Surgery for CHDs Flashcards
PDA
most common presentation?
what happens to the pulmonary blood flow?
increase incidenxe of respiratory infections
increased pulmonary blood flow
machinery murmur at the left infraclavicular area due to turbulence of blood
Indications for PDA close surgery
respiratory distress
recurrent respiratory infection
large, hemodynamically signigicant PDA
failure of 2 courses of indomethacin and ibuprofen
Anatomical landmarks for PDA close surgery
PDA is identified by the vagus nerve
Recurrent laryngeal nerve hooks around PDA (paos when cut)
Coarctation of aorta distinguishing features
Narrowing of aorta
Diagnosed by 2D echo
Common in males
What is the most common associated lesion of CoArc?
Bicuspid aortic valve –> results in aortic stenosis (doesn’t open much during ventricular systole)
PE findings of CoArc
BP elevated at the upper ex (above the coarctation)
BP lowered at the lower ex
Femoral and other peripheral pulses are weak or absent
Without intervention, CoArc would lead to…
Severe UE hypertension, leads to aneurysm and LV hypertrophy
Management of CoArc
IV prostaglandins
Balloon angioplasty
End-to-end anastomosis via left posterolateral thoracoromy
ASD
F > M?
F > M
ASD irreversible contraindication for surgery, will manifest as a R to L shunt with clubbing
Pulmonary hypertension
ASD murmurs that are not true anatomic, but because of high volume entering tricuspid and pulmonic valve
TS and PS
ASD PE finding upon auscultation
Wide-split, fixed S2 (lub-d-dub)
Due to delayed pulmonic valve closure, due to increased load
ASD X-ray findings
Hypervascularity of pulmonary lung fields
–> increased pulmonary blood flow (also im VSD and PDA)
ASD indications for surgery
QP:QS => 1.5:1
2D echo findings - RV volume overload
RA, RV enlargement
+ arrhythmias and heart failure
VSD PE finding
Pansystolic murmur
VSD types that do not close spontaneously
Outlet and Inlet types
VSDs are closed by _______ patch (not pericardium), unlike ASD (patched with pericardium)
PTFE: polytetrafluoroethylene patch
Cyanotic CHDs are _____ shunts
R to L shunts
Cyanotic Ts
TOF
TGA
True anomalous pulmonary venous return
Tricuspid valve atresia
Components of TOF
VSD
Overriding aorta
RV outflow tract obstruction
RV hypertophy
TOF clinical characteristics
Mid-systolic ejection murmur at 2nd or 3rd ICS radiating to the axilla
Clubbing Squatting Polycythemia Hemoptysus Hypercyanotic episodes, Tet spells
TOF x-ray findings
Boot-shaped heart - displaced cardiac apex
Dark lung area (low PBF)
Small pulmonary artery
RA enlargrment
TOF surgical interventions (can only be cured with surgery)
Palliative:
-shunts (Potts - between left PA to descending aorta; Waterston - between PA and ascending aorta) - augment PBF, especially if px is cyanotic
-Blalock-Taussig-Thonas shunt
Definitive:
-infundibulectomy - removal of hypertrophied muscles (obstruction) from the infundibulum
- enlargement of RV outflow tract
- closing of VSD (can patch)
- artificial monocuspid valve from pericardium to replace dysplastic pulmonic valve
- overriding aorta not corrected, automatically corrected with patching
TGA
Aorta from RV, PA from LV –> blood flow is reversed
Common in males
Not compatible with life (if with VSD, PDA, surgery, can live for six months)
