March 1, 2016 - Right to Left Shunts

Question 1

Central Cyanosis

Answer 1

True cyanosis

Central mucous membranes

Question 2

Peripheral Cyanosis

Answer 2

Acrocyanosis

Perioral cyanosis

Often normal in otherwise healthy children

Question 3

Transposition of the Great Arteries (TGA)

Answer 3

The aorta is connected to the right ventricle and the pulmonary artery is attached to the left ventricle.

Deoxygenated blood and oxygenated blood are on different circuits.

There needs to be a patent foramen ovale (PFO), atrial septal defect (ASD), or ventricular septal defect (VSD) to allow the blood to mix and the baby to survive.

Babies are often born cyanotic.

Keep the ductus arteriosus open by using prostaglandins, and surgery is needed in the first few weeks of life.

https://www.youtube.com/watch?v=lBGUtiBp8k8

Question 4

TGA Treatment

Answer 4

Prostaglandins to keep the ductus arteriosus open, and surgery is needed during the first few weeks of life to switch the pulmonary artery and aorta to their normal locations.

Question 5

Tetralogy of Fallot

Answer 5

1. Pulmonary stenosis
2. Over-riding aorta
3. VSD
4. Right ventricular hypertrophy

Needs surgical repair.

Question 6

Truncus Arteriosus

Answer 6

A common arterial trunk is shared between both the aorta and the pulmonary artery. A VSD allows the mixing of blood in a common chamber, and the mixed blood is pumped through the trunk which goes to the body, and to the lungs.

As the baby ages, the pulmonary pressure drops, causing too much blood to go to the lungs, resulting in congestive heart failure.

Requires surgery