Congenital Cardiac Anesthesia Society
A Section of the the Society for Pediatric Anesthesia

{“questions”:{“vvqb5”:{“id”:”vvqb5″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Derik Neilson, DO – Benefis Health System, Great Falls, MT and\r\nDestiny F. Chau, MD – Arkansas Children\u2019s Hospital\/University of Arkansas for Medical Sciences, Little Rock, AR \r\n\r\nPhenylephrine has been reported to have mixed effects on cardiac output. From which vascular bed does the administration of phenylephrine contribute the MOST to an increase in cardiac output in hypovolemic patients? \r\n”,”desc”:””,”hint”:””,”answers”:{“ymzi6”:{“id”:”ymzi6″,”image”:””,”imageId”:””,”title”:”A.\tRenal”},”q7p7f”:{“id”:”q7p7f”,”image”:””,”imageId”:””,”title”:”B.\tAortic”},”mdmgs”:{“id”:”mdmgs”,”image”:””,”imageId”:””,”title”:”C.\tPulmonary”},”idjir”:{“id”:”idjir”,”image”:””,”imageId”:””,”title”:”D.\tSplanchnic”,”isCorrect”:”1″}}}},”results”:{“1a1t9”:{“id”:”1a1t9″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/09\/CCAS-QOW-Posted-9-1-2022.pdf”}}}

{“questions”:{“anj5q”:{“id”:”anj5q”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Destiny F. Chau, MD – Arkansas Children\u2019s Hospital\/University of Arkansas for Medical Sciences, Little Rock, AR and Meera Gangadharan, MD \u2013 McGovern Medical School, UTHealth, Houston \r\n\r\nA 17-year-old male adolescent with a history of hypoplastic left heart syndrome and Fontan palliation presents for diagnostic cardiac catheterization due to cyanosis with baseline saturations of 87% on room air. A transthoracic echocardiogram shows adequate right ventricular systolic function with mild tricuspid regurgitation and normal neo-aortic valve function. The hemodynamic catheterization reveals Fontan pressures of 13 mmHg, transpulmonary gradient of 4 mmHg, right ventricular end diastolic pressure of 9 mmHg, and an open Fontan pathway with device occlusion of the fenestration. A focused transthoracic echocardiography saline microbubble contrast study is performed with injections into the right pulmonary artery (PA) and produced the findings below. \r\nL Panel R Panel\r\nFigure 1. Apical 4 chamber view by transthoracic echocardiogram with saline contrast study. Before (L panel) and after (R panel) saline injection into the right pulmonary artery (RPA). (Image source credit: authors). \r\nWhat is the MOST LIKELY etiology of decreased oxygen saturation?\r\n\r\n”,”desc”:””,”hint”:””,”answers”:{“s0y26”:{“id”:”s0y26″,”image”:””,”imageId”:””,”title”:”A. Coronary sinus drainage”},”3btu7″:{“id”:”3btu7″,”image”:””,”imageId”:””,”title”:”B. Pulmonary arteriovenous malformations”,”isCorrect”:”1″},”au4hp”:{“id”:”au4hp”,”image”:””,”imageId”:””,”title”:”C. Elevated Fontan pressure”},”d20ha”:{“id”:”d20ha”,”image”:””,”imageId”:””,”title”:”D. Veno-venous collaterals”}}}},”results”:{“07lc1”:{“id”:”07lc1″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/08\/CCAS-QOW-Posted-8-25-2022.pdf”}}}

{“questions”:{“3isy2”:{“id”:”3isy2″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Jed Kinnick, MD and Destiny F. Chau, MD – Arkansas Children\u2019s Hospital\/University of Arkansas for Medical Sciences, Little Rock, AR \r\n\r\nAccording to Van Praagh\u2019s embryological theory, Tetralogy of Fallot (TOF) is the result of a single anomaly which also gives rise to two other congenital cardiac anomalies. What is the single anomaly that gives the basis for Van Praagh\u2019s embryologic theory of TOF?”,”desc”:””,”hint”:””,”answers”:{“d4uh3”:{“id”:”d4uh3″,”image”:””,”imageId”:””,”title”:”A. Infundibular underdevelopment “,”isCorrect”:”1″},”8u5ss”:{“id”:”8u5ss”,”image”:””,”imageId”:””,”title”:”C. Leftward displacement of septum primum “},”0ectr”:{“id”:”0ectr”,”image”:””,”imageId”:””,”title”:”D. Abnormal communication between epicardial plexus and aortic buds”},”w5l5f”:{“id”:”w5l5f”,”image”:””,”imageId”:””,”title”:”E. Endocardial cushion defects \r\n\r\n”}}}},”results”:{“pz1pr”:{“id”:”pz1pr”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/08\/CCAS-QOW-Posted-8-18-2022.pdf”}}}

