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Chapter 20: Congenital Heart Disease

The most common form of atrial septal defect (ASD) is

A. Sinus venosus defect

B. Ostium primum defect

C. Ostium secundum defect

D. Combined primum and secundum defect

Answer: C

Atrial septal defects (ASDs) can be classified into three different types: (1) sinus venosus defects, comprising approximately 5 to 10% of all ASDs; (2) ostium primum defects, which are more correctly described as partial atrioventricular canal defects; and (3) ostium secundum defects, which are the most prevalent subtype, comprising 80% of all ASDs. (See Schwartz 10th ed., pp. 695–696.)

The most common age to close asymptomatic ASDs is

A. In the immediate newborn period

B. After the child reaches 10 kg in weight

C. Age 4–5 years

D. During puberty

Answer: C

ASDs are closed when patients are between 4 and 5 years of age. Children of this size can usually be operated on without the use of blood transfusion and generally have excellent outcomes. Patients who are symptomatic may require repair earlier, even in infancy. Some surgeons, however, advocate routine repair in infants and children, as even smaller defects are associated with the risk of paradoxical embolism, particularly during pregnancy. Reddy and colleagues, report 116 neonates weighing less than 2500 g who underwent repair of simple and complex cardiac defects with the use of cardiopulmonary bypass and found no intracerebral hemorrhages, no long-term neurologic sequelae, and a low operative-mortality rate (10%). These results correlated with the length of cardiopulmonary bypass and the complexity of repair. These investigators also found an 80% actuarial survival at 1 year and, more importantly, that growth following complete repair was equivalent to weight-matched neonates free from cardiac defects. (See Schwartz 10th ed., p. 697.)

Which of the following is NOT an acceptable treatment for aortic valve stenosis with a hypoplastic left ventricle (LV)?

A. Balloon valvotomy

B. Intubation and initiation of prostaglandin

C. Surgical valvotomy

D. Norwood procedure

Answer: A

In patients with critical aortic stenosis, the degree of left ventricular hypoplasia is assessed and based on this the decision for biventricular and univentricular repair is made. Urgent intervention is needed in these critically ill neonates including intubation, inotropic support, and prostaglandin to ...

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