CSC Congenital Heart Disease Surgery 1 — Questions and Answers
Question 1: What are the four components of Tetralogy of Fallot?
- Ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy (Correct answer)
- Atrial septal defect, pulmonary stenosis, overriding aorta, and left ventricular hypertrophy
- Ventricular septal defect, aortic stenosis, overriding pulmonary artery, and right ventricular hypertrophy
- Ventricular septal defect, pulmonary atresia, transposed great arteries, and right ventricular hypertrophy
Correct answer: Ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy
Tetralogy of Fallot consists of VSD, pulmonary stenosis (RVOTO), overriding aorta, and right ventricular hypertrophy — all resulting from anterosuperior displacement of the infundibular septum.
Question 2: The definitive repair for Tetralogy of Fallot involves which two key components?
- Blalock-Taussig shunt creation and atrial septectomy
- VSD patch closure and right ventricular outflow tract reconstruction (Correct answer)
- Arterial switch operation and coronary transfer
- Pulmonary artery banding and atrial baffle creation
Correct answer: VSD patch closure and right ventricular outflow tract reconstruction
Complete repair of Tetralogy of Fallot requires closing the VSD with a patch and relieving RVOT obstruction, often using a transannular patch or conduit.
Question 3: The classic Blalock-Taussig (BT) shunt anastomoses which two structures?
- Ascending aorta to main pulmonary artery
- Superior vena cava to right pulmonary artery
- Subclavian artery to ipsilateral pulmonary artery (Correct answer)
- Right ventricle to pulmonary artery via a conduit
Correct answer: Subclavian artery to ipsilateral pulmonary artery
The classic BT shunt connects the subclavian artery end-to-side to the ipsilateral pulmonary artery, increasing pulmonary blood flow in cyanotic congenital heart disease.
Question 4: Which anatomical feature distinguishes a secundum ASD from a primum ASD?
- Secundum ASD occurs in the fossa ovalis; primum ASD is in the inferior septum adjacent to the AV valves (Correct answer)
- Secundum ASD is in the inferior atrial septum; primum ASD is in the fossa ovalis
- Secundum ASD involves the coronary sinus; primum ASD involves the superior vena cava
- Secundum ASD is always associated with a VSD; primum ASD is always isolated
Correct answer: Secundum ASD occurs in the fossa ovalis; primum ASD is in the inferior septum adjacent to the AV valves
Secundum ASDs occur centrally at the fossa ovalis, while primum ASDs are located in the inferior atrial septum adjacent to the AV valves and are part of the atrioventricular septal defect spectrum.
Question 5: What is the primary hemodynamic indication for surgical closure of a ventricular septal defect (VSD)?
- Presence of any audible murmur regardless of shunt size
- Qp:Qs ratio greater than 1.5:1 with symptoms or evidence of volume overload (Correct answer)
- Detection of VSD in any newborn before 6 months of age
- VSD diameter exceeding 3 mm on echocardiography
Correct answer: Qp:Qs ratio greater than 1.5:1 with symptoms or evidence of volume overload
Surgical closure is indicated when the pulmonary-to-systemic flow ratio exceeds 1.5:1, particularly when accompanied by symptoms, recurrent infections, or ventricular volume overload.
Question 6: The arterial switch operation (Jatene procedure) is the definitive repair for which congenital defect?
- Tetralogy of Fallot with pulmonary atresia
- Hypoplastic left heart syndrome
- D-transposition of the great arteries (Correct answer)
- Total anomalous pulmonary venous connection
Correct answer: D-transposition of the great arteries
The arterial switch operation corrects D-TGA by transecting both great arteries and re-anastomosing them to their correct ventricular origins, along with coronary artery reimplantation.
Question 7: During the Norwood Stage I procedure for hypoplastic left heart syndrome, which key anastomosis creates unobstructed systemic outflow?
- Superior vena cava to right pulmonary artery (Glenn anastomosis)
- Damus-Kaye-Stansel anastomosis connecting the proximal pulmonary artery to the aorta (Correct answer)
- Fontan tunnel connecting the inferior vena cava to the pulmonary artery
- Blalock-Taussig shunt from the innominate artery to the pulmonary artery
Correct answer: Damus-Kaye-Stansel anastomosis connecting the proximal pulmonary artery to the aorta
The Damus-Kaye-Stansel anastomosis connects the proximal main pulmonary artery to the hypoplastic ascending aorta, creating an unobstructed outflow from the single right ventricle to the systemic circulation.
CSC Congenital Heart Disease Surgery 1
What are the four components of Tetralogy of Fallot?