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T or F: A sat of 90% or below is normal for ES?
Pulmonary HTN with reversed or bidirectional shunt.
What are possible shunt locations?
- Patent Ductus arteriosus
- aortico-pulmonary septal defect
- Total anomolous pulmonary return
- Tricuspid atresia
- pulmonary stenosis
- single ventricle
ES starts with a L to R shunt. describe what this does to the pulmonary system.
- increased blood flow --> vessel damage (become more muscular) --> Pulm HTN
- R to L shunt
- R sided cardiomegaly and heart failure
When sx of ES occur it is ____ ____ for surgery.
What percent of CHD pt's develop ES?
The incidence of perioperative death with ES is ___, and the rate of maternal mortality is ____.
What occurs with increased FiO2 and what should be considered with ES pt's?
pulm vasodilation with increased O2 will decrease shunt fraction in normal patients. O2 causes VASODILATION!
Why is NO pathway used for ES? what drugs are used in this category?
- increased cGmp causes smooth muscle relaxation
prostacyclin analogue, direct dilator but must have continuous infusion
- endothelin receptor antagonist.
- Can decrease PVR by 25%.
- oral takes months to work and decreases effectiveness of oral contraceptives.
_________ are used with O2 therapy to cause _______ __________.
- pulmonary vasodilation
____ ________ are contraindicated in ES pt's.
What complications are seen with ES?
- bleeding disorders- ^ PT PTT
- renal dysfunction-
- Hypertrophic Osteoarthropathy- seen in ankles.
What decreases are seen in the pulmonary system?
- lung capacity
- vital capacity
- peak exp flow rate
What increases are seen in the pulmonary system?
- residual volume
- closing lung volume
increasd ___ pressure should be avoided with ES. what other things will increase PVR and shunt fraction?
- increased pulm blood flow
what things should be avoided with ES?
- myocardial depression
- extreme HR changes
- decreased venous return
- volume overload
keep the shunt ________. Causes of increased R L shunt are:
- decreased SVR
- increased PVR
avoid ____ _______. ___ drugs will work ____ and inhalational drugs will work _____. Be careful with fluid titration bc lowered tolerance for pre-load and afterload. RBC threshold is _______. Avoid Pain.
- air embolism
should you use a Pulm artery catheter in ES?
risks outweigh benefits.
Bosentan and EPoprostenol can prolong what drugs?
What two things should be kept low with ES?
AHA antiboitic IE prophylaxis for CHD with low O2 levels, not fully repaired and surgical shunt or conduit.
also with any residual effects if repaired or recently repaired
Spinal may cause ________, and should not be done.
max insufflation pressure for laparoscopic surgery _____. should do open when possible.
ES will show high ___ > ___%
How can shunt be monitored in a pt with ES due to PDA?
L foot will have a lower sat bc descending aorta is post-ductal