AP III Exam 1 - CHD part 1
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What is the rate of congenital heart dz births?
- 8 in 1000
- 85% will survive into adulthood
Define "repaired" congenital heart dz and which defects fall into this category.
- No impact on pt's longevity, physical status or need for further medical care.
- PDA ligation
- repair of secundum ASD in 1st decade
- uncomplicated VSD in first yr (possibly)
Ventricular septal defect (VSD) causes a __ --> ___ shunt. This is the _____ _______ ______, found in 16.6% of CHD.. Repair invlolves _______ of defect, commonly with ______ _____.
- L R
- Most common defect
- synthetic cloth
Describe why VSD can cause CHF:
- After birth, PVR will fall, and therefor RV will fall. This decrease (along with increasing systemic pressure) causes an increased gradient btw the L and R ventricles and blood will flow back into R from L side.
- CHF occurs when Qp is 2x Qs.
What side effects are seen if VSD is repaired later in life?
- elevated PVR
- Excess RV workload
- decreased exercise tolerance
What is CAVC?
- Atrioventricular Canal Defects
- AKA- endocardial cushion, atrioventricular septal defect
CAVC is common with ________ ___. Describe this defect:
- trisomy 21
- open wall between chambers (like knocking out walls in apt to make it a studio. Often only one av valve that must be made into 2 surgically.
What is tx for CAVC?
repair of VSD, ASD, valves (making 1 into 2).
What problems can occur with CAVC?
- Incomplete closure of ASD or VSD
- Stenosis or insufficient valves
- elevated PVR (especially if repaired later)
- *** DS pt's often have sleep apnea and develop high PVR more easily than non downs pt's.
Tetralogy of Fallot has four associated lesions:
- pulmoary stenosis
- overriding aorta
- RV hypertrophy
TOF pt's after surgery are _____ but not ______
What are the surgical goals of TOF repair?
- Close VSD
- relieve PS or RV outflow tract obstruction (RVOTO)
with TOF RVOTO can be what three things?
how can this be treated and what can be a problem?
- 1- muscular stenosis
- 2- valvular or annular stenosis
- 3- supravalvular stenosis
- transannular patch- increases volume work of RV, dilation may occur leading to possible regurge of tricuspid valve over time
TOF is a ___ to ____ shunt, and division of PA and Aorta during embryonic development is ____.
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