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Fall25 AdvPrin C > Pediatric Cardiovascular Surgery (Exam II) > Flashcards

Pediatric Cardiovascular Surgery (Exam II) Flashcards

1
Q

Name the normal adult anatomy depicted by 1 in the figure below.

A

Brachiocephalic Artery

Also called the Innominate Artery.

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2
Q

Name the normal adult anatomy depicted by 2 in the figure below.

A

Right Subclavian Artery

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3
Q

Name the normal adult anatomy depicted by 3 in the figure below.

A

Right Common Carotid Artery

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4
Q

Name the normal adult anatomy depicted by 4 in the figure below.

A

Left Common Carotid Artery

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5
Q

Name the normal adult anatomy depicted by 5 in the figure below.

A

Left Subclavian Artery

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6
Q

What limits blood flow to the lungs in the neonate?

A

High PVR

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7
Q

What vessels bypass pulmonary circulation in neonates?

A

Foramen Ovale & Ductus Arteriosus

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8
Q

What vessels are connected via the ductus arteriosus?

A

Pulmonary Artery & Aorta

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9
Q

What is the purpose of the Ductus Venosus?

A

The DV allows for maternal blood going to the fetus to be shunted past the liver directly into the Vena Cavae.

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10
Q

Fetal Circulation Diagram

A
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11
Q

What are the three major changes that occur with fetal circulation at birth?

A
  • ↓PVR
  • ↑ blood flow through pulmonary veins
  • Placental flow ceases
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12
Q

What occurs with neonatal alveolar PCO₂ and PO₂ at birth?

A
  • PCO₂ decreases
  • PO₂ increases

occurs within minutes.

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13
Q

What occurs due to the massive decrease in PVR at birth?

A

Blood flow moves through previously low flow pulmonary veins.

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14
Q

What occurs between Left Atrial Pressure (LAP) & Right Atrial Pressure (RAP) as a neonate is born?

A
  • LAP exceeds RAP and forces closure of Foramen Ovale
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15
Q

Why should air in venous access be avoided in children under the age of 5?

A

50% of children in this age group still have a patent Foramen Ovale.

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16
Q

What occurs with SVR as a neonate is born?

A

SVR increases

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17
Q

What occurs with Vena Cava flow as a neonate is born?

A

Vena Cava flow decreases

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18
Q

What occurs with right atrial pressure as a neonate is born?

A

RAP decreases

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19
Q

What occurs with DA flow as a neonate is born?

A

DA flow reverses and fills with oxygenated blood.

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20
Q

The DA is mostly closed by ____ after birth.

A

two days

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21
Q

How long does the DV remain patent after birth?

A

several days

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22
Q

What is the consequence of a patent DV in a neonate needing surgery the day after being born?

A

Drug metabolism is delayed due to blood flow still shunting away from the liver.

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23
Q

What two factors cause closure (constriction) of the DA?

A
  • ↑ PaO₂
  • Loss of Prostaglandins
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24
Q

What can occur if hypoxia occurs immediately after birth?

A

PVR can increase & FO & DA may reopen.

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25
Q

What is the clinical consequence of reopening FO & DA?

A

Hypoxia worsens (due to blood bypassing lungs)

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26
Q

What conditions can prolong transitional circulation?

A
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27
Q

In the neonate, is the RV or the LV thicker?

A

RV

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28
Q

What is the electrical consequence of a neonate having a thickened RV?

A

180° axis

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29
Q

Why are neonates rate dependent for CO?

A

Cardiac tissue is less contractile (inability to change SV).

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30
Q

What are the consequences of neonates having immature myofibrils and sarcoplasmic reticulums?

A
  • Sensitivity to CCBs & citrated PRBCs
  • Ca⁺⁺ exchange more dependent on sarcolemma
  • Ca⁺⁺ replacement more necessary than in adults.
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31
Q

What is the consequence of neonates having immature autonomic innervation?

A

Inability to respond to stress (fever, acidosis, etc.)

32
Q

Left to Right shunts are known as ______ shunts.

A

Acyanotic

33
Q

Name examples of Left-to-Right shunts.

A
  • ASD
  • VSD
  • PDA
  • Coarctation of the Aorta
34
Q

What is the PVR in Acyanotic shunts?

A

↓PVR

35
Q

What is the consequence of low PVR in Left-to-Right shunts?

A
  • Pulmonary blood flow increases
  • Pulmonary volume overload
  • ↑ LV workload (CHF?)
36
Q

What should be avoided in left-to-right shunts?

A
  • Vasodilators
  • 100% FiO₂
  • ↓ PCO₂
  • Alkalosis
37
Q

What are the hemodynamic features of a Left-to-Right shunt?

A
  • ↑ pulmonary perfusion
  • ↓ CO
  • ↓ systemic perfusion
  • ↓ BP
  • LV overload
38
Q

Cyanotic shunts are also known as _______ shunts.

A

Right-to-Left

39
Q

Why do Right-to-Left shunts occur?

A

PVR or Pulmonary outflow tract pressure > than SVR.

40
Q

What are the features of Cyanotic shunts?

A
  • ↓ Pulmonary Blood Flow
  • Deoxygenated blood in circulation
  • Systemic Hypoxia
  • RV failure
41
Q

What are examples of Cyanotic shunts?

