Congenital and Pediatric Cardiac Surgery
Congenital cardiac surgery tests lesion physiology, timing and shunt direction. The exam expects you to separate duct-dependent systemic or pulmonary circulation from lesions that can wait.
Core rules
- Duct-dependent lesions need prostaglandin E1 and urgent echocardiography; do not withdraw support before defining anatomy.
- Shunt direction depends on pulmonary and systemic vascular resistance; Eisenmenger physiology contraindicates simple shunt closure.
- Tetralogy of Fallot repair relieves right ventricular outflow obstruction and closes the VSD; timing depends on symptoms and anatomy.
- Bypass in neonates requires precise perfusion, myocardial protection and awareness of immature organ function.
Worked example
A 3-day-old with cyanosis, single-ventricle physiology and duct-dependent pulmonary blood flow becomes acidotic when prostaglandin is stopped. The correct reasoning is that ductal patency maintains pulmonary flow; restart prostaglandin, correct acidosis and plan staged palliation after echo and multidisciplinary review. Closing a shunt or giving oxygen as the only treatment misses the physiology.
Traps
Do not assume all murmurs are innocent; do not close a VSD in Eisenmenger physiology; do not ignore acidosis and low mixed venous saturation; do not plan corrective repair without defining pulmonary arteries and coronary anatomy in complex lesions.