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Peds > Peds Test 5 > Flashcards

Peds Test 5 Flashcards

1
Q

Patent Ductus Arteriosus (PDA)

A
  • L to R (flow from aorta to pulm after birth)
  • aortic runoff with low aortic diastolic pressure= hypo perfusion
  • common with Down Syndrome
  • if not fixed= increase pulm flow= pulm HTN= shunt reversal= cyanosis
  • -percutaneous correction: transcatherter device closure
  • -surgical correction: 1) ligation- tie shut 2) division- tie and cut = No CPB
  • keep it open with Prostaglandin E1 (PGE1) “alpostadil”= reopens within 30 min to 2 hr
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2
Q

Absent Pulmonary Valve

A
  • pulm insufficiency= R/pulm over circulation
    1) no pulm valve
    2) dilated pulm artery- extrinisc compression of bronchial airway= compromised oxgygen saturation
    3) VSD R-L
  • -treatment= plication of PA, valve replacement, VSD closure
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3
Q

Pulmonary Atresia with Intact Ventricular Septum

A

1) ASD R-L
2) Atretic Pulm valve- closed off entrance to PA
3) PDA- only way for BF to get to lungs
4) Hypoplastic right ventricle and TV= results in coronary artery sinusoids (coronaries get their blood from RV)
- PA normal size, Hight RV resistance/pressure= better for coronary perfusion
- decompressing the RV by opening the pulm valve= ischemia
- –Treatment= PGE1
- -with RV dependent sinusoids or RV hypolastic= balloon atrial septostomy to decompress RA and BT shunt with Fontan later
- -NO RV dependent sinusoids and RV large enough= put in valve, then systemic to PA shunt (BDG?) or PDA stent
- -prone to hemodynamic instability, ICU 1-2 weeks

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4
Q

Pulmonary Atresia with VSD

A

normal RV, large VSD: R-L=cyanosis

1) Confluent branch of PA fed by ductus arteriosus
- –repair- Rastelli (RV to PA) and close VSD
2) Hypoplastic branch PAs with aortopulmonary collaterals (discontinuous-some PAs coming from aorta)= progressive stenosis and hypoxemia
- –repair- unifocal of AP collaterals (reattach them to pulm vessels), RVOT reconstruction, eventually close VSD

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5
Q

Pulmonary Stenosis

A

-increase RV tension/work= RV hypertrophy
–normal= 25 mmHg, mild= 45, mod= 46-89, severe/supra= 90 (mod and higher= ventricular hypertrophy)
-if ASD: R-L
Repair (or Rastelli: RV to PA)
–Supra= balloon angioplasty/stent or enlargement
–Vavular (can cause PA dilation)= balloon angioplasty or commissurotomy
–Infundibular/outflow tract stenosis= remove extra muscle

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6
Q

Aortic Stenosis

A
  • any shunting would be L-R, develops LV hypertrophy (decrease LV function and MI)
    1) Supravalvular (with Williams Syndrome)
  • -correction= zig zag cut stenosis out, CPB is short
    2) Subaortic Stenosis (with coarctation or interrupted arch)
  • -correction= remove as much tissue thru aorta and Aortic Valve, CPB is short
  • -Konno Procedure (often with Ross)= if small annulus and need to replace valve==remove aortic valve, coat triangle out of ventricle to enlarge and replace valve
    3) Critical AS= present in neonatal period, symptoms worse as PDA closes
  • -correction= relieve obstruction of blood flow thru aortic valve w/o causing AI= percutaneous blood valvotomy OR surgical AV commissure
  • post op- depends on LV function- ECMO, VAD and may require a valve replacement later
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7
Q

Aortic Insufficiency

A

LV dilation, low CO, CHF, exercise intolerance, dyspnea, dizzy, edema

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8
Q

Ross Procedure

A
  • aortic valve replacement with patient’s own pulm valve= grows with kid and no anticoagulants
  • coronaries are re-implanted, RVOT reconstructed, cryopreserved homograft (w/ valve) interned into original pulm root (fails first)
  • -CBP
  • cannulation= aortic and bicaval or single
  • CPG= antegrade arresting dose, retro maintenance
  • 28 degrees and mod-long timing (2-3 hours)
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9
Q

Ebstein’s Malformation/Anomaly

A

“atrialezed RV”= tricuspid valve below annular ring (needs PDA)
-has ASD/PFO, pulm atresia
-RV pumps blood back into RA= cyanotic cuz ASD
=clubbing, TV insufficient, RA,RV dysfunction, mall RV= PV doesn’t open (PV atresia)
–Correction= want normal TV and close ASD (separate pulm and systemic circulations)
1) Postnatal= Bi-ventricular = plicate atrialized portion of RV, reconstruct TV annulus, close ASD, resect the redundant atrial wall
2) Neonatal= univentricular = patch TV with fenestrations (closing off RV), OPEN ASD more,, plicate RV, divide PDA and add PA shunt, BDG, Fontan

