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Definition
| is the intentional and temporary cessation of the heart, to produce asystole .Cardioplegia is a speclized solution that is introduced into the coronary circulation. This is done to slow the metabolism of the heart and prevent damage to the LV and the RV. |
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Definition
| Normal cardiac position; ant. Inferior and to the left |
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Definition
| heart on the other side (not on left on right) apex still to the left |
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Definition
| Heart in the middle (portion or all of lung removed) |
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Definition
| normal alignment (LV w/ LA; RV w/ RA) |
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Definition
| abnormal alignment w/ great vessels & chambers |
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Definition
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| How long does a tissue valve replacement typically last? |
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Definition
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Term
| How long does a mechanical valve replacement typically last? |
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Definition
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Term
| What type of valve typically lasts longer, tissue or mechanical? |
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Definition
| Mechanical typically lasts longer than tissue |
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Term
| How long does it usually take fetal hemoglobin to convert to adult hemoglobin? |
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Definition
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Term
| How long does it usually take fetal blood saturation to convert to adult blood saturation? |
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Definition
| 2 hours to 24 hours to reach normal saturation levels |
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Term
| What is a LVAD and what does it do? |
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Definition
| Left Ventricular Assist Device; a kind of mechanical heart that is placed inside a person's chest to help the heart pump oxygen-rich blood throughout the body. |
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| What is the Impella device and what does it do? |
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Definition
| A small rotary pump attached to the end of a catheter which is passed retrograde through the aortic valve into the left ventricle from which it aspirates blood which it delivers immediately above the aortic valve. Inpatient use only. |
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Term
| Name 4 types of Atrial Septal Defects; which one is most common? |
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Definition
1. Ostium Secundum: the most common type of ASD (accounting for 50-70% of all cases). The hole is located near the center of the atrial septum.
2. Sinus Venosus: the hole is located near one of the two places where the vena cava enters the right atrium. The two kinds of sinus venosus defect are distinguished by whether the hole is near the entry point of the SVC or of the IVC.
Ostium Primum: the hole is located in the lower part of the atrial septum, near the tricuspid valve
4. Common Atrium: absence of interatrial septum |
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Term
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Definition
| Atrial Septum Defect: a hole in the atrial septum, that separates the right and left atria. Because of the lower pressure in the right atrium, this hole typically allows oxygenated blood from the lungs to shunt from the left into the right atrium. This blood proceeds into the right ventricle, which pumps it back to the lungs rather than to the body. ASDs vary in size and in the severity of symptoms they may cause. They account for between 5%-10% of all cases of congenital heart disease and are twice as prevalent among girls as boys. |
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Term
| What is the surgical correction for ASDs? |
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Definition
| Transcatheter septal occluder or surgically sealed with pericardium patach or gortex |
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Term
| Which ASD is an Endocardial Cushion Defect? |
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Definition
| Ostium Primum; EC did not meet the Septum Primum during fetal development. They did not arch and/or fuse properly. This type of defect can effect the AV valves (cleft valve). |
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Term
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Definition
Mild, moderate, severe
*mild grade is insignificant hemodynamically |
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| What is the surgical correction for a Common Atrium? |
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Definition
| Gortex patch or multiple graphs |
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Term
| How would an ASD effect the heart? What chambers are impacted? |
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Definition
| Physical findings vary due to age, weight, and medical history of the baby. ASDs can go undetected for years; however, can lead to symptoms such as, feeding difficulties, fatigue, SOB, sleepy, noticable change in activity, right side arhythmias, systolic murmurs, pulmonary congestion, Eisenmenger's. |
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Term
| What is Eisenmenger's PYSIOLOGY? |
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Definition
| Hemodynamic significant VSD; volume overload then pressure overload, the R heart will enlarge. ↑ volume ↑ pressure→pulmonary hypertension |
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Term
| Name 3 types of Ventricular Septal Defects |
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Definition
Supercristal: lies just below the Pulmonary valve in the infundibular septum
Perimembraneous:occur beneath the aortic valve on the left side of the septum, extending to the right under the septal leaflet of the tricuspid valve
Muscular: divided into separate distinct regional groups, including midmuscular, apical, anterior, and posterior. Gives a "Swiss cheese" look. |
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| What is absent with a common ventricle? |
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Definition
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| What is the grading criteria for a VSD? |
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Definition
| Insignificant, small, moderate, large |
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Definition
| A ventricular septal defect communicating directly between the left ventricle and right atrium. |
