M2-C5-L40 --> Chd Ii

Front 1

OVERVIEW

- Clinical Cyanosis is the presence of what in the Systemic Circulation?

- This means you can't clinically see cyanosis until satO2 is?

Back 1

3 to 5% of Unsaturated Hemoglobin

Mid-80's or less

Front 2

OVERVIEW

- what are 3 Pulmonary causes of Cyanosis?

Back 2

(DMV)

- Diffusion disorders
- Mismatch V/Q
- Ventilation Inadequate

Front 3

OVERVIEW

- what are 3 Cardiac causes of Cyanosis?

Back 3

(LAP)

- Limited PBF
- Admixture lesion
- Poor mixing

Front 4

OVERVIEW

- list 2 Non-Pulmonary, Non-Cardiac causes of Cyanosis.

Back 4

- Persistant Pulmonary HTN (PFC)

- Methemoglobinemia

Front 5

OVERVIEW

- The underlying physiologic principle of CARDIAC Cyanosis is?

Back 5

- Right to Left Shunt

Front 6

OVERVIEW

- Cyanotic CHD in newborns is seen in which 8 conditions

Back 6

(5 Ts & ESP)

- TOF
- TGV
- Tricuspid Valve Atresia
- TAPVR
- Truncus Arteriosus

- Epstein's Anomaly of Tricuspid
- Single Ventricle heart
- Pulmonary Atresia

Front 7

TETRALOGY OF FALLOT

- list 4 features of TOF

Back 7

(PROVe)

- Pulmonary stenosis
- Right Ventricular Hypertrophy
- Overriding Aorta
- VSD

Front 8

TETRALOGY OF FALLOT

- Accounts for what % of CHD?

- Frequency compared to other Cyanotic Congenital Cardiac Lesion

Back 8

- 8-10%

- MC Cyanotic Congenital cardiac lesion at ALL AGES

Front 9

TETRALOGY OF FALLOT

- Conotruncal anomaly in TOF may be seen with what syndrome?

- what is the marker?

Back 9

- DiGeorge Syndrome

- 22q11 chromosome marker

Front 10

TETRALOGY OF FALLOT

- CXR would show what? x3

Back 10

- Boot shaped heart
(coeur en sabot)

- Decreased PBF

- Right sided Aortic Arch (25-30%)

Front 11

TETRALOGY OF FALLOT

- Prognosis if untreated after 5 year?

- Prognosis if untreated after 20 years?

Back 11

- 50% live 5 year

- 10% live 20 years

Front 12

TETRALOGY OF FALLOT

- may be palliated with what shunts? x2

Back 12

CENTRAL SHUNT
(Aorta - Pulmonary artery)

MODIFIED BLALOCK-TAUSSIG shunt
(Subclavian branch to Pulmonary artery branch)

Front 13

TETRALOGY OF FALLOT

- what symptom may be observed in TOF patients at the UE?

- Degree of Cyanosis depends on?

Back 13

- clubbing of fingers

- PS

Front 14

TETRALOGY OF FALLOT

- the conus displaces how?

- this causes what structural abnormality? x3

Back 14

- Anteriorly

- Overriding Aorta
- VSD
- Malalignment

Front 15

TETRALOGY OF FALLOT

- any normal vitals on PE?

- RSB reveals what on PE?

- LSB reveals what on PE?

Back 15

- Pulse is normal

- RV impulse increased @ RSB
- Murmur along LSB

Front 16

TETRALOGY OF FALLOT

- the degree of Cyanosis depends on?

Back 16

- PS

Front 17

TETRALOGY OF FALLOT

- LSB murmur is Systolic or Diastolic

- the murmur is turbulence going through what?

Back 17

- Systolic

- Pulmonary Stenosis
(not VSD!)

Front 18

TETRALOGY OF FALLOT

- what is the likelihood of CHF in TOF?

Back 18

- unlikely

Front 19

TETRALOGY OF FALLOT

- the Central Graft Shunt is a palliative shunt that shunts what?

- the Modified Blalock-Taussig Shunt is a palliative shunt that shunts what?

Back 19

- Central Aorta to Pulmonary Artery

- Subclavian artery to Pulmonary Artery branch
(on the same side)

Front 20

TETRALOGY OF FALLOT

- TOF repair usually involves what?

- how does this affect % Survival?

Back 20

- VSD closure

- 85% survival @ 35 years

Front 21

TRANSPOSITION GREAT VESSELS

- accounts for what % of CHD's

Back 21

- 5%

Front 22

TRANSPOSITION GREAT VESSELS

- describe the presentation of cyanosis

- under what conditions would the cyanosis be less severe? x2

Back 22

- 1st week severe cyanosis

- Newborns with TGV & VSD
- Newborns with TGV & ASD

Front 23

TRANSPOSITION GREAT VESSELS

- describe the associated murmur

Back 23

- No murmur usually

Front 24

TRANSPOSITION GREAT VESSELS

- describe what is seen on CXR

Back 24

- Egg shaped heart

Front 25

TRANSPOSITION GREAT VESSELS

- Palliative procedure?

- Surgery of Choice?

Back 25

- Balloon Septostomy

- Arterial Switch operation

Front 26

TRANSPOSITION GREAT VESSELS

- what is the anatomical defect?

- what is the genesis of this defect?

Back 26

- Aorta comes off LV
- Pulmonary artery comes off RV

- Lateral conotruncal swelling

Front 27

TRANSPOSITION GREAT VESSELS

- describe the hemodynamics of this disorder if there was a PDA

Back 27

- Blood flow from RV Aorta (low satO2) will go to LV Pulmonary artery (high satO2) due to pressure gradient.

Front 28

TRANSPOSITION GREAT VESSELS

- in normal anatomy, describe the location of the Aorta and Pulmonary artery in respect to each other

- describe above in TGV

Back 28

- Pulmonary artery Anterior to Aorta

- Aorta is Anterior (& more right) to Pulmonary artery

Front 29

TRANSPOSITION GREAT VESSELS

- on PE, describe the cyanosis

- on PE, what are the normals? x2

- on PE, what are the murmurs if any? x2

Back 29

- moderate to severe
(satO2 50-80%)

- Pulses normal
- RV impulse normal (to slight increase)

- LSB Soft Systolic Flow murmur
(or none)
- Loud Single S2 with Anterior Ao

Front 30

TRANSPOSITION GREAT VESSELS

- CXR would show what? x2

- may be normal in?

Back 30

- Egg shaped heart (1/3)
- Increased PBF

- neonates

Front 31

TRANSPOSITION GREAT VESSELS

- describe the Egg shaped heart

Back 31

- Narrow Mediastinum

- Ovoid heart

Front 32

TRANSPOSITION GREAT VESSELS

- Describe the Atrial Balloon Septostomy used in palliative Tx.

- Basically, you are creating what?

Back 32

- take catheter across Foramen Ovale
- inflate the balloon on other side
- jerk and tear

- creating an ASD

Front 33

TRANSPOSITION GREAT VESSELS

- after performing an Arterial Switch for TGV, what is the survival rate?

Back 33

- 90% for many years