ABTS Congenital Cardiac cheat sheet

Prostaglandin E1 at 0.01–0.05 mcg/kg/min maintains ductal patency in ductal-dependent neonatal lesions; apnea, hypotension, and fever are common adverse effects.

The arterial switch operation for d-transposition of the great arteries is ideally performed within the first two weeks; after roughly four weeks, left ventricular mass regression increases risk.

Norwood stage I palliation for hypoplastic left heart syndrome includes atrial septectomy, neoaortic reconstruction with arch repair, and a modified Blalock-Taussig shunt or right ventricle-to-pulmonary artery conduit.

Obstructed total anomalous pulmonary venous connection is a surgical emergency; prostaglandin E1 can increase pulmonary blood flow and worsen pulmonary edema, so it is generally avoided.

In pulmonary atresia with intact ventricular septum, coronary sinusoids may make right ventricular decompression unsafe; a systemic-to-pulmonary artery shunt may be required to preserve myocardial perfusion.

Critical neonatal aortic stenosis is usually treated first with balloon aortic valvuloplasty; surgery is reserved for failed dilation, severe regurgitation, or unsuitable anatomy.

Truncus arteriosus is repaired in the neonatal period with ventricular septal defect closure and right ventricle-to-pulmonary artery conduit; 22q11.2 deletion testing is indicated.

A modified Blalock-Taussig shunt in a neonate is typically 3.0–4.0 mm; target oxygen saturation is about 75–85%, and a larger shunt risks pulmonary overcirculation and heart failure.

Restrictive atrial septum in hypoplastic left heart syndrome requires urgent balloon atrial septostomy to decompress the left atrium and improve pulmonary venous drainage.

Bidirectional Glenn shunt is usually performed at 3–6 months; prerequisites include low pulmonary artery pressure, unobstructed pulmonary arteries, and acceptable ventricular function.

Fontan completion is typically performed at 2–4 years; fenestration is considered for high-risk patients with elevated pulmonary artery pressure, ventricular dysfunction, or significant atrioventricular valve regurgitation.

Tetralogy of Fallot repair closes the ventricular septal defect and relieves right ventricular outflow tract obstruction; preserving pulmonary valve function reduces late pulmonary regurgitation.

Atrioventricular septal defect repair closes the atrial and ventricular septal defects and reconstructs the common atrioventricular valve; residual mitral regurgitation and pulmonary hypertension affect long-term outcome.

Ebstein anomaly cone repair mobilizes and reattaches tricuspid leaflets; concomitant arrhythmia surgery is considered for accessory pathways or atrial arrhythmias.

Adults with Marfan syndrome generally warrant aortic root replacement at a root diameter of about 50 mm or with rapid growth; lower thresholds apply with additional risk factors.

Eisenmenger syndrome is a contraindication to pregnancy because fixed pulmonary vascular resistance causes high maternal mortality; effective contraception and preconception counseling are essential.

Coarctation in adults is often treated with catheter stenting for suitable native or recurrent lesions; complex arch disease or associated aneurysms may require surgical repair.

Sinus venosus atrial septal defect with partial anomalous pulmonary venous return can be repaired with a baffle or Warden procedure; avoiding superior vena cava or pulmonary vein obstruction is critical.

Postoperative neonatal cardiac intensive care tracks lactate trend, central venous oxygen saturation, urine output, and systemic oxygen delivery; rising lactate with low urine output suggests low cardiac output.

After a systemic-to-pulmonary artery shunt, target oxygen saturation is about 75–85%; avoid hyperoxia, keep PaCO2 near 35–45 mm Hg, and monitor for pulmonary overcirculation.

Qp/Qs equals (SaO2 − SvO2) divided by (pulmonary venous oxygen saturation − pulmonary artery oxygen saturation); a ratio near 1 indicates balanced pulmonary and systemic flow.

Milrinone is infused at 0.25–0.75 mcg/kg/min to improve cardiac output; hypotension and thrombocytopenia are potential adverse effects, especially in neonates.

Pulmonary hypertensive crisis management avoids hypoxia, acidosis, and agitation; inhaled nitric oxide at 20–40 ppm, sedation, and pulmonary vasodilators reduce right ventricular afterload.

Junctional ectopic tachycardia after congenital heart surgery is managed by correcting electrolytes, treating fever, reducing catecholamines, and using amiodarone or pacing when needed.

Chest tube output exceeding 3 mL/kg/hour for three consecutive hours after pediatric cardiac surgery warrants evaluation for coagulopathy, surgical bleeding, and possible reexploration.

Delayed sternal closure is used when edema or hemodynamic instability prevents safe closure after neonatal cardiac surgery; closure is performed after swelling resolves in the intensive care unit.

Neonates with ductal-dependent systemic circulation are at increased risk of necrotizing enterocolitis; slow enteral feeding advancement and human milk are commonly used.

Echocardiography uses the subcostal window for septal and venous anatomy, the apical window for atrioventricular valves, and the suprasternal notch for aortic arch and pulmonary artery branches.

Qp/Qs by the Fick principle equals (SaO2 − SvO2)/(SpvO2 − SpaO2), where SpvO2 is pulmonary venous saturation and SpaO2 is pulmonary arterial saturation.

Arterial oxygen content is calculated as CaO2 = 1.34 × hemoglobin × SaO2 + 0.003 × PaO2; oxygen delivery further depends on cardiac output.

The Fick principle states that cardiac output equals oxygen consumption divided by the arteriovenous oxygen content difference; it is used for invasive hemodynamic calculations.

Cardiac magnetic resonance quantifies right ventricular volumes and pulmonary regurgitation after tetralogy of Fallot repair and helps time pulmonary valve replacement.

Computed tomography angiography defines vascular rings, anomalous coronary arteries, and complex aortic arch anatomy when echocardiography is insufficient.

Eisenmenger physiology results from irreversible pulmonary vascular disease with reversed shunt flow and cyanosis; vasodilator testing rarely restores operability.

Balloon atrial septostomy enlarges an atrial communication in d-transposition or hypoplastic left heart with restrictive atrial septum, improving mixing or pulmonary venous drainage.

Fetal echocardiography screens the four-chamber view, outflow tracts, and aortic and ductal arches; suspicious findings warrant specialized fetal cardiology evaluation.

Informed consent for pediatric cardiac surgery includes risks, benefits, alternatives, and expected recovery; parental or guardian consent is required, and child assent is sought when developmentally appropriate.

The best interest standard guides surrogate decisions for children; clinicians and families weigh medical benefit, burden, and the child's values, with emergency exceptions when delay would cause harm.

I-PASS handoff covers illness severity, patient summary, action list, situation awareness, and synthesis by the receiver; structured handoffs reduce communication failures.

Just culture distinguishes human error from at-risk or reckless behavior; it encourages error reporting and system improvement while retaining accountability for unsafe choices.

Quality improvement in congenital cardiac programs commonly uses Plan-Do-Study-Act cycles, morbidity and mortality review, and transparent outcome metrics.

Conflicts of interest in congenital heart care require disclosure and management, especially for industry relationships, device selection, and research funding.

Family-centered rounds incorporate caregivers, interpreters, and cultural humility; shared language and teach-back improve understanding of complex cardiac plans.

Research involving children requires institutional review board approval, minimized risk, parental permission, and child assent when appropriate.

Resource stewardship in congenital cardiac surgery includes transparent prioritization, avoiding low-value testing, and monitoring access, cost, and equity.