Congenital Heart Disease — Viva

Q1: Classification (2 min)

"How do you classify congenital heart disease?"

• Acyanotic (L→R): VSD (commonest), ASD, PDA, AVSD — pulmonary overcirculation
• Cyanotic (R→L): TOF, TGA, tricuspid atresia, TAPVD, HLHS
• Obstructive: coarctation, aortic stenosis, pulmonary stenosis
• Duct-dependent: TGA, HLHS, critical PS/AS, severe coarctation — need PGE1

Q2: VSD (3 min)

"Describe VSD and its management."

• Commonest CHD (30-35%)
• Pansystolic murmur at LLSE
• Small (under 3mm): 75% close spontaneously by age 2
• Large: failure to thrive, recurrent infections, pulmonary HTN
• Management: medical (diuretics, ACEi) as bridge; surgical closure by 6 months for large VSD to prevent Eisenmenger

Q3: TOF (3 min)

"What is Tetralogy of Fallot?"

• PROVe: Pulmonary stenosis, RVH, Overriding aorta, VSD
• Cyanotic spells (Tet spells): knee-chest + O2 + morphine + phenylephrine + propranolol
• Squatting increases SVR → more blood to lungs
• CXR: boot-shaped heart
• Surgery: complete repair at 4-6 months (VSD patch + RVOT relief)

Q4: Duct-Dependent (2 min)

"How do you manage a duct-dependent lesion?"

• PGE1 0.05-0.1 mcg/kg/min to maintain ductal patency
• Side effects: apnoea, hypotension, fever
• Rashkind balloon septostomy for TGA
• Definitive surgery as soon as possible
• NEVER give 100% oxygen to these patients (causes ductal constriction) [1]

References

1. [1]van der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM, Roos-Hesselink JW. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol, 2011.PMID 22078432