AP III Exam I Cardiac- CHD part 2

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AP III Exam I Cardiac- CHD part 2
2013-06-05 12:49:42
aa emory

CHD part II: TGA, anesthetic management
Show Answers:

  1. Define TGA.
    Transposition of Great arteries.  PA to LV and Aorta to RV.
  2. TGA results in 2 _______ ________.
    separate circulations
  3. 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
  4. What are the two types of surgeries for TGA?
    • Atrial switch
    • arterial switch
  5. 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
  6. Atrial Switch:  2 main complications:
    • supraventricular arrhythmias common (due to atrial suturing)
    • RV given systemic load- coronary suppy problems
  7. Arterial Switch can be difficult because transfer of _____ _______ also required.
    coronary arteries
  8. Later problems with arterial switch are _________ but include:
    • uncommon
    • supravalve stenosis of PA or aorta
    • aortic valve insufficiency
    • coronary ostial stenosis
  9. 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!
  10. 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.
  11. 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)
  12. 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
  13. BT-shunt considerations:
    may cause diminished perfusion to right arm
  14. CHD requires IE prophylaxis
    in most cases, yes but depends on surgery?