ABTS Congenital Cardiac flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Prostaglandin E1 infusion

PGE1 at 0.01–0.05 mcg/kg/min maintains ductal patency in ductal-dependent lesions; monitor for apnea, hypotension, fever, and tachycardia.

Arterial switch operation

For d-transposition of the great arteries, the arterial switch is ideally performed within the first two weeks before left ventricular mass regresses; coronary transfer is critical.

Norwood stage I

Stage I palliation for hypoplastic left heart syndrome includes atrial septectomy, neoaortic reconstruction with arch repair, and a systemic-to-pulmonary shunt or RV-PA conduit.

Obstructed TAPVC

Obstructed total anomalous pulmonary venous connection is a surgical emergency; avoid prostaglandin E1 because increasing pulmonary blood flow can worsen pulmonary edema.

PA/IVS with coronary sinusoids

In pulmonary atresia with intact ventricular septum, coronary sinusoids may make RV decompression unsafe; a systemic-to-pulmonary shunt may be preferred to protect myocardial perfusion.

Critical aortic stenosis

Neonatal critical aortic stenosis is usually treated first with balloon aortic valvuloplasty; surgery is reserved for failed balloon dilation or associated severe regurgitation.

Truncus arteriosus repair

Neonatal repair closes the ventricular septal defect and establishes right ventricle-to-pulmonary artery continuity with a conduit; 22q11.2 deletion should be assessed.

Bidirectional Glenn shunt

Superior cavopulmonary connection is usually performed at 3–6 months; it requires low pulmonary artery pressure, unobstructed pulmonary arteries, and acceptable ventricular function.

Fontan completion

Total cavopulmonary connection is typically completed at 2–4 years; fenestration may be used in high-risk patients with elevated pulmonary pressure or ventricular dysfunction.

Tetralogy of Fallot repair

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

AV septal defect repair

Repair closes the atrial and ventricular septal defects and reconstructs the common atrioventricular valve; residual mitral regurgitation and pulmonary hypertension affect outcomes.

Ebstein cone repair

Cone repair reconstructs the tricuspid valve by mobilizing and reattaching leaflets; concomitant arrhythmia surgery is considered when accessory pathways or atrial arrhythmias are present.

Marfan aortic root threshold

Adults with Marfan syndrome generally warrant aortic root replacement when the root reaches about 50 mm or grows rapidly; lower thresholds apply with additional risk factors.

Eisenmenger pregnancy

Eisenmenger syndrome causes fixed pulmonary vascular resistance and cyanosis; pregnancy is contraindicated because maternal mortality is high, so effective contraception is essential.

Qp/Qs formula

Pulmonary-to-systemic flow ratio equals (SaO2 minus SvO2) divided by (pulmonary venous oxygen saturation minus pulmonary artery oxygen saturation).

Milrinone infusion

Milrinone, a phosphodiesterase-3 inhibitor, is infused at 0.25–0.75 mcg/kg/min to improve cardiac output; hypotension and thrombocytopenia are potential adverse effects.

Pulmonary hypertensive crisis

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

Junctional ectopic tachycardia

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

Delayed sternal closure

The sternum may remain open after neonatal cardiac surgery when edema or hemodynamic instability prevents safe closure; delayed closure occurs after swelling resolves in the intensive care unit.

Chest tube bleeding

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

Single-ventricle oxygen target

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

Qp/Qs by saturations

The Fick-based shunt fraction uses oxygen saturation differences: Qp/Qs = (SaO2 − SvO2)/(SpvO2 − SpaO2), where SpvO2 is pulmonary venous and SpaO2 pulmonary arterial saturation.

Oxygen content formula

Arterial oxygen content equals 1.34 times hemoglobin times arterial oxygen saturation plus 0.003 times arterial oxygen tension; it estimates oxygen carried in blood.

Fick principle

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

Eisenmenger physiology

Long-standing left-to-right shunts can cause irreversible pulmonary vascular disease, reversing shunt flow and producing cyanosis; vasodilator testing does not usually restore operability.

Cardiac MRI after TOF

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

CT for vascular rings

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

Balloon atrial septostomy

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

Informed consent in pediatrics

Consent for a child's cardiac surgery is obtained from a parent or guardian; the child's assent is sought when developmentally appropriate, using risks, benefits, and alternatives.

Best interest standard

When a child cannot decide, surrogate decision-makers should choose the option that best serves the child's interests, considering medical benefit, burdens, and the family's values.

I-PASS handoff

I-PASS is a structured handoff covering illness severity, patient summary, action list, situation awareness, and synthesis by receiver; it improves communication and reduces preventable harm.

Just culture

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