The most common form of atrial septal defect (ASD) is:
Atrial septal defects (ASDs) can be classified into three different types:
The most common age to close asymptomatic ASDs is:
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.
Which of the following is NOT an acceptable treatment for aortic valve stenosis with a hypoplastic left ventricle (LV)?
In patients with critical aortic stenosis, the degree ofleft 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 maintain ductal patency for systemic blood flow. In the presence of hypoplastic LV, isolated aortic valvotomy should not be performed because studies have demonstrated high mortality in the population following isolated valvotomy. The Norwood procedure is the first part of the staged single ventricle pathway.
The most common location for a coarctation of the aorta (COA) is:
Coarctation of the aorta (COA) is defined as a luminal narrowing in the aorta that causes an obstruction to blood flow. This narrowing is most commonly located distal to the left subclavian artery. The embryologic origin of COA is a subject of some controversy. One theory holds that the obstructing shelf, which is largely composed of tissue found within the ductus, forms as the ductus involutes. The other theory holds that a diminished aortic isthmus develops secondary to decreased aortic flow in infants with enhanced ductal circulation.
The treatment of choice for recurrent COA (after surgical repair) in a preschool-aged child:
Children younger than 6 months with native COA should be treated with surgical repair, while those requiring intervention at later ages may be ideal candidates for balloon dilatation or primary stent implantation. Additionally, catheter-based therapy should be employed for those cases of restenosis following either surgical or primary endovascular management.
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