adverse side effects of indomethacin.
Indomethacin can result in renal and platelet dysfunction.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 749.
What is a patent ductus arteriosus?
A patent ductus arteriosus is the failure of the ductus arteriosus
to close after birth. Closure usually occurs within 24-48 hours
after birth. The ductus arteriosus connects the descending
aorta to the left pulmonary artery in the fetus, and it serves as a
bypass for pulmonary arterial blood to directly enter the
descending aorta rather than the deflated lungs. This failure to
close results in a continuous blood flow from the aorta to the
pulmonary artery.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 52.
What is the effect of an increased systemic vascular
resistance or decrease in pulmonary vascular
resistance on a patient with an ASD?
There is an increase in the left-to-right shunt
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 49-50.
Do patients with VSDs presenting for noncardiac
surgery require prophylactic treatment against
infective endocarditis?
Yes
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 51.
What are the ECG manifestations of large VSDs?
Evidence of left ventricular and atrial enlargement is present. If
pulmonary hypertension also exists, there is a rightward shift of
the QRS axis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 51.
Where would the murmur of a moderate to large
VSD be auscultated the loudest?
he lower left sternal border. This murmur is holosystolic.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 51.
What effect do large VSDs have on ventricular
systolic pressures?
There is an equalization of ventricular systolic pressures. The
degree of pulmonary and systemic blood flow is determined by
the vascular resistances located within the two circulations.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 51.
What are the two determinants of the physiological
magnitude of a VSD?
- The size of the VSD 2. The resistance in the pulmonary and
systemic circulations
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 51.
Where are most VSDs located anatomically?
In the membranous portion of the intraventricular septum
(70%). VSDs can also be found in the muscular portion of the
septum (20%), close to the junction of the mitral and tricuspid
valve (5%), and inferior to the aortic valve, resulting in aortic
regurgitation (5%)
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 51.
How does positive-pressure ventilation affect left to
right shunts?
Positive-pressure ventilation increases pulmonary vascular
resistance, which results in a decrease in the left-to-right shunt.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 50.
What ECG findings are typical in patients with
congenital aortic stenosis?
There is evidence of left ventricular hypertrophy, and ST
segment depression often occurs during exercise.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54.
What effect does the use of a high FiO2 have on a
patient with an ASD?
There is a decrease in pulmonary vascular resistance, which
results in an increase in pulmonary blood flow and left-to-right
shunt.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 50.
What is the most common congenital abnormality
that results in aortic dissection?
Although Marfan syndrome and Ehlers-Danlos syndrome are
associated with an increased risk for aortic aneurysm and
dissection, bicuspid aortic valve is far more common, occurring
in 1% of the population.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 155.
Why would a patient with a double aortic arch avoid
flexion of their neck?
Flexion of the neck worsens tracheal compression.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 67.
What are some signs and symptoms of a double
aortic arch?
Dysphagia, inspiratory stridor, and difficulty in the mobilization
of secretions
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 67.
What is tricuspid atresia?
Tricuspid atresia is a type of congenital heart disease in which
there is a complete absence of the tricuspid valve. The right
ventricle is small, the left ventricle is enlarged, arterial
hypoxemia is present, and there is a significant decrease in
pulmonary blood flow. An ASD is present, and pulmonary blood
flow occurs from a VSD, bronchial blood vessels, or a PDA.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 61.
What is the most common cyanotic congenital heart
disease?
Tetralogy of Fallot
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56.
When a patient with Eisenmenger’s syndrome
undergoes noncardiac surgery, what should the
maintenance of anesthesia be based upon?
Maintaining the same degree of systemic vascular resistance
that existed preoperatively will help avoid an increase in the
right-to-left shunt that occurs with vasodilation.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 59-60.
What impact does an increase in systemic vascular
resistance have on a patient with an ASD?
There is an increase in the left-to-right shunt
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 50.
What are the symptoms associated with large ASDs?
Right heart failure, supraventricular dysrhythmias, dyspnea on
exertion, recurrent pulmonary infections, paradoxical embolism
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 50.
What are signs and symptoms of Eisenmenger’s
syndrome?
As the right-to-left shunt increases, decreased exercise
tolerance and cyanosis develops. Erythrocytosis develops as a
result of arterial hypoxemia, which increases the viscosity of the
blood, leading to headaches, dizziness, paresthesias, and
visual problems. Palpitations often occur due to the onset of
atrial flutter or atrial fibrillation. Hemoptysis and coagulopathies
are seen, as well as an increased chance of CVA and brain
abscess.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 59.
What is Ebstein’s anomaly?
A tricuspid valve abnormality in which the valve leaflets are
displaced into the right ventricle, or the leaflets are malformed.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 60.
List three things that can increase the right-to-left
shunt of patients with TOF.
- An increase in myocardial contractility 2. An increase in
pulmonary vascular resistance 3. A decrease in systemic
vascular resistance
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56-57.
What is the key to understanding the management of
anesthesia in patients with tetralogy of Fallot?
An in-depth knowledge of the drugs and different events
affecting the extent of the right-to-left shunt.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56.
What is truncus arteriosus?
Truncus arteriosus is a congenital heart defect in which the
aorta and pulmonary arteries derive from a single trunk that
overrides both the left and right ventricles. A VSD is present,
and the mortality rate is high.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 64.
