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

{“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”}}}

{“questions”:{“aojro”:{“id”:”aojro”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Author: Anna Hartzog MD and Chinwe Unegbu MD \u2013 Children\u2019s National Hospital \r\nA 16-year-old, 60 kg female adolescent with severe aortic insufficiency and symptomatic bradycardia presents for aortic valve repair versus replacement and pacemaker implantation. Which of the following complications is the LEAST LIKELY to occur after insertion of a transvenous pacemaker as compared to an epicardial pacemaker? \r\n\r\n\r\n”,”desc”:””,”hint”:””,”answers”:{“rtacs”:{“id”:”rtacs”,”image”:””,”imageId”:””,”title”:”A. Thromboembolic event “},”gi4ey”:{“id”:”gi4ey”,”image”:””,”imageId”:””,”title”:”B. Endocarditis”},”e5wq8″:{“id”:”e5wq8″,”image”:””,”imageId”:””,”title”:”C. Lead fracture and failure”,”isCorrect”:”1″},”ejul1″:{“id”:”ejul1″,”image”:””,”imageId”:””,”title”:”D. MRI incompatibility \r\n\r\n”}}}},”results”:{“xxpib”:{“id”:”xxpib”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/07\/CCAS-QOW-Posted-7-28-2022.pdf”}}}

{“questions”:{“231g1”:{“id”:”231g1″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Author: Anna Hartzog MD and Chinwe Unegbu MD \u2013 Children\u2019s National Hospital \r\n\r\nA 9-month-old male with Hypoplastic Left Heart Syndrome who has undergone Stage I repair with the Norwood procedure and a modified Blalock Taussig shunt followed by a bidirectional Glenn procedure presents for routine cardiology follow-up. Which of the following echocardiographic findings has the GREATEST PROBABILTY to increase mortality in this patient? \r\n”,”desc”:””,”hint”:””,”answers”:{“8qyjx”:{“id”:”8qyjx”,”image”:””,”imageId”:””,”title”:”A. Mild tricuspid regurgitation”},”sw9l4″:{“id”:”sw9l4″,”image”:””,”imageId”:””,”title”:”B. Mild neoaortic insufficiency”},”0kq9m”:{“id”:”0kq9m”,”image”:””,”imageId”:””,”title”:”C. Thickened interventricular septum “,”isCorrect”:”1″},”zyu5c”:{“id”:”zyu5c”,”image”:””,”imageId”:””,”title”:”D. Small contractile left ventricle”}}}},”results”:{“zwnnw”:{“id”:”zwnnw”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/07\/CCAS-QOW-Posted-7-21-2022.pdf”}}}

{“questions”:{“0ot6i”:{“id”:”0ot6i”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Author: Anna Hartzog MD and Chinwe Unegbu MD \u2013 Children\u2019s National Hospital \r\nA 14-year-old male adolescent patient with severe idiopathic pulmonary hypertension presents for right heart catheterization. As compared to a similar aged patient with repaired Tetralogy of Fallot and residual severe pulmonary valve stenosis, which echocardiographic feature MOST ACCURATELY describes the adaptation of the right ventricle in this patient with idiopathic pulmonary hypertension?”,”desc”:””,”hint”:””,”answers”:{“b33vr”:{“id”:”b33vr”,”image”:””,”imageId”:””,”title”:”A. Decreased transverse right ventricular shortening”,”isCorrect”:”1″},”qorfs”:{“id”:”qorfs”,”image”:””,”imageId”:””,”title”:”B. Increased longitudinal right ventricular deformation”},”w7e5u”:{“id”:”w7e5u”,”image”:””,”imageId”:””,”title”:”C. Mild apical right ventricular dilation “},”in3pk”:{“id”:”in3pk”,”image”:””,”imageId”:””,”title”:”D. Increased left ventricular end diastolic volume\r\n\r\n”}}}},”results”:{“1u3yl”:{“id”:”1u3yl”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/07\/CCAS-QOW-Posted-7-14-2022.pdf”}}}

{“questions”:{“fuyda”:{“id”:”fuyda”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Author: Anna Hartzog MD and Chinwe Unegbu MD \u2013 Children\u2019s National Hospital \r\nA 16-year-old male with a BMI of 60.1 kg\/m2 presents for sleeve gastrectomy. During his preoperative exam, a III\/VI systolic ejection murmur is auscultated. He indicates that he has been having chest pain and dyspnea on exertion. A transthoracic echocardiogram demonstrates a bicuspid aortic valve, moderate aortic stenosis, mild aortic insufficiency, mild left ventricular (LV) dysfunction, and a LV ejection fraction (EF) of 52%. What is the STRONGEST indication for aortic valve repair prior to sleeve gastrectomy in this patient?”,”desc”:””,”hint”:””,”answers”:{“zm8yp”:{“id”:”zm8yp”,”image”:””,”imageId”:””,”title”:”A. Left ventricular dysfunction with EF of 52%”},”wso7z”:{“id”:”wso7z”,”image”:””,”imageId”:””,”title”:”B. Moderate aortic stenosis”},”lp15h”:{“id”:”lp15h”,”image”:””,”imageId”:””,”title”:”C. Exertional chest pain”,”isCorrect”:”1″},”skxr3″:{“id”:”skxr3″,”image”:””,”imageId”:””,”title”:”D. Mild aortic insufficiency”}}}},”results”:{“dnd4s”:{“id”:”dnd4s”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/07\/CCAS-QOW-Posted-7-7-2022.pdf”}}}