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| What are possibel clinical finding for a Gerbode VSD? |
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Definition
| Depending on age and the underlying risks, there maybe AS with a murmer at 2nd or 3rd LICS, AV valve regurge, early stages of RHF such as distended neck veins, SOB (may need to be inubated), increased HR, decreased O2 Sats, enlarged RH and/or dilated PA in x-ray |
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Term
| With an Endocardial Cushion Defect, what are two ways that this defect can be termed? |
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Definition
| Compete or partial AV Canal Defect |
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Term
| What are some clinical findings for Endocardinal Cushion Defects? |
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Definition
| Failure of EC to form IAS septum; usually combined with other defects such as valve defects. Partial involves usually one valve. Complete will envolve 2 or more valves. |
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Term
| What are some associated defects with a Partial ECD? |
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Definition
| Primum ASD,cleft MV, EC partially fused resulting in the division of the AV Canal, R/L ostium, volume overload to RH |
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Term
| What are some associated defects with a Complete ECD? |
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Definition
| Involves all 4 valves and chambers, large membranous VSD and large primum ASD, MV and TV can be merged together so there is one valve, shunting at both levels, usually the AV is incompetent, can be AI, LVOT slightly narrowed |
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Term
| What is "Failure to thrive"? |
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Definition
| Means that the way things are, there is not chance for survival |
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| State some possible critical findings for ECDs. |
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Definition
| Failure to thrive, fatigue, dyspnea, PHTN→↑PRV, large cardiac silhouette, abnormal EKG, L-axis deviation, signs of CHF |
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| Why could there be a split S2 with ECDs? |
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Definition
| Volume overload in RH → delay P2 |
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Term
| What would produce a thrill with ECD? |
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Definition
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Term
| What is the survival rate if ECD is not repaired within 1 year? |
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Definition
| 20%, mortality rate at 80% |
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| What are some surgical processes for ECDs? |
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Definition
| Close ASD & VSD, narrow flow rate with pulmonary band, reconstruct MV/TV (reset, suture, anular ring), repair any additional defects |
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Term
| What is TV Atresia and what are some anomalies that might come with it? |
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Definition
| A cyanotic lesion, with complete failure of the TV to form; there is only thickened annulus/membrane. The RV is small and underdeveloped. The PA and Ao may be transposed or normal. This is usually an ASD, VSD, PDA which the baby needs. |
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| How is TV Atresia initially treated? |
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Definition
| Surgical treatment is first palliative (relieving pain or alleviating a problem without dealing with the underlying cause), blood flow to the lungs needs to be established or increase. ProstagladinE' is administered to help keep PDA open. The baby then is taken to Cath Lab for a balloon septostomy. |
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| What are the 3 surgeries used to treat TV Atresia/Hypoplastic Left Heart Syndrome? Describe them in detail and when the surgies typically take pace. |
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Definition
1. Stage I: Within 4-7 weeks, the first procedure is the Norwood Procedure uning a Blalock-Tausigg shunt; an ASD/VSD is created and the L. Subclavian Artery is divided and connected to the L. PA allowing blood to flow into the lungs to pick up O2. An alternative is to use the Modified Blalock-Tausigg utilizing a conduit between the PA and a branch off the Ao, typically the Inominate Artery.
2. Stage II: Typically 4-6 months, the next procedure is the Glen Shunt Procedure where the SVC and the RPA are surgically connected allowing venous return to flow passively into the RPA/LPA. This allows a bridge for the 3rd sugical procedure...
3. Stage III: Within 18 months to 3 years, the Fontane Procedure completes the process. A graft re-routes blood flow from the SVC to bypass the RA directly to the PA, then a baffle reroutes IVC blood flow directly to the PA or the IVC is connected to the RPA by a tunnel-like patch to the PA. A PA band maybe used to slow flow. ASD/VSD are closed. |
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Term
| What is Ebstein's anomaly |
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Definition
| A rare cyanotic lesion defect involving an abnormality in the TV, which connects the RA with the RV. The valve forms abnormally and is displaced inferiorly toward the apex causing the RV to become atrialized nd the RVOT becomes the main pumping chamber. The leaflets of the TV are usually thickened and incompetant which leads to PHTN→PVR. |
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Term
| What are some associated lesions and clinical presentations you might find with Ebsteins Anomaly? |
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Definition
| ASD/VSD tritology of flow, coarctation of the Ao, PV atrisia, signs and symptoms of CHF(SOB, ↑HR, ↓activity, PHTN), murmur (TVI, MVI), dyspnea, feeding difficulties, arrhythmias (SVT, WPW) |
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Term
| What is the surgical procedure to repair Ebstein's Anomaly? |
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Definition
| Repair or replace the TV with a tissue valve, close ASD & PDA, correct any associated CHDs with PA band, diuretics to control PHTN, and possible ventilator to ↑ SaO2 |
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Term
| What is Tretalolgy of Fallot (TET) and the 4 characteristic? |
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Definition
A most common cyanotic lesion caused by the a maldevelopment of the conus septum→division of septum moved too far anterior
1) A large VSD (L→R predominately but can be bi-directional)
2) An infundibular stenosis RVOT into the pulmonary artery and/or pulmonary valve narrowing. (PA atresia most severe).
