[02.25] SUR - Surgical Management of Congenital Heart Disease V2.1.pdf

Heart transplantation

What is called the final frontier in the surgical management of congenital heart disease

Philippines

In which country is pediatric heart transplantation currently not available

Two to three decades

For how many decades have more resource-rich countries been conducting pediatric heart transplantation

Pig hearts into baboons

What animal models are used in current breakthrough research on heart xenotransplantation

Lack of donors

What is the primary problem with heart transplantation that drives research into xenotransplantation

Expanding the donor pool

What is the current cutting-edge research focus to shorten the heart transplant list

Non-humans

Which group of donors is being considered to expand the donor pool for heart transplantation

Baby Fae

What is the name of the historic infant in the 1984 xenotransplant case

1984

In what year did the historic infant xenotransplant case of Baby Fae occur

Loma Linda, CA, USA

In which location did the historic infant xenotransplant case of Baby Fae take place

Baboon heart

What animal organ was used in the first pediatric heart transplant involving Baby Fae

Hypoplastic left heart syndrome

With what end-stage condition was Baby Fae born

Transplantation

What was the only therapeutic resort for infants born with hypoplastic left heart syndrome in 1984

One to two months

How long did Baby Fae survive after her xenotransplant surgery

Acute rejection

What immunological complication caused Baby Fae to not survive beyond one to two months

Traditional classification

Which classification gives an idea of the pathophysiology of a congenital heart lesion by placing it as cyanotic or non-cyanotic

Non-cyanotic heart disease

Under which traditional classification is a ventricular septal defect categorized

Cyanotic heart disease

Under which traditional classification is tetralogy of fallot categorized

Right-to-left shunting of deoxygenated blood

What mechanical flow characterizes cyanotic congenital heart disease

Deoxygenated blood

What type of blood is shunted into systemic circulation in cyanotic congenital heart disease

Pulmonary congestion

What is the primary mechanism of heart failure in non-cyanotic congenital heart disease

Operative classification and analysis

Which practical classification scheme leads surgeons to analyze congenital heart lesions based on shunts and obstructions

Determine the level of the shunt

What is the first analysis step in evaluating shunt lesions under the operative classification

Shunt

What is a hole or communication between the systemic left side and the pulmonary right side circulation called

Left side

Which side of the heart represents systemic circulation in a shunt lesion

Right side

Which side of the heart represents pulmonary circulation in a shunt lesion

Atrial, ventricular, and post-aortic valve

What are the three potential levels of communication for shunt lesions

Post-aortic defect

What level of shunt is represented by a patent ductus arteriosus

Severity and natural history

What clinical insights are gained by determining the level of a shunt lesion

Obstructive lesions

Which lesions are evaluated by determining whether they obstruct the left or right ventricular outflow

Interactions between the shunt lesion and the obstructive lesion

What must be determined in operative analysis to predict pulmonary and systemic blood flow changes

Reduced or increased pulmonary blood flow, or reduced systemic blood flow

What three flow abnormalities can result from interactions between shunts and obstructions

Shunt

What cardiovascular abnormality connects one chamber or circulatory system to another

Obstructions

What cardiovascular abnormality blocks outflow from one system to the other

Heart failure or circulatory collapse

What are the two major systemic outcomes of interactions between shunts and obstructions

Cyanosis

What state is defined by the cardiac output coming from the heart being unoxygenated

Blue blood or blue babies

What is the clinical manifestation of unoxygenated cardiac output entering systemic circulation

Heart failure

What chronic clinical event is characterized by reduced cardiac output and congested lungs

Congested lungs

What is the primary clinical manifestation of heart failure due to damming of blood back to the lungs

Circulatory collapse

What acute event is defined by zero cardiac output and represents a true surgical emergency

Alleviate the lesion's effects on the heart

What is the primary goal of surgery during an acute circulatory collapse

18 years old

What is the age of the female patient presenting with palpitations and occasional shortness of breath in Case 1

Palpitations and occasional shortness of breath

What are the clinical presentations of the 18-year-old female patient in Case 1

Clear breath sounds with no signs of pulmonary congestion

What were the lung exam findings in the 18-year-old female patient in Case 1

Systolic murmur on the left upper parasternal area

What was the key physical exam finding on the chest of the patient in Case 1

Pulmonary valve

Which valve's anatomical location corresponds to the left upper parasternal systolic murmur heard in Case 1

No left ventricular enlargement

What did the chest X-ray show regarding left ventricular size in the patient in Case 1

Apex

Which part of the cardiac silhouette on chest X-ray represents the left ventricle

