The Foetal Circulation and Congenital Problem

Question 1

Is the placenta included in the foetal circulation?

Answer 1

Yes

Question 2

What state are the lungs in in a foetus?

Answer 2

Fluid filled and unexpanded

Question 3

The foetal heart pumps blood to the placenta via what?

Answer 3

Umbilical arteries

Question 4

Blood from the placenta returns to the foetus via what?

Answer 4

Umbilical vein

Question 5

Where does oxygenated blood in the foetus return to?

Answer 5

The right side of the heart

Question 6

What are the 3 cardiac shunts, specific to foetal life?

Answer 6

Ductus venosus, foramen ovale, ductus arteriosus

Question 7

What does the ductus venosus connect?

Answer 7

The umbilical vein to the IVC

Question 8

What does the foramen ovale connect?

Answer 8

Right atrium to left atrium

Question 9

What does the ductus arteriosus connect?

Answer 9

Connects pulmonary bifurcation to the descending aorta

Question 10

Does blood from the placenta go into the portal circulation?

Answer 10

No

Question 11

The membrane flap of the foramen ovale is on which side?

Answer 11

Left atrium

Question 12

What maintains patency of the ductus arteriosus?

Answer 12

Prostaglandin E2

Question 13

Where is prostaglandin E2 produced?

Answer 13

Placenta

Question 14

What happens to the resistance of the pulmonary and systemic circulations after birth?

Answer 14

Pulmonary resistance decreases and systemic resistance increases

Question 15

As resistance of circulations is changed after birth, what happens to the relative pressures of the atria?

Answer 15

Left atrial pressure exceeds right atrial pressure

Question 16

What does the anatomical closure of the ductus arteriosus form?

Answer 16

Ligamentum arteriosum

Question 17

What are treatment options for patent ductus arteriosus?

Answer 17

wait and watch, NSAIDs, surgery

Question 18

What can be used to keep the ductus arteriosus open until further treatment is available?

Answer 18

Prostaglandin E2

Question 19

What is the basis of persistent pulmonary hypertension of the newborn?

Answer 19

Lung vascular resistance fails to drop

Question 20

What are some clinical signs of persistent pulmonary hypertension of the newborn?

Answer 20

Blue baby, large difference between finger and foot O2 saturations

Question 21

What counts as major congenital heart disease?

Answer 21

Requires surgery within the first year of life

Question 22

Congenital heart defects can present up to about?

Answer 22

8 weeks

Question 23

Can murmurs be normal in newborn babies?

Answer 23

Yes

Question 24

What causes cyanosis in a newborn baby?

Answer 24

Any condition which causes deoxygenated blood to bypass the lungs and enter the systemic circulation

Question 25

What congenital disease causes a collapse at the time of the duct closure?

Answer 25

Transposition of the great vessels

Question 26

Will babies with transposition of the great vessels be acidotic or alkalotic?

Answer 26

Acidotic

Question 27

What is the treatment for transposition of the great vessels?

Answer 27

ABC, prostaglandin E2, multi-system supportive treatment

Question 28

What causes a presentation with heart failure?

Answer 28

Usually moderate to large left to right shunts

Question 29

When does a left to right shunt tend to present?

Answer 29

After a few weeks when pulmonary pressure drops

Question 30

When does a murmur of a VSD occur?

Answer 30

In the first few weeks as pulmonary pressure drops

Question 31

What are the components of tetralogy of fallot?

Answer 31

VSD, pulmonary stenosis, right ventricular hypertrophy, overriding aorta