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

Invasive

What type of procedure is cardiac catheterization described as in terms of entry into the body

Small catheters

What tools are advanced into the chambers and great vessels of the heart during cardiac catheterization

Chambers and great vessels

Into which cardiac regions are small catheters advanced during cardiac catheterization

Various blood vessels

Through which blood vessels do adult patients enter during cardiac catheterization

Femoral artery and vein

Through which blood vessels do pediatric patients predominantly enter during cardiac catheterization

Internal jugular vein

Through which neck blood vessel do pediatric patients occasionally enter during cardiac catheterization

Cardiac catheterization lab

What is the specialized laboratory room where cardiac catheterization is performed

Diagnostic

What was the primary clinical purpose of cardiac catheterization historically

Angiogram

What type of imaging procedure is demonstrated in Figure 2 showing the left coronary artery

Left coronary artery

Which specific coronary artery is visualized in the angiogram in Figure 2

Dilated coronary artery fistula

What vascular malformation is shown in the left coronary artery angiogram in Figure 2

Right atrium

Into which cardiac chamber did the dilated coronary artery fistula in Figure 2 drain

Implanted coils

What devices were used to occlude the dilated coronary artery fistula in Figure 2

Bottom left corner

Where on Figure 2 are the implanted coils located

Right and left pulmonary arteries

Which major blood vessels are visualized in the angiogram in Figure 3

Right

Which specific pulmonary artery shows an abnormal pattern in Figure 3

1970s

In which decade was ultrasound technology noted as being less accurate than today

Pulmonary arteriovenous malformation

What is the full clinical term for the abbreviation AVM in Figure 4

Right lower lung field

In which specific lung zone is the pulmonary AVM located in Figure 4

Left ventricular angiogram

What type of ventricular angiogram is shown in Figure 5

Ventricular septal defect

What type of septal defect is demonstrated in Figure 5

White

What color represents the interventricular septum on the angiogram in Figure 5

Above the septum

Where is the ventricular septal defect located relative to the septum on the angiogram in Figure 5

Creating atrial septal defect

What intervention is done for obligatory right to left or left to right shunt lesions

Obligatory right to left or left to right

What type of shunt lesions require the creation of an ASD

Balloon angioplasty

What specific interventional technique is used for relieving obstructions

Stenting

What interventional technique is used for the ductus arteriosus and other vascular structures

Occlusion or closure

What is the primary intervention for congenital heart defects like PDA, VSD, or ASD

PDA, VSD, or ASD

What three specific congenital heart defects are routinely occluded or closed via catheterization

Balloon Atrial Septostomy

What does BAS stand for in pediatric cardiac catheterization

Transposition of the Great Arteries

For what specific congenital cyanotic defect is Balloon Atrial Septostomy routinely performed

Right ventricle

In TGA, which ventricle is abnormally connected to the aorta

Aorta

In TGA, which great vessel is abnormally connected to the right ventricle

Left ventricle

In TGA, which ventricle is abnormally connected to the pulmonary artery

Pulmonary artery

In TGA, which great vessel is abnormally connected to the left ventricle

Left side

On which side of the heart is oxygenated blood stuck in patients with TGA

Pulmonary arteries and pulmonary veins

Through which blood vessels is oxygenated blood recirculating uselessly in TGA

Patent foramen ovale

What small interatrial opening is crossed with a catheter during BAS

Left side

On which side of the atrial septum is the balloon inflated during BAS

Tear it open

What is the mechanical objective of pulling the inflated balloon very hard and quickly across the septum in BAS

Left atrium to right atrium

In which direction does BAS allow oxygenated blood to flow

Fluoroscopy

What real-time imaging modality is shown in Figure 7 during BAS

Left

On which side of the septal wall is the balloon inflated in Figure 7

Right atrium

Into which chamber does the balloon arrive after a sudden hard pull across the atrial septum

Shakes with the tug

What physical movement of the patient's heart and body occurs when the BAS balloon is pulled hard

Thin atrial septal walls

What anatomical characteristic of the atrial septum is required for BAS to be effective

Under 1 month old

In what pediatric age group is BAS usually performed

Blade septostomy

What procedure is used when the atrial septum has thickened due to late diagnosis

Intermittently in different parts

How does the blade cut the septum during a blade septostomy

Slices the atrial septum

What is the action of pulling the blade down during blade septostomy

Collapsed

What must be done to the blade after cutting to prevent damaging unnecessary cardiac structures

