CSC Congenital Heart Disease Surgery 2 — Questions and Answers
Question 1: The bidirectional Glenn procedure connects which two structures?
- Inferior vena cava end-to-side to the main pulmonary artery
- Superior vena cava end-to-side to the right pulmonary artery (Correct answer)
- Subclavian artery side-to-side to the pulmonary artery
- Right atrium to the right pulmonary artery via a tunnel
Correct answer: Superior vena cava end-to-side to the right pulmonary artery
The bidirectional Glenn shunt connects the superior vena cava end-to-side to the right pulmonary artery, directing upper body venous return passively to both lungs without ventricular pumping.
Question 2: At what approximate age is Fontan completion typically performed following the bidirectional Glenn procedure?
- 1 to 3 months of age
- 6 to 12 months of age
- 2 to 4 years of age (Correct answer)
- 8 to 12 years of age
Correct answer: 2 to 4 years of age
Fontan completion is typically performed between ages 2 and 4 years, after adequate reduction of pulmonary vascular resistance has been achieved following the Glenn procedure.
Question 3: Coarctation of the aorta most commonly occurs at which anatomical location?
- Ascending aorta proximal to the innominate artery origin
- Aortic arch between the left common carotid and left subclavian arteries
- Juxtaductal position near the insertion of the ligamentum arteriosum (Correct answer)
- Descending thoracic aorta at the level of the diaphragm
Correct answer: Juxtaductal position near the insertion of the ligamentum arteriosum
Coarctation most commonly occurs at the juxtaductal position in the proximal descending thoracic aorta, near the insertion of the ligamentum arteriosum (remnant of the ductus arteriosus).
Question 4: Total anomalous pulmonary venous connection (TAPVC) requires urgent surgical repair when which condition is present?
- Mild right ventricular dilation on echocardiogram
- Pulmonary venous obstruction causing severe cyanosis and pulmonary edema (Correct answer)
- Bidirectional shunting at the atrial level
- Pulmonary artery pressure equal to 50% of systemic pressure
Correct answer: Pulmonary venous obstruction causing severe cyanosis and pulmonary edema
Obstructed TAPVC is a surgical emergency because pulmonary venous obstruction causes severe pulmonary edema, profound hypoxemia, and cardiovascular collapse without urgent repair.
Question 5: In Ebstein anomaly, what is the primary anatomical abnormality of the tricuspid valve?
- Prolapse of the anterior leaflet into the right atrium during systole
- Apical displacement of the septal and posterior leaflets into the right ventricle (Correct answer)
- Fusion of all three leaflets causing severe tricuspid stenosis
- Absence of the septal leaflet with a single large anterior leaflet
Correct answer: Apical displacement of the septal and posterior leaflets into the right ventricle
Ebstein anomaly is characterized by downward (apical) displacement of the tricuspid valve's septal and posterior leaflets into the right ventricle, creating an atrialized portion of the RV.
Question 6: Which surgical technique for Ebstein anomaly repair involves detaching and rotating the available leaflet tissue to create a cone-shaped valve?
- Konno-Rastan aortoventriculoplasty
- Cone reconstruction (da Silva technique) (Correct answer)
- Damus-Kaye-Stansel anastomosis
- Danielson repair with posterior plication
Correct answer: Cone reconstruction (da Silva technique)
The cone reconstruction (da Silva technique) detaches, rotates, and reattaches the leaflet tissue to create a three-dimensional cone resembling a normal tricuspid valve, with superior long-term outcomes.
Question 7: In the Collett and Edwards classification, what defines Type I truncus arteriosus?
- Separate pulmonary arteries arising from the posterior truncus with no main pulmonary artery segment
- A short main pulmonary artery segment arising from the left side of the common truncal root (Correct answer)
- Pulmonary arteries arising as collaterals from the descending aorta
- Complete atresia of the pulmonary valve with ductal-dependent pulmonary flow
Correct answer: A short main pulmonary artery segment arising from the left side of the common truncal root
Type I truncus (most common) features a short main pulmonary artery segment arising from the common truncal root before dividing into left and right pulmonary arteries.
CSC Congenital Heart Disease Surgery 2
The bidirectional Glenn procedure connects which two structures?