A
  • TOF
  • Transposition
  • Truncus Arteriosus
  • Hypoplastic Left Heart
42
Q

What should be avoided in Right-to-Left shunts?

A
  • SNS stimulation
  • ↓ FiO₂
  • ↑ PCO₂
  • Acidosis
43
Q

How will an inhaled induction change when comparing a patient with Right-to-Left vs a patient with Left-to-Right shunt?

A

Right-to-Left

  • Prolonged inhaled induction

Left-to-Right

  • Normal inhaled induction
44
Q

Why are inhaled inductions slower in Right-to-Left shunt patients?

A

Blood is bypass lungs thus slower uptake of VAA.

45
Q

What type of cardiac defect is defined as having pulmonary & systemic O₂ saturations that are almost identical?

A

Mixing lesions

46
Q

What is an example of a mixing lesion?

A

Truncus Arteriosus

47
Q

What are examples of obstructive lesions?

A
  • Aortic Stenosis
  • Coarctation of the Aorta
48
Q

What is the hemodynamic result of severe obstructive lesions?

A

Overloaded ventricle just proximal to the lesion.

  • Profound ventricular failure
  • Impaired coronary circulation
  • Systemic ↓BP
  • Hypoxemia
49
Q

Obstructive lesions require the _____ to provide systemic flow.

A

PDA (patent ductus arteriosus)

50
Q

Why does PVR decrease so quickly after birth?

A

Due to Lung expansion & oxygenation

51
Q

Infant PVR has reach adult pressure levels by ____ of age.

A

6 months

52
Q

What things increase PVR?

A
  • PEEP
  • Atelectasis
  • ↓ FiO₂
  • Acidosis
  • ↑ H/H
  • ↑ SNS
  • Direct surgical stimulation
  • Vasoconstrictors
53
Q

What things decrease PVR?

A
  • Low airway pressures
  • Lung expansion to FRC
  • ↑ FiO₂
  • Alkalosis
  • ↓ H/H
  • Deep Anesthesia
  • NO
  • Vasodilators (milrinone, PG’s, etc.)
54
Q

NO is a _______ pulmonary vasodilator.

A

selective

55
Q

What is the typical inhaled NO dose?

A

20 - 40 ppm

56
Q

Why should NO be discontinued slowly?

A

Abrupt discontinuation can cause rebound pHTN.

57
Q

Patent Foramen Ovale is a subtype of Atrial Septal Defect. T/F?

A

True

58
Q

Watch video on the different types of Atrial Septal Defect

A
59
Q

What is the most common congenital defect?

A

VSD’s

20% of congenital heart defects

60
Q

What are the two types of VSD?

A
  • Restrictive: small defect
  • Unrestrictive: large defect
61
Q

How does monitoring change for PDA repairs?

A
  • Two pulse oximeters (one on right hand and one on left foot)
62
Q

If your left foot pulse oximeter loses its reading during a PDA repair, what would the CRNA expect?

A

Aorta may be clamped

63
Q

What is the most common cyanotic heart defect?

A

Tetralogy of Fallot

64
Q

What are the four components of ToF?

A
  • VSD
  • Overriding Aorta
  • RV outflow obstruction
  • RV Hypertrophy
65
Q

What are TET spells?

A

Episodes where stress (crying, feeding, acidosis, surgical stimulation) causes epidoses of hypercyanosis & worsening RV outflow obstruction.

66
Q

What are components of anesthesia for TOF repair?

A
  • Preop sedation (to prevent TET spells)
  • 100 FiO₂
  • β blockade
67
Q

What option (other than complete repair) is there for TOF patients?

A

Blalock-Taussig Shunt

Systemic-Pulmonary shunt
- From subclavian artery to branch pulmonary artery.

68
Q

What are the components of Transposition of the Great Arteries? (ToGA)

A
  • Aorta comes off the RV
  • Pulmonary Artery comes off the LV
  • Some mixing via PDA or VSD
69
Q

What allows for a patient with ToGA to live despite this defect?

A

Oxygenated blood mixing via PDA or VSD

70
Q

What would indicate an urgent/emergent repair of ToGA?

A

ToGA w/ no VSD (no mixing = no oxygenation)

71
Q

What are the features of Truncus Arteriosus?

A
  • Fusion of PA & Aorta
  • Common valve between PA & Aorta
  • Large VSD
72
Q

Truncus Arteriosus is associated with what syndrome?

A

DiGeorge Syndrome

73
Q

Besides DiGeorge syndrome, what other abnormalities are associated with Truncus Arteriosus?

A
  • Aortic Arch issues
  • Absent parathyroids
  • Immune deficiency
74
Q

What are features of Hypoplastic Left Heart Syndrome? (HLH)

A
  • Hypoplastic LV
  • Mitral Stenosis/Atresia
  • Aortic Stenosis/Atresia
  • Hypoplastic Aortic Arch
  • ASD
75
Q

An HLH patient’s sats are typically in the _____.

A

80%’s

76
Q

Patients who survive past the age of 5 with HLH eventually require ______.

A

Heart Transplantation

77
Q

What are the goals of HLH anesthesia?

A
  • Balance PVR and SVR
  • PaCO₂ normal
  • Keep FiO₂ very low

Fall25 AdvPrin C (11 decks)

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