Dangerous

How does the text describe the act of using a blade inside the heart

Several times

How many times is the septum typically cut during blade septostomy

Balloon atrioseptoplasty

What procedure is performed after blade septostomy to stretch the cuts with a balloon

7 to 8 mm

What is the final hole diameter created by balloon atrioseptoplasty

Angiogram

What imaging modality is shown in Figure 8 depicting an open blade cutting the atrial septum

Inferior portion

In which portion of Figure 8 is the open blade visible

Balloon atrioseptoplasty

What procedure is demonstrated in Figure 9 showing balloon inflation

Stent

What device is placed across the atrial septum when the septum is very thick and no blades are available

Stent of the atrial septum

What procedure is shown in Figure 10

Contrast injected

What is shown in the upper left image of Figure 10 to identify the left side of the heart

Across the atrial septum

Where is the stent positioned in the lower left image of Figure 10

Being inflated

What is happening to the stent in the upper right image of Figure 10

Fully inflated

What is the state of the stent in the lower right image of Figure 10

No restrictions to flow

What is the flow condition shown after full stent inflation in Figure 10

Pulmonary balloon valvuloplasty

What intervention is shown in Figure 11 to relieve pulmonary valve obstruction

Right ventricle

In which ventricle is the catheter positioned during pulmonary balloon valvuloplasty

Thickened pulmonary valve

What anatomical abnormality of the pulmonary valve is shown on the pre-procedure angiogram

Narrow jet of contrast

What is seen flowing through the narrowing of the pulmonary valve on the pre-procedure angiogram

Dilated pulmonary artery

Where does the contrast flow after passing through the narrow pulmonary valve on the pre-procedure angiogram

Wire and balloon

What are placed across the stenotic pulmonary valve in Figure 12

Waist

What indentation appears on the balloon during inflation across the stenotic pulmonary valve

Narrowing of the valve

What does the visible waist on the inflated balloon represent during valvuloplasty

Disappears

What happens to the waist when the pulmonary valve has been successfully stretched open

RV pressure

What is rechecked by taking another angiogram after pulmonary balloon valvuloplasty

Better flow of contrast

What post-valvuloplasty angiogram finding indicates an opened pulmonary valve

Never

When can the pulmonary valve be fully opened back to normal anatomy after valvuloplasty

Maximally relieved

What is the mechanical goal for the pulmonary valve obstruction if it cannot be fully opened

Aortic balloon valvuloplasty

What procedure is shown in Figure 14 and 15

Aortic valve stenosis

For what specific valvular pathology is aortic balloon valvuloplasty performed

Right carotid artery

What is the catheter entry site used for aortic balloon valvuloplasty in infants because it is easier

Femoral artery

What is the catheter entry site used for aortic balloon valvuloplasty in older patients

Left ventricle

Through which chamber does the catheter cross to perform the pre-procedure angiogram in older aortic stenosis patients

Femoral vein

From which vessel is the second catheter introduced to place the pacing wire in aortic valvuloplasty

Pacing wire

What device is passed into the right ventricle to stabilize the balloon during aortic valvuloplasty

Ventricular tachycardia

What rapid ventricular arrhythmia is intentionally induced during aortic balloon valvuloplasty

Stabilize the balloon

Why is ventricular tachycardia intentionally induced during aortic valvuloplasty

Prevent balloon ejection

What is the objective of stabilizing the balloon with rapid ventricular pacing during aortic valvuloplasty

Right ventricle

Into which chamber is the pacing wire passed during aortic balloon valvuloplasty

Aortic root angiogram

What angiographic study is performed immediately after aortic balloon valvuloplasty

Aortic valve insufficiency

What major procedural complication is checked for on the post-procedure aortic root angiogram

Coarctation of the aorta balloon dilatation

What procedure is depicted in Figure 22

Descending aorta

In which specific aortic segment does the narrowing occur in coarctation of the aorta

Left

Which angiogram panel in Figure 22 shows the narrowing of the descending aorta

Middle

Which angiogram panel in Figure 22 shows the balloon being inflated with a waist at the coarctation site

Right

Which angiogram panel in Figure 22 shows marked resolution of the coarctation

Recoil

What term refers to the narrowing that persists or returns due to elastic properties after balloon dilatation

Medical management

What did the adult patient in Case 3 require post-procedure to control residual hypertension

Control hypertension

What was the clinical goal of medical management after coarctation balloon dilatation in the adult patient

Covered stent

What device is placed at the coarctation site if the narrowing is extremely severe