Peds Test 8 Flashcards
Hypoplastic Left Heart Syndrome
- atretic/hypoplastic aorta
- large PDA
- hypoplastic LV
- small MV or AV
- hopefully ASD (left to right)= as if not, first palliative to create ASD
Embrological Causes
endocardial tube gets pinched
pinched at bulbus cordis= HRHS
pinched at ventricular region= HLHS
HRHS
-pulmonary atresia
-hypoplastic PA
-small TV
-PDA and PFO
==cyanotic
Palliation for HLHS/HRHS
1) Rashkind Procedure= balloon atrial septostomy (open ASD)
2) Hanlon Procedure= blade septectomy
Surgical Stages 3
1) Norwood- first week= 75%
2) BDG or Hemi Fontan- 6 months= 95%
3) Fontan- 18 months= 90%
Norwood
1) close PDA
2) combine PA and aorta (and cut off PA trunk)
3) BT or Sano shunt (during rewarming)
Art can= PA or innominate (for innominate you HAVE to arrest first)
ven can- single= DHCA
antegrade/retro cerebral
one integrate CPG through arterial line
BT vs Sano Shunt
BT- subclavian artery to right PA
Sano- RV to Pa (more central, high pressure, larger, more stable)
Managing new BF
Qp:Qs P=Q (conduit size)xR (PVR and SVR)
- –control PVR and SVR (BT/sano shunt biggest component of resistance)
- -shunt size determined by patient size and hemodynamics/O2 sats
= (Aorta Sat- IVC Sat)/(PV Sat - PA Sat)
Factors that increase/decrease SVR and PVR
increase SVR= increase pH, increase FiO2, constrict
decrease SVR= increase CO2, dilate
increase PVR= decrease pH, decrease FiO2, increase CO2, PEEP
decrease PVR= increase pH, increase FiO2, decrease CO2, iNO
Ideal Post Op Blood Gases (pH/CO2/O2, SaO2, HCT)
7.4/40/40/
75%
>40%
BDG and Fontan Bypass Stuff
can- aorta/bicaval
warm
no XC (except for intra fontan= integrate CPG)
-CPB on standby
-also for Fontan= want high CVP and WONT do if high PVR
Hybrid Treatment for HLHS
palliation= cath lab= 2 stents and band
-PDA stent, Atrial Septal (PFO) stent, Bilateral PA banding
