Term
| Maintenance for TOF includes avoiding agents that decrease SVR. How can this be achieved? |
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Definition
1) Avoid increasing O2 demand
2) Maintain SVR, systemic BP (no hypotension)
3) Minimize PVR
4) avoid dehydration
5) oral premed (versed)
6)*use Ketamine
7) Ventilation patterns (no excessive insp. or short exp. times which = increase in intrathoracic pressure and decreased blood flow across RV) |
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Term
| What are two ways to minimize RV obstruction & PRV in TOF? |
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Definition
1) O2 - run alkalotic
2) beta blockers - improves filling time
*may also consider: nitroglycerine, nitric oxide (decreases PVR), prostaglandin E1. |
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Term
| How do you determine shunt direction? |
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Definition
the ratio of pulmonary blood flow (Qp) divided by systemic blood flow (Qs):
Qp/Qs
where a ratio <1 = R -- L shunt
or
where a ratio >1 = L -- R shunt |
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Term
| If the flow through the systemic system is > pulmonary system, which direction is the shunt? |
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Definition
R - L shunt
ratio <1
*eg: Qp=0, Qs=5
Qp/Qs= 0/5
<1 |
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Term
| If the flow through the pulmonary system is > than the systemic, which way is the shunt direction? |
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Definition
L - R shunt
ratio >1
*eg Qp=5, Qs=0
Qp/Qs = 5/0
>1 |
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Term
| What is essential of there if a pt has tricuspid atresia? |
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Definition
A patent foramen ovale or an ASD.
Also, a patent PDA or VSD must be present for blood to flow from L - R into the right ventricle to enter pulmonary circulation. |
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Term
| What is tricuspid atresia? |
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Definition
Blood cannot flow out of the right atrium d/t failure of the tricuspid valve to develop.
- 3rd most common cyanotic CHD
*atresia is a blockage |
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Term
| What is two interventions needed to survive tricuspid atresia? |
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Definition
1) early survival depends on prostaglandin used to maintain fetal circulation by keeping PDA open.
2) A Fontan shunt procedure is done (shunt graft b/t RA and pulmonary artery, bypassing tricuspid & RV) |
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