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Congenital 10

By David Blitzer / February 4, 2023

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Congenital Heart Surgery 0%

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Question 1 of 20

1. Question
A 5 year-old patient is referred to you for surgical evaluation after workup of heart failure symptoms revealed a patent ductus arteriosus. There are no other cardiac abnormalities. The patient undergoes preoperative cardiac catheterization, revealing bidirectional flow and elevated pulmonary vascular resistance. What should the next step in surgical evaluation be?
- Evaluation of response in PVR to nitric oxide
- Indomethacin course
- Proceed with surgical PDA ligation
- Refer for transcatheter PDA closure
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Question 2 of 20

2. Question
7. A 11-month-old infant received a palliative operation followed by a corrective cardiac surgery early in life. Current echocardiogram reveals pulmonary artery stenosis and echogenicity suggestive of PA scarring. The most likely palliative operation patient received is:
- Cavo-Pulmonary shunt
- Pulmonary artery band
- Aorto-Pulmonary shunt
- Hemi-Fontan
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Question 3 of 20

3. Question
Which shunt might be indicated in patients with pulmonary hypertension in order to increase their 6-minute walk:
- Classic Blalock-Taussig shunt
- Shumaker-Mandelbaum’s shunt
- Sano shunt
- Potts’s Shunt
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Question 4 of 20

4. Question
6. All these conditions can be current indications for Pulmonary artery banding except in:
- Truncus arteriosus
- Ventricular septal defects
- Transposition of great arteries
- congenitally corrected Transposition of great arteries
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Question 5 of 20

5. Question
1. What of the following congenital heart defects would have a Qp:Qs <1?
- Pulmonic stenosis
- Aortic stenosis with closed ductus
- Tetralogy of Fallot
- Atrioventricular septal defect
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Question 6 of 20

6. Question
20. What is a normal physiologic cardiac alteration during the fetal-neonatal transition?
- Decrease in pulmonary blood flow
- Decrease in systemic vascular resistance
- Decrease in arterial oxygen tension
- Decrease in ductus venosus flow
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Question 7 of 20

7. Question
11. What is not characteristic of Eisenmenger syndrome?
- Advanced form of pulmonary artery hypertension
- Diagnosis in the neonatal period
- Pulmonary vascular resistance exceeds systemic vascular resistance
- Erythrocytosis or hyperviscosity syndrome
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Question 8 of 20

8. Question
4. A 3.5 kg infant with Tricuspid Atresia has a modified BT shunt with 4.5 mm PTFE conduit. Spo2 is 95% with BP of 90/25 mmHg. The following stateme…
- The shunt size is adequate
- The shunt is too small
- The shunt is too large
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Question 9 of 20

9. Question
17. Which is the disadvantage of stenting the PDA versus surgical shunt creation includes?
- Stenting violates the operative field
- May result in chylothorax
- May distort the pulmonary arteries
- High risk associated
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Question 10 of 20

10. Question
All of the following can increase the right-to-left shunt in tetralogy of Fallot except:
- Tachycardia
- increased preload
- loss of atrioventricular synchrony
- general anesthesia
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Question 11 of 20

11. Question
Which of the following statements about tetralogy of Fallot is TRUE?
- prenatal diagnosis improves outcomes
- squatting worsens cyanosis
- Mortality approaches 50% at one year when untreated
- Cyanosis is always present
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Question 12 of 20

12. Question
Which of the following additional cardiac defects is NOT associated with tetralogy of Fallot?
- right sided aortic arch
- ASD
- additional VSDs
- congenital aortic stenosis
- genetic syndromes
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Question 13 of 20

13. Question
Which scenario represents the optimal time to operate on a patient with a VSD?
- A three-month-old with a mildly restrictive VSD who is responding well to medical management.
- A 12-month old with non-restrictive VSD, significant left-to-right shunting, and normal PVR.
- A 6-month old patient, on medical treatment for CHF related to VSD and is responding appropriately, PVR is normal.
- A 1 month old who is found to have a non-restrictive VSD with significant left-to-right shunting but has not developed CHF, elevated PVR, or other symptoms of VSD.
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Question 14 of 20

14. Question
Which of the following is true regarding cardiac catheterization data from an 18-month old patient with a non-restrictive VSD?
- PVR < 8 Wood units; the VSD should be closed
- PVR < 8 Wood units; the VSD should not be closed
- PVR > 12 Wood units; the VSD should be closed
- PVR is 8-12 Wood units; the VSD should be closed without consideration of response to vasodilators.
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Question 15 of 20

15. Question
Which of the following is a notable, significant complication of patch-repair of a VSD that one must consult his or her patient about:
- Late patch degradation or dehiscence requiring reoperation
- Complete heart block
- RV failure
- Failure to thrive/CHF
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Question 16 of 20

16. Question
Which of the following is true regarding medical management for VSD?
- It is aimed at closing the VSD.
- It is aimed at treating heart failure in the infant with left to right shunting.
- It is made up of no cardiovascular medications, only medication and therapy for failure to thrive
- It is second line therapy when surgery has not been offered.
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Question 17 of 20

17. Question
Which of the following is not a cyanotic heart lesion found at birth?
- Truncus Arteriosus
- Tricuspid Atresia
- Transposition of the Great Arteries
- Ventricular Septal Defect
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Question 18 of 20

18. Question
The surgical approach to a non-restrictive peri-membranous VSD is:
- PA banding within the first week of life in order to restrict left to right shunting across the VSD and the subsequent pulmonary overcirculation.
- Right ventriculotomy and primary repair.
- Apical approach with Gore-Tex repair.
- Right atriotomy, trans-tricuspid approach with Gore-Tex patch closure.
Correct

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Question 19 of 20

19. Question
Which of the following is true regarding the pulmonary circulation in a 6 month old, healthy patient, who is being followed due to VSD?
- The resultant pulmonary hypertension from non-restricted blood flow across the VSD will be non-reversible; surgery should be planned immediately.
- The degree of pulmonary hypertension should be documented with cardiac catheterization.
- Elevated PA pressures are unlikely to have set in at this point; and, if they have, they are likely to be reversible. The patient should continue to be followed with physical exam and echocardiogram.
- If the PVR is less than 8 mmHg/L/min/m2 (resistance or Wood units) then the VSD should not be repaired.
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Question 20 of 20

20. Question
Trans-catheter VSD closures is associated with
- improved mortality and lower rates of complications than open closure methods
- first line therapy for patients with normal PVR and persistent left-to-right shunting who have been trialed on medical management
- increased mortality and increased rates of heart block as compared to open closure methods.
- treatment of small VSDs that otherwise may close spontaneously
Correct

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