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

{“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”}}}

{“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”}}}