TOF Flashcards
TOF: right aortic arch
Shouldn’t affect kid
Risk factors during pregnancy to increase risk of TOF
Alcoholism Diabetes >40 years old Poor nutrition Rubella or viral illness
TOF with pulmonary atresia
Blood shunts completely from RV to LV
Lungs perfused via extensive collaterals from systemic arteries and PDA
Body response to low saturation and decreased pulmonary blood flow
Elevate HCT (often over 50%)
Symptoms of TOF
Low blood oxygen saturation with or without cyanosis Pink TET: baby is not cyanotic TET spells: series of severe hypoxia Clubbing Difficult feeding, failure to gain weight Passing out Poor development Squatting during episodes of cyanosis
TET spells
Period of severe hypoxia
Rapid, deep breathing
Fainting, loss of consciousness
Increasing cyanosis of lips, tongue, and nail beds
Irritability or uncontrolled crying
Squatting increases pressure on left heart, decreasing R–>L shunt
Advantages of central shunt
Applicable to small children with small peripheral vessels
Prevents distortion of pulmonary arteries
Equal pulmonary blood flow to both lungs
Lower occlusion rates
Avoidance of subclavian artery steal
Ease of closure during corrective repair
CPB case notes for TOF
Heart warms quickly due to pulm collaterals so lots of CPG
RV stressed preop so careful with it
Low BP worsens RV dysfunction so be careful with vasodilators
Use inotropes to keep BP high
CVP and RV will be high Postop
ECMO often used because of RV dysfunction
Be prepared to deal with high HCT (no blood in prime, end MUF early)
Symptoms of DORV
Baby tires easily Bluish skin color Clubbing Failure to gain weight Peripheral edema Dyspnea
Complications from DORV
CHF
Pulmonary HTN
Irreversible damage in lungs due to high BP in lungs
TOF: left aortic arch
Enlarged aorta overriding VSD
Pulmonary valve and aortic stenosis
Stenosis of infundibulum (RVOT)
