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

{“questions”:{“ozlj0”:{“id”:”ozlj0″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Author: Sana Ullah, MB ChB, FRCA \u2013 Dallas, TX \r\n\r\nA 16-year-old, 65 kg adolescent male is placed on peripheral veno-arterial (VA) extracorporeal membrane oxygenation via the left femoral artery and the right femoral vein due to acute fulminant myocarditis. Following five days of ECMO, a transthoracic echocardiogram demonstrates improved left ventricular function with an epinephrine infusion of 0.05 mcg\/kg\/min. Pulse oximetry on the right arm and right leg demonstrates oxygen saturations of 60% and 96% respectively. Non-invasive cerebral oximetry has decreased from 80 to 40 with a fractional inspired oxygen of 1.0 and a chest x-ray demonstrating appropriate endotracheal tube position. What is the MOST APPROPRIATE clinical intervention at this time ?”,”desc”:””,”hint”:””,”answers”:{“reebi”:{“id”:”reebi”,”image”:””,”imageId”:””,”title”:”A.\tIncrease inotropic support”},”4f8c9″:{“id”:”4f8c9″,”image”:””,”imageId”:””,”title”:”B.\tIncrease ECMO circuit flow”},”9xwx6″:{“id”:”9xwx6″,”image”:””,”imageId”:””,”title”:”C.\tConvert to central ECMO cannulation “},”52isr”:{“id”:”52isr”,”image”:””,”imageId”:””,”title”:”D.\tInsertion of an additional arterial cannula into the right internal jugular vein”,”isCorrect”:”1″}}}},”results”:{“flkox”:{“id”:”flkox”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/10\/CCAS-QOW-Posted-10-13-2022.pdf”}}}

{“questions”:{“qsvss”:{“id”:”qsvss”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Author: Sana Ullah, MB ChB, FRCA. Children\u2019s Medical Center, Dallas TX \r\n\r\nWhich vascular structure in the fetal circulation has the LOWEST oxygen saturation?”,”desc”:””,”hint”:””,”answers”:{“14ktg”:{“id”:”14ktg”,”image”:””,”imageId”:””,”title”:”A. Umbilical vein”},”qilwm”:{“id”:”qilwm”,”image”:””,”imageId”:””,”title”:”B. Umbilical artery”},”uwrk9″:{“id”:”uwrk9″,”image”:””,”imageId”:””,”title”:”C. Coronary sinus”,”isCorrect”:”1″},”plukh”:{“id”:”plukh”,”image”:””,”imageId”:””,”title”:”D. Superior vena cava”}}}},”results”:{“k4hss”:{“id”:”k4hss”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/10\/CCAS-QOW-Posted-10-6-2022.pdf”}}}

{“questions”:{“dpd6s”:{“id”:”dpd6s”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Author: Michael A. Evans, MD \u2013 Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern Feinberg School of Medicine \r\n\r\nA 9-month-old is seen by his pediatrician due to difficulty gaining weight and is found to have a murmur on exam. A transthoracic echocardiogram demonstrates a ventricular septal defect (VSD) with a size and location that are thought to be amenable to transcatheter closure in the cardiac catheterization laboratory. Which of the following is the MOST COMMON immediate complication of transcatheter VSD closure?\r\n”,”desc”:””,”hint”:””,”answers”:{“v1qeh”:{“id”:”v1qeh”,”image”:””,”imageId”:””,”title”:”A. Device embolization”},”8ot7m”:{“id”:”8ot7m”,”image”:””,”imageId”:””,”title”:”B. Residual shunt”,”isCorrect”:”1″},”8mrk1″:{“id”:”8mrk1″,”image”:””,”imageId”:””,”title”:”C. Mortality”},”8o3sc”:{“id”:”8o3sc”,”image”:””,”imageId”:””,”title”:”D. Complete heart block “}}}},”results”:{“ls1pc”:{“id”:”ls1pc”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/09\/QOW-Posted-9-29-2022.pdf”}}}

{“questions”:{“ufgwj”:{“id”:”ufgwj”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Benjamin Rosenfeld, MD and Michael A. Evans, MD \u2013 Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern Feinberg School of Medicine \r\n\r\nAn 18-year-old adolescent male with a past history of Tetralogy of Fallot undergoes surgical pulmonary valve replacement complicated by myocardial ischemia secondary to coronary thromboembolism in the immediate postoperative period. Five days after surgery the patient develops cardiogenic shock secondary to severe mitral regurgitation and acute rupture of the posteromedial papillary muscle. Which coronary artery distribution is MOST LIKELY to contribute to posteromedial papillary muscle rupture?”,”desc”:””,”hint”:””,”answers”:{“wmpfd”:{“id”:”wmpfd”,”image”:””,”imageId”:””,”title”:”A. Left anterior descending artery”},”culs8″:{“id”:”culs8″,”image”:””,”imageId”:””,”title”:”B. Left circumflex artery”},”g7c6m”:{“id”:”g7c6m”,”image”:””,”imageId”:””,”title”:”C. Right acute marginal artery”},”eifgr”:{“id”:”eifgr”,”image”:””,”imageId”:””,”title”:”D. Posterior descending artery”,”isCorrect”:”1″}}}},”results”:{“banfa”:{“id”:”banfa”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/09\/CCAS-QOW-Posted-9-22-2022.pdf”}}}

{“questions”:{“ny5tw”:{“id”:”ny5tw”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Michael A. Evans, MD \u2013 Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern Feinberg School of Medicine \r\nA previously healthy four-year-old child undergoes surgical closure of a large secundum-type atrial septal defect (ASD). After separation from cardiopulmonary bypass and release of caval snares, the oxygen saturation (SpO_{2<\/sub>) decreases to 85% from 100% with a fractional inspired oxygen (FiO2<\/sub>) of 60% and normal peak inspiratory pressures. The FiO2 is increased to 100%, but the SpO2 remains at 85%. Transesophageal echocardiography (TEE) reveals an underfilled right atrium and right ventricle with normal systolic function and no tricuspid regurgitation. The left atrium and left ventricle are of normal size and function. An agitated saline study is performed through the right internal jugular central venous catheter and is negative. \r\n\r\nWhich of the following is the BEST INITIAL STEP to correct this patient\u2019s hypoxemia?\r\n\r\n\r\n”,”desc”:””,”hint”:””,”answers”:{“xpc7g”:{“id”:”xpc7g”,”image”:””,”imageId”:””,”title”:”A.\tAdminister inhaled nitric oxide “},”cy657”:{“id”:”cy657″,”image”:””,”imageId”:””,”title”:”B.\tRevise the ASD patch”,”isCorrect”:”1″},”ni7b3″:{“id”:”ni7b3″,”image”:””,”imageId”:””,”title”:”C.\tTransfuse packed red blood cells”},”rse1u”:{“id”:”rse1u”,”image”:””,”imageId”:””,”title”:”D.\tAdminister albuterol”}}}},”results”:{“ssx0w”:{“id”:”ssx0w”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/09\/CCAS-QOW-Posted-9-15-2022.pdf”}}}}