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Congenital 2

By David Blitzer / February 4, 2023

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Congenital Heart Surgery 0%

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Question 1 of 20

1. Question
Which scenario represents a patient at the optimal time for VSD repair?
- 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, who has normal PVR.
- 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 2 of 20

2. Question
Which of the following is a significant complication of VSD patch-repair?
- Late patch degradation or dehiscence requiring reoperation.
- Complete heart block.
- RV failure.
- Failure to thrive
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Question 3 of 20

3. Question
The optimal surgical approach to a non-restrictive perimembranous VSD is:
- PA banding within the first week of life to restrict left to right shunting across the VSD and prevent subsequent pulmonary overcirculation.
- Right ventriculotomy and primary repair.
- Apical approach with Gore-Tex repair.
- Right atriotomy, trans-tricuspid approach with Gore-Tex patch closure.
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Question 4 of 20

4. Question
Which of the following is true regarding the pulmonary circulation in a healthy 6 month old patient who is being followed due to VSD diagnosed at birth?
- 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 every 6 months 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 5 of 20

5. Question
Which of the following is true regarding transcatheter VSD closure?
- It is associated with decreased mortality and lower rate of complications than open closure methods
- It is considered first line therapy for patients with normal PVR and persistent left-to-right shunting who have been trialed on medical management
- It is associated with increased mortality and increased rate of heart block compared to open closure methods.
- It is indicated for treatment of small VSDs that otherwise may close spontaneously.
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Question 6 of 20

6. Question
Which of the following is false regarding ventricular septal defect?
- It is the most common cyanotic heart lesion.
- It is the most common congenital heart lesion.
- It is frequently associated with trisomy syndromes.
- Its diagnosis is typically made at the time of birth.
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Question 7 of 20

7. Question
Which of the following prenatal exposures is NOT directly associated with PDA?
- Maternal diabetes mellitus
- Congenital rubella
- Pre-eclampsia
- High altitude birth
- In-utero exposure to ACE inhibitors
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Question 8 of 20

8. Question
While effective when used for medical closure of PDA, indomethacin is associated with all the following toxicities EXCEPT:
- Renal failure
- Necrotizing enterocolitis
- Pulmonary hemorrhage
- Long term neurological damage
- Bowel perforation
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Question 9 of 20

9. Question
Avoidance of which of the following risks is the primary indication for endovascular or surgical closure of a small PDA in an asymptomatic adult?
- Increased risk of aneurysmal dilatation and rupture
- Increased risk of endocarditis
- Imminent risk of congestive heart failure
- Increased risk of ventricular arrhythmias and sudden death
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Question 10 of 20

10. Question
Which of the following is NOT a contraindication to indomethacin-mediated closure of PDA?
- Renal failure
- Concomitant VSD
- Thrombocytopenia
- Sepsis
- Necrotizing enterocolitis
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Question 11 of 20

11. Question
Which of the following statements is TRUE regarding the management of PDA in the adult?
- Medical therapy is superior to surgical repair.
- VATS techniques have yielded superior short and long term results compared to open surgical techniques
- Adults often require sternotomy for complete closure.
- Antibiotic prophylaxis is recommended even after complete closure.
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Question 12 of 20

12. Question
The most common complication of surgical ligation of the PDA is:
- Phrenic nerve injury
- Recannalation of the ductus arteriosus
- Chylothorax
- Left recurrent laryngeal nerve injury
- Cerebrovascular accident
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Question 13 of 20

13. Question
Which of the following is not a potential operative goal of palliative operations?
- Increased intracardiac shunt
- Reduction of pulmonary blood flow
- Anatomical correction
- Increase in pulmonary blood flow
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Question 14 of 20

14. Question
An iecrease in pulmonary blood flow may be desired in all of the the following conditions except:
- Ebstein’s anomaly
- Interrupted aortic arch
- Hypoplastic left heart syndrome
- Tricuspid atresia
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Question 15 of 20

15. Question
Which of the following is not considered a characteristic of an effective shunt?
- Technically simple operation
- Proven durability for the lifetime of the patient
- Easily reversible
- Good functionality without residual shunt
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Question 16 of 20

16. Question
Atrial Septostomy is designed to palliate which of the following?
- Tetralogy of Fallot
- Hypoplastic left heart syndrome
- Transposition of the great arteries
- All of the above
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Question 17 of 20

17. Question
What are the disadvantage of stenting the PDA versus surgical shunt creation?
- Stenting violates the operative field
- Stenting may result in chylothorax
- Stenting may lead to difficult ligation at the time of corrective surgery
- Higher risk is associated with stenting
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Question 18 of 20

18. Question
A superior cavopulmonary anastomosis (Modified Glenn shunt)
- Always needs CPB to perform the shunt
- Needs cardioplegic arrest of the heart
- Is performed through a right thoracotomy
- Is performed through a median sternotomy
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Question 19 of 20

19. Question
Characteristic echocardiographic feature that differentiates Ebstein’s anomaly from other causes of congenital tricuspid insufficiency is
- Degree of apical displacement of septal leaflet
- Degree of right atrial dilation
- Degree of tricuspid annular dilation
- Degree of right ventricular dilation
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Question 20 of 20

20. Question
A newborn with Ebstein’s has cyanosis and severe RV failure despite medical therapy. Echocardiography shows severe pulmonary stenosis, severely depressed RV function, and good LV function. The most appropriate surgical option is
- Tricuspid valve repair
- Univentricular repair
- Biventricular repair
- Cardiac transplantation
Correct

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