3) The aorta is enlarged and "overrides," or sits directly above, the VSD. (malalignment of Ao/PA)
4) RVH because of volume overload and PHTN |
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Term
| What are some common symptoms of Tetralogy of Fallot? |
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Definition
1. cyanosis
2. clubbing
3. squatting |
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Term
| What is the most severe form or Tetralogy of Fallot? |
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Definition
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| What are some possible associated congenital lesions in Tetralogy of Fallot? |
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Definition
| Bicuspid PV, right-sided Ao Arch, coronary anomalies, right to left shunt |
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Term
| What is the surgical repair for Tetralogy of Fallot and what are some surgical complications? |
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Definition
1. Blalock-Tausigg removed if pallative measures were taken, ASD/VSD closed, PDA closed, in PS the RVOT can be surgically reconstructed
2. Infection, arrythmias, CHF, subacute bacterial endocarditis, pacemaker, death |
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Definition
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Definition
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| What is Eisenmenger's COMPLEX? |
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Definition
| Characterized by: large VSD, over-riding Ao, no RVOT obstruction, PA can be dilated, TV thickened and stenotic, ↑PVR, Eisenmenger's Physiology if blood flow reverses |
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Term
| What are some physical signs and symptoms associated with Bicuspid Ao? |
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Definition
| 2 cusps of unequal size or 3 cusps with raphe (fused) between two cusps, valve maybe stenotic with varying degrees of AI, coarchtation of the descending Ao, Ao root diated, sbe prophylaxis (treat with anitbiotics), CHF or LV failure, murmur, AS or AI, SOB, PHTN, Ventricular arrythmias |
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Term
| What is the ratio males to females for Bicuspid Ao Valve? |
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Definition
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Term
| What are some options to surgically repair Bicuspid Ao? |
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Definition
1. Do nothing
2. Ao valvuplasty
3. Ao valve replacement
*may need pacemaker, antiarrhythmic agents |
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Term
| What is coarctation of the Ao? |
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Definition
| an abnormality of the tunica media of decending Ao (thickening) causing a stenosis of Ao→HTN→↑afterload |
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Term
| What is the most popular prosthetic valve? |
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Definition
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Term
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Definition
| Ao cusps are fused and not thickened (can become calcific later in life), can be well tolerated if there are no symptoms. |
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Term
| What are some symptoms and physical findings of Congenital AS? |
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Definition
| Evidence of PHTN, CHF/LV failure, SBE, fatigue, chest pain, arrthymias, dyspnea, murmur, wide mediastinum and large LV in x-ray silhouette, pulmonary congestion, repiratory infections |
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| What are some sugical options for Congenital AS? |
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Definition
valvuplasty, Ao valve replacement, Ross procedure (replace Ao with PV and leave PA open or install new PV)
*repair other lesions if present |
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Term
| What is Hypoplastic Left Heart Syndrome and some of its characteristics? |
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Definition
| The LV is severely underdeveloped; cyanotic lesion, RVE, RVH, hypoplastic LV maybe filled with clot, coronary circulation maybe insufficient, AoV hypoplastic, AI, MS or Coarctation. NOT COMPATIBLE WITH LIFE, NEED A VERY LARGE ASD! |
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Term
| What type of medical care is required for Hypoplastic Left Heart Syndrome? |
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Definition
| Keep PDA open for Coronary Arterty flow (retrograde), correct metabolic acidosis, manipulate PVR with medications, intubation, cardiac medication management, O2 suppliment |
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Term
| What is Hypertrophic Cardiomyopathy (HOCM)and some characteristics? |
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Definition
| a condition in which the heart muscle becomes thick causing a small LV cavity with a degree of LVOT obstruction. The thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood. (EF @ 75-80%). Venturi effect (the reduction in fluid pressure that results when a fluid flows through a constricted section of pipe/vessel.)→Systolic anterior motion of the MV or chordae (SAM). Diastolic failure due to hypertrophy. ↑Intracardiac pressures; ↑LVP reflected in LA back to RH |
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Term
| What are the 2 classifications of HOCM? |
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Definition
| Obstructive or non-obstructive |
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Term
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Definition
| Asymetrical Hypertrophy (refers to muscular septum) |
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