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10
Q

Tricuspid Atresia

A

1) ASD: R-L= cyanotic
2) TV atresia (no TV valve)
3) Hypoplastic RV
4) Pulm stenosis
5) VSD: L-R, then to PA
6) PDA
-severe cyanosis, clubbing, dyspnea, fatigue, RHF
–Correction= systemic to PA shunt (BT, BDG, Fontan) OR Rashkind (balloon atrial septostomy)
–Can’t do valve replacement
CPB
-cannulation- aortic and bicaval
-CPB- one antegrade dose

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11
Q

Mitral Valve Insufficiency vs. Prolapse

A

Insuff= LA filling, dilation, hypertrophy

Prolapse- with or without regurgitation, many asymptomatic, have SOB, palpitations, chest pain, only treat if severe

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12
Q

Mitral Stenosis

A
  • may only have one papillary muscle= parachute
  • LA dilation, high La pressures= pulm HTN, edema, RHF
  • -Correction= if pulm edema= diuretics
  • -surgical MV repair/replacement
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13
Q

Valve Procedures

A

1) Valvuloplasty= transcatheter balloon valvuloplasty with echo (for stenosis- inflates and makes bigger)
2) Percutaneous Pulm Valve Insertion= Melody valve- catheter pulm valve for failed RV to PA conduits (for stenosis or regurge= palliative to open shunt (so aka. placing inside Rastelli)
3) TAVR (transcatheter aortic valve replacement)= for aortic stenosis, retrograde trans arterial insertion (must lower CO for inserting)
- bad positions- leaks, emboli, coronary occlusion
4) Edwards Sapien 3= bovine Aortic valve= transapical is dangerous! go transferor
5) Percutaneous MV Repair (Mitra Clip)= transvenous or transeptal with TEE= clip grabs mitral leaflets
- -CPB: cannulate aorta and bicaval, CPG antegrade

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14
Q

Cor Triatriatum

A
  • sinistrum- forms when pulm vein fails to incorporate pul circulatory into LA or abnormal growth of septum premium
  • dextrum- right horn of sinus venous valve- forms membrane and IVC goes to forman ovale to left heart (chiari network- lots of holes)
  • -correction by cutting membrane and going thru PFO
  • -Short CPB (if pulm veins not involved)
  • canulation- aortic bicaval
  • DHCA if small child and pulm veins involved
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15
Q

Anomalous Left Coronary Artery to Pulm Artery (ALCAPA)

A

LCA originates from pulm artery OR from right side of aorta
-LV dysfunction- coronary hypo perfusion
-collaterals form b/w RCA and LCA
-Patho: tolerated in fetal life cuz PAP=systemic pressure
: get retro flow when bored and PAP lower than systemic= ischemic and infarction: perfusion is maintained with high PVR
-in adults- collaterals are worse become they steal from LV BF = aortic to pulm shunt (L-R)
-if LCA back dominatnt= sever LV dysfunction
–Correction- to get LCA back to aorta
1) Coronary Reimplantation- cut off PA and move LCA and put on aorta with buttons
2) Takeuchi Procedure- creating A-P window, make tunnel from LCA osmium in PA thru PA and into aorta
CPB-
-cannulation aortic and bicaval
-LV Vent thru right superior pulm vein and arteries snared to avoid run off
-CPG= Aotic root and ostial of LCA
-coming off bypass make ASD so if LV isn’t working won’t have high LA pressure

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16
Q

Vascular Rings Double Aortic Arch

A

surrounds trachea and esophagus

  • Right arch= RCC and R subclavian
  • Left arch= LCC and L subclavian
  • -Surgical Correction- no CPB
  • enter 4/5 rib
  • double arch repair- cut after left side head vessel
  • right arch with left PDA repair- kommemells diverticulum- blind tube leading from cavity
17
Q

Interrupted Aortic Arch (IAA)

A

faulty in week 5-7 of fetus development
-discontinuation of part of aortic arch
-ALWAYS VSD, LV supplies head, RV supplies lower body due to PDA
Type A: interruption distal to L subclavian (all head vessels from aorta), so desc. aorta comes from PA
Type B: interruption distal to LCC
Type C: interruption proximal to LCC
–Surgical Correction= arch reconstruction (end to side)
CPB
- cannulation= Bi aortic cannulas Y’d together, single venous
-DHCA- for head vessel reconstruction
-CPG- first in aortic root, 2nd in ostial

18
Q

Aortic Coarctation

A

doesn’t develop with 4th or 6th aortic arches in embryo

  • Narrowing of Aorta= increase pressure to head vessels
  • Surgical Correction= balloon aortoplasty- No CPB
    a) interposition graft
    b) end-to-end anastomosis
    c) patch augmentation
    d) subclavian flap repair
    e) ascending to descending aorta bypass graft
19
Q

Shunts to increase Pulm BF

A 
BT- subclavian to PA
Central- asc. aorta to main PA
Waterson- asc. aorta to RPA
Potts- desc. aorta to LPA
Brock- Pulmonary valvotomy closed
20
Q

Shunts to increase mixing

A

Blalock-Hanlon
Rashkind= balloon septosomy
Open Atrial septectomy
–all making ASD bigger

Peds (8 decks)

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