What are the signs and symptoms of truncus
arteriosus?
Failure to thrive, congestive heart failure, arterial hypoxemia
and cyanosis
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 64.
Management of anesthesia in patients with truncus
arteriosus is influenced by what main factor?
The degree of pulmonary blood flow that is present.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 64.
Describe the difference between partial and total
anomalous pulmonary venous return.
Partial anomalous pulmonary venous return is a cardiac defect
in which the left or right pulmonary veins empty into the right
side of circulation instead of the left atrium. In total anomalous
pulmonary venous return, all four pulmonary veins drain into the
systemic venous system.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 65.
Should patients with PDAs presenting for noncardiac
surgery be given prophylactic antibiotics to protect
against infective endocarditis?
Yes
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 53.
What is the significance of a double aortic arch?
A double aortic arch creates a vascular ring that produces
compression of the trachea and esophagus.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 67.
Without surgical correction, what is the mortality rate
of patients with tetralogy of Fallot?
Over 50% by the age of 3
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 57.
What congenital heart disorders create mechanical
obstruction to the trachea?
Aberrant left pulmonary artery, double aortic arch, absent
pulmonic valve
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 67-68.
What are the signs and symptoms of an aberrant left
pulmonary artery?
Expiratory stridor, arterial hypoxemia, wheezing
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 67-68.
What is an aberrant left pulmonary artery?
A congenital heart defect in which there is an absent left
pulmonary artery. The left lung receives arterial blood via a
branch of the right pulmonary artery that passes between the
trachea and esophagus.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 67-68.
What is the result of an absent pulmonic valve?
Pulmonary artery dilation which can cause compression of the
left mainstem bronchus and trachea.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 68.
Should patients undergoing dental or surgical
procedures with tetralogy of Fallot receive antibiotics
for prophylactic treatment of infective endocarditis?
Yes
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 57.
What is hypoplastic left heart syndrome?
A congenital heart defect in which parts of the left side of the
heart are not completely developed. The left ventricle, mitral
valve, and ascending aorta are hypoplastic, aortic valve atresia
is present, and there is a patent ductus arteriosus.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 65-66.
How is pulmonic stenosis identified in patients not
exhibiting signs or symptoms of disease?
A loud systolic ejection murmur is present. It can be best heard
on the left side at the second intercostal space.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54.
What considerations should be given during the
management of anesthesia during a surgical
resection of coarctation of the aorta?
- The likelihood of systemic hypertension once the aorta is
cross-clamped 2. Adequacy of blood flow to the lower body
once the aorta is cross-clamped 3. The risk of spinal cord
ischemia and the neurologic outcomes that would occur due to
the cross-clamping of the aorta.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 55.
What mean arterial pressure is desired in the lower
extremities during aortic cross-clamping to ensure
blood flow is adequate to the spinal cord and
kidneys?
40 mmHg or greater
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 55.
Does a patient with an ASD require prophylactic
treatment against infective endocarditis?
Unless there is an associated valvular disorder, patients with an
ASD do not require prophylactic treatment against infective
endocarditis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 50.
What arrhythmias are common in patients following
surgical repair of tetralogy of Fallot?
Atrial fibrillation, atrial flutter, right bundle branch blocks
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 59.
What other disorders may accompany patients with
coarctation of the aorta?
PDA, aneurysms of the Circle of Willis, mitral regurgitation or
stenosis, Turner’s syndrome, bicuspid aortic valve.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54-55.
Describe transposition of the great vessels.
In transposition of the great vessels, the aorta arises from the
right ventricle, and the pulmonary artery arises from the left
ventricle. The result is a complete separation of systemic and
pulmonary circulations.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 62-63.
When managing the anesthetic of a patient with
congenital pulmonic stenosis, what cardiac changes
must be avoided?
Increases in myocardial contractility and heart rate must be
avoided due to the increased oxygen demand it places on the
right ventricle.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54.
At what point should surgical repair for coarctation of
the aorta be considered?
When the transcoarctation pressure gradient is more than 30
mmHg, surgical intervention should be considered.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54-55.
How is congenital pulmonic stenosis treated?
Percutaneous balloon valvuloplasty
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54.
Describe the characteristics of hypercyanotic attacks.
Hypercyanotic attacks frequently accompany exercise or crying
and are associated with tachypnea, worsening arterial
hypoxemia and cyanosis. In extreme instances, seizures, loss
of consciousness, cerebrovascular accidents, and even death
can occur.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 57.
What pharmacologic agents cause a decrease in
systemic vascular resistance and result in an
increase in the right-to-left shunt of patients with
TOF?
Alpha adrenergic blockers, volatile anesthetics, ganglionic
blockers, and agents that evoke histamine release.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 58-59.
What intracranial disorder are patients with cyanotic
congenital heart disease at major risk for developing?
A brain abscess
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 56.
How does an increase in systemic vascular
resistance or a decrease in pulmonary vascular
resistance affect the left-to-right shunt in a patient
with a PDA?
The left-to-right-shunt is increased
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 52-53.
How does a decrease in systemic vascular
resistance affect the left-to-right shunt in a patient
with a PDA?
The left-to-right shunt is decreased, therefore, systemic blood
flow is improved.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 424.
Is coarctation of the aorta seen more frequently in
males or females?
Males
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 54-55.
