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Define TGA.
Transposition of Great arteries. PA to LV and Aorta to RV.
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TGA results in 2 _______ ________.
separate circulations
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Most pt's born with TGA have some communication btw circulations through a ____ (ASD), and/or VSD. Surgical approach is perform ______ ______ _______ to facilitate adequate mixing.
- PFO
- Balloon Atrial septostomy
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What are the two types of surgeries for TGA?
- Atrial switch
- arterial switch
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Atrial switch, aka _____ or ________ procedure. ____-_____ _______ directs venous blood to ____ valve, ____ and out the ____. Pulmonary (red venous blood) passes to _____ valve, ___ and out aorta.
- Mustard or Senning
- intra-atrial baffle
- mitral, LV, PA
- tricuspid, RV, aorta
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Atrial Switch: 2 main complications:
- supraventricular arrhythmias common (due to atrial suturing)
- RV given systemic load- coronary suppy problems
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Arterial Switch can be difficult because transfer of _____ _______ also required.
coronary arteries
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Later problems with arterial switch are _________ but include:
- uncommon
- supravalve stenosis of PA or aorta
- aortic valve insufficiency
- coronary ostial stenosis
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Single Ventricle Lesions tx can involve BT shunt. what is this?
What is the fontan procedure?
- used for hypoplastic right sided-lesions
- systemic to pulmonary shunt
- systemic venous blood routed to vena cava, then directly to pulmonary arteries with out a vetricle!
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Norwood procedure used for _____. What are the two anatomic requirements? what is the procedure?
- HLHS
- absence of impediment to pulmonary flow (low PVR)
- good single ventricle function
- one pump for both circulations.
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What can occur with fontan failure?
- increase in EDV can cause increase in PVR. above 20 causes hepatic congestion, edema, protein loss
- transient PVR increase, which reduces CO (via reduced pre-load)
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What things are important to management of CHD pt's?
- cardiology consult (recent), echo, MRI, contact with cardiologist
- consider extent of procedure
- maintain ventricular function
- prevent PVR increase
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BT-shunt considerations:
may cause diminished perfusion to right arm
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CHD requires IE prophylaxis
in most cases, yes but depends on surgery?
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