Neonatal Cardiovascular Assessment and Care Flashcards

Which congenital heart defect is classically associated with a 'boot-shaped' cardiac silhouette on chest X-ray?

Answer: Tetralogy of Fallot

Tetralogy of Fallot causes right ventricular hypertrophy and reduced pulmonary blood flow, resulting in an upturned cardiac apex (boot or coeur en sabot appearance) on chest X-ray.

Tetralogy of Fallot consists of which four anatomical abnormalities?

Answer: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy

Tetralogy of Fallot is defined by a VSD, pulmonary stenosis (obstruction to right ventricular outflow), an aorta that overrides the VSD, and resultant right ventricular hypertrophy.

Prostaglandin E1 (PGE1) is initiated in a neonate with suspected ductal-dependent congenital heart disease. What is its primary mechanism of action?

Answer: Maintains or reopens the ductus arteriosus

PGE1 stimulates prostaglandin receptors in the ductal wall to relax smooth muscle, maintaining ductal patency and preserving pulmonary or systemic blood flow in duct-dependent lesions.

A neonate diagnosed with transposition of the great arteries (TGA) is hemodynamically unstable. Which intervention is most critical to improve oxygenation before surgical repair?

Answer: Balloon atrial septostomy (Rashkind procedure) to improve intracardiac mixing

Balloon atrial septostomy creates or enlarges an atrial communication, allowing mixing of oxygenated and deoxygenated blood and dramatically improving systemic oxygen delivery in TGA.

Which statement about ventricular septal defects (VSD) in newborns is most accurate?

Answer: Small, muscular VSDs frequently close spontaneously within the first year of life

Small muscular VSDs commonly close spontaneously as the muscular septum grows; the decision to intervene is based on size, location, and hemodynamic significance.

A neonate with hypoplastic left heart syndrome (HLHS) is awaiting the Norwood procedure. Which management strategy is CONTRAINDICATED in the preoperative period?

Answer: Administration of supplemental oxygen above room air

Supplemental oxygen lowers pulmonary vascular resistance, increasing pulmonary blood flow and stealing from the systemic circulation, worsening systemic hypoperfusion in single-ventricle HLHS physiology.

Which chest X-ray finding is classically described as an 'egg on a string' appearance and is associated with which congenital heart defect?

Answer: Egg on a string; transposition of the great arteries

Transposition of the great arteries produces a narrow superior mediastinum (due to the parallel relationship of the great vessels) and an oval cardiac silhouette, creating the 'egg on a string' appearance.