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11 Cards in this Set
- Front
- Back
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def
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rf/present
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d/ test / tx
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A case presentation of transposition of great arteries (important):
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A case presentation of transposition of great arteries (important): a newborn appears with cyanosis within first hours of life, cyanosis progressively gets worse, also dyspnea. Examination reveals lower extremities are less cyanotic than upper extremities, hyperactive precordium, either no murmur or PDA murmur of grade 3/6, 2nd heart sound single and loud, or occasionally itmay be split. (Important for Board examination
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CXR:
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CXR: mild cardiomegaly, normal or increased pulmonary flow, narrow mediastinum
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EKG:
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EKG: (R)ventricular hypertrophy,which is normal for a newborn
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ABG:
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ABG: Paoz15to30mmofHg(veryhypoxic),0,saturation30to70%.
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HYPEROXIA TEST IN 100% OXYGEN:
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HYPEROXIA TEST IN 100% OXYGEN: PaO2 only increasess lightly
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Preferred diagnostic study
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MOST LIKELY DIAGNOSIS: transposition o fgreat arteries
Preferred diagnostic study:echocardiogram |
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Key words
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TREATMENT:
(a) Initially PGE1 immediately in cyanotic child. Hypothermia should be avoided because it causes metabolic acidosis. Sodium bicarbonateisgivenformetabolicacidosis. Infusionofglucoseisgiventoavoidhypoglycemia. (b) SURGICAL PROCEDURE OF CHOICE: arterial switch [jatene] operation. It is performed within first 2 weeks of life. (c) METABOLICALLY STABLE CHILD: balloon atrial septostomy (Rashkind) through cardiac catheterization It is initial procedure of choice. It increases the Pa02 35-50 mm Hg. (d) MUSTARD OPERATION (BAFFLE PROCEDURE): atrial baffle connecting systemic venous blood flow through mitral valve into (L) ventricle and pulmonary venous blood flow through tricuspid valve into (R) ventricle. It has high long-term morbidity. It is reserved for patients with TGV and severe pulmonic stenosis in which arterial switch operation cannot be performed, |
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Key words
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Key words: severe cyanosis, lower extremities are less cyanotic than upper extremities, hyperactive precordium, no murmur or PDA murmur, 2ndheart sound single andloud.
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