{“questions”:{“entel”:{“id”:”entel”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Mikayla B. Troughton, MD \u2013 Northwestern University Feinberg School of Medicine, Chicago, IL and Destiny F. Chau, MD – Arkansas Children\u2019s Hospital\/University of Arkansas for Medical Sciences, Little Rock, AR. \r\n\r\nA previously healthy 10-year-old female child sustains a cardiac arrest while playing soccer. Return of spontaneous circulation was achieved with cardiopulmonary resuscitation. Upon hospital admission, an electrocardiogram demonstrated Q-waves and ST segment depression with inversion in the anterolateral leads. An echocardiogram revealed depressed left ventricular function, mild to moderate mitral valve regurgitation, lack of left ventricular outflow tract obstruction and the presence of abnormal collateral connections between the right and left coronary systems. A cardiac MRI was completed and demonstrated the following (Source credit: authors): \r\n\r\n\r\nFigure 1. Cardiac MRI image: Ao = Aorta; PA = Pulmonary Artery <\/em> \r\n\r\nWhich of the following is the MOST LIKELY etiology for the cardiac arrest? “,”desc”:””,”hint”:””,”answers”:{“u8uuh”:{“id”:”u8uuh”,”image”:””,”imageId”:””,”title”:”A.\tHypertrophic obstructive cardiomyopathy (HOCM) “},”e91ek”:{“id”:”e91ek”,”image”:””,”imageId”:””,”title”:”B.\tBrugada Syndrome “},”pbi87”:{“id”:”pbi87″,”image”:””,”imageId”:””,”title”:”C.\tAnomalous left coronary artery from the pulmonary artery (ALCAPA) “,”isCorrect”:”1″},”947sc”:{“id”:”947sc”,”image”:””,”imageId”:””,”title”:”D.\tHeritable dilated cardiomyopathy”}}}},”results”:{“k1yd2”:{“id”:”k1yd2″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/08\/CCAS-QOW-Posted-8-11-2022.pdf”}}}

{“questions”:{“m434g”:{“id”:”m434g”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Nikhil Kamath, MD \u2013 Baptist Health Medical Center, Little Rock AR and\r\nDestiny F. Chau, MD – Arkansas Children\u2019s Hospital\/University of Arkansas for Medical Sciences, Little Rock, AR \r\n\r\nA 16-year-old, 50 kg adolescent male with a history of subvalvular aortic stenosis repaired as a child presents for laparoscopic appendectomy due to perforated appendicitis. Following rapid sequence induction with propofol and succinylcholine, the blood pressure decreases to 64\/32 with new onset ST-segment depressions unresponsive to a fluid bolus and epinephrine. Transesophageal echocardiography demonstrates hyperdynamic ventricular contractility along with the following findings shown in the image below. (Image source credit: authors). What is the MOST LIKELY factor contributing to refractory hypotension in this patient? \r\n\r\n\r\n Figure 1- Deep Transgastric Long Axis View “,”desc”:””,”hint”:””,”answers”:{“8ryow”:{“id”:”8ryow”,”image”:””,”imageId”:””,”title”:”A. Septic shock”},”rfm9n”:{“id”:”rfm9n”,”image”:””,”imageId”:””,”title”:”B. Anaphylactic shock”},”2n97n”:{“id”:”2n97n”,”image”:””,”imageId”:””,”title”:”C. Myocardial ischemia “},”h6xt0”:{“id”:”h6xt0″,”image”:””,”imageId”:””,”title”:”D. Left ventricular outflow tract obstruction”,”isCorrect”:”1″}}}},”results”:{“3hc1n”:{“id”:”3hc1n”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/08\/CCAS-QOW-Posted-8-4-2022.pdf”}}}