Displaced to the left side

Where is the cardiac apex displaced if there is left ventricular enlargement

No cardiac waist

What is the term for a chest X-ray finding where the normal depression in the area of the pulmonary artery and aorta is lost

Depression in the area of the pulmonary artery and aorta

What anatomical feature defines the normal cardiac waist on a chest X-ray

Bump on the pulmonary artery

What did the chest X-ray demonstrate in Case 1 to indicate an abnormal cardiac waist

Normal right atrium and ventricle

What did the blue arrow on the chest X-ray in Case 1 indicate about the right heart chambers

Right ventricular enlargement

What does a bulging right heart contour on chest X-ray indicate

Atrial septal defect

What does the red box highlight on the 2D echo in Case 1

Under the breastbone

Where is the right ventricle located relative to the chest wall during a 2D echocardiogram

Right atrium

Which right-sided chamber drains directly into the right ventricle

Posteriorly

Where are the left chambers of the heart located anatomically relative to the right chambers

Roughly 2 cm

What was the size of the atrial septal defect in Case 1

Noticeably enlarged

What was the state of the right-sided chambers on the echocardiogram in Case 1

Left ventricle

In a normal heart, which ventricle is larger than the other

Right ventricle cavity and contour larger than left ventricle

What was the abnormal ratio of ventricular sizes seen on 2D echo in Case 1

Shunt connecting LA to RA

Why does right-sided cardiomegaly occur in an atrial septal defect

Atrial septal defect

What is the term for a communication between the right and left atria

LA to RA

In what direction does blood shunt through an atrial septal defect

Pressure gradient

What physical force drives blood from the left atrium to the right atrium in an ASD

Left atrium

Which atrium has the higher pressure in a simple atrial septal defect

10-15 mmHg

What is the normal pressure of the left atrium

5-8 mmHg

What is the normal pressure of the right atrium

Central venous pressure or CVP

What is another clinical term for the normal right atrial pressure of 5-8 mmHg

Oxygenated blood

What type of blood moves from the left atrium to the right atrium through an ASD

Right-sided heart enlargement

What anatomical change is caused by increased blood volume on the right side of the heart in an ASD

Flooding them with already oxygenated blood

What is the consequence of increased blood flow from the right ventricle into the lungs in an ASD

5 years old

What is the age of the boy presenting in the VSD case

Short stature, poor weight gain, and shortness of breath on exertion

What are the clinical presentations of the 5-year-old boy in the VSD case

Clear breath sounds

What were the pulmonary physical exam findings in the 5-year-old VSD patient

Left upper parasternal area

Where was the systolic murmur heard in the 5-year-old VSD case

Displaced towards the left

Where was the cardiac apex positioned on the chest X-ray of the VSD patient

Grossly enlarged

What was the overall size of the heart compared to the thoracic cavity in the VSD patient

More than 50 percent

What was the width ratio of the heart compared to the thoracic cavity in the VSD patient

Left ventricular enlargement

What does a displaced apex towards the left suggest on chest X-ray in a VSD patient

Exaggerated pulmonary artery

What did the red arrow highlight on the chest X-ray of the VSD patient

Smaller

How does the cardiac waist appear when the pulmonary artery knob is enlarged on chest X-ray

Not much bigger than normal

What was the size of the right side of the heart on the chest X-ray of the VSD patient

Communication between the right and left ventricles

What does the yellow box show on the 2D echo in the VSD case

Left ventricle is dilated

What is the ventricular finding on 2D echo in a patient with a VSD

Back to the lungs and into the left side

Where does the shunted oxygenated blood find its way after passing through the VSD into the right side

Goes in circles

How does the shunted blood flow repeatedly in a patient with a VSD shunt

Volume-loading the left side

What hemodynamic change strains the left heart and ultimately causes heart failure in VSD

Small fraction

What fraction of blood actually goes out into the systemic circulation in a large VSD

Double-time

How hard must the heart work in a patient with a VSD shunt

Degree of pulmonary congestion

What is significantly different when comparing ASD versus VSD shunt lesions

VSD

Between ASD and VSD, in which condition does pulmonary congestion present earlier

VSD

Between ASD and VSD, in which condition is there more pulmonary congestion

VSD

Between ASD and VSD, where is the severity of heart failure increased

High systemic pressure of 120 mmHg

Why is there more heart failure in VSD compared to ASD

Systemic pressure

What type of pressure is pumped through the VSD and into the lungs, causing early damage

Hypertensive

What do the lungs become earlier in VSD compared to ASD due to the high-pressure shunt

Pressure and volume overload

What dual hemodynamic overload does VSD cause to the lungs

Size of the defects

Upon what does the degree of lung congestion depend in shunt lesions