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

{“questions”:{“wv074”:{“id”:”wv074″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Laura Rodr\u00edguez, MD\u2014 Hospital de Especialidades Pedi\u00e1tricas Omar Torrrijos Herrera\/ Universidad de Panam\u00e1, Ciudad de Panam\u00e1, Panam\u00e1 and Destiny F. Chau, MD\u2014University of Arkansas for Medical Science\/Arkansas Children\u2019s Hospital, Little Rock, AR, USA \r\n\r\nPregunta\/ Question \r\nUn ni\u00f1o de 12 meses de edad se presenta en el laboratorio de hemodin\u00e1mica para una valvuloplast\u00eda percut\u00e1nea con bal\u00f3n de la v\u00e1lvula pulmonar. La estenosis de la v\u00e1lvula pulmonar es severa, con un gradiente m\u00e1ximo de 115 mmHg. La valvuloplast\u00eda con bal\u00f3n fue exitosa y el gradiente baj\u00f3 a 15 mmHg. Durante los minutos siguientes se nota inestabilidad hemodin\u00e1mica, presi\u00f3n sist\u00e9mica 50\/30, frecuencia card\u00edaca 165 en ritmo sinusal y SpO_{2<\/sub> 55%. La presi\u00f3n intraventricular derecha ahora se observa en 195 mmHg. Adem\u00e1s de un bloqueador beta, \u00bfqu\u00e9 m\u00e1s se deber\u00eda administrar ahora?\r\n\r\n\r\nA 12-month-old male infant presents to the cardiac catheterization laboratory for percutaneous pulmonary balloon valvuloplasty of severe pulmonary stenosis with a peak gradient of 115 mm Hg. Balloon valvuloplasty is successful with a decrease in the gradient to 15 mm Hg. In the minutes following valvuloplasty, the following vital signs are noted: BP 50\/30, HR 165 bpm (sinus rhythm) and SpO2<\/sub> 55%. The right intraventricular pressure is 195 mmHg. In addition to a beta-blocker, what is the MOST appropriate immediate therapy?\r\n\r\n”,”desc”:””,”hint”:””,”answers”:{“5oved”:{“id”:”5oved”,”image”:””,”imageId”:””,”title”:”A. Volumen\/ Fluid bolus”,”isCorrect”:”1″},”ctmvi”:{“id”:”ctmvi”,”image”:””,”imageId”:””,”title”:”B. Epinefrina\/ Epinephrine”},”si84u”:{“id”:”si84u”,”image”:””,”imageId”:””,”title”:”C. Cardioversi\u00f3n sincronizada\/ Synchronized cardioversion”},”qxenf”:{“id”:”qxenf”,”image”:””,”imageId”:””,”title”:”D. Milrinona\/ Milrinone\r\n\r\n”}}}},”results”:{“r38rf”:{“id”:”r38rf”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/04\/CCAS-QOW-Posted-4-28-2022.pdf”}}}}

{“questions”:{“5w29h”:{“id”:”5w29h”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Nicole Ribeiro Marques MD, Felipe Medeiros MD, Destiny Chau MD\u2013 University of Arkansas for Medical Science\/Arkansas Children\u2019s Hospital, Little Rock \r\n\r\nA 32-year-old woman with a history of interrupted aortic arch and complex left ventricular outflow tract (LVOT) obstruction status post aortic arch reconstruction and apico-aortic valved-conduit insertion presents for emergent exploratory laparotomy due to ruptured tubal pregnancy. Preoperative transthoracic echocardiogram demonstrated moderate obstruction at the native LVOT, LV hypertrophy and dilation with mildly diminished function and difficulty in visualizing the conduit. New-onset ST segment elevation in leads II and V are evident after anesthetic induction with the following vital signs: BP 88\/38, HR 145, and SpO2 97%. Which medication is the MOST appropriate choice to manage this patient? “,”desc”:””,”hint”:””,”answers”:{“at4nb”:{“id”:”at4nb”,”image”:””,”imageId”:””,”title”:”A. Ephedrine”},”j7x0z”:{“id”:”j7x0z”,”image”:””,”imageId”:””,”title”:”B. Phenylephrine”,”isCorrect”:”1″},”bkmhd”:{“id”:”bkmhd”,”image”:””,”imageId”:””,”title”:”C. Labetalol”},”vw556″:{“id”:”vw556″,”image”:””,”imageId”:””,”title”:”D. Epinephrine”}}}},”results”:{“aqjrg”:{“id”:”aqjrg”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/04\/CCAS-QOW-Posted-4-21-22.pdf”}}}

{“questions”:{“yu071”:{“id”:”yu071″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Meera Gangadharan, MD and Prabhat Mishra, MD –Arkansas Children\u2019s Hospital\/University of Arkansas for Medical Sciences, Little Rock, AR \r\n\r\nA 12-year-old male child with a medical history of proximal muscle weakness, intellectual impairment, and retinitis pigmentosa presents for dental rehabilitation. A transthoracic echocardiogram reveals hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. There is a family history of male relatives with similar symptoms and early death in the second and third decade. What is the MOST likely diagnosis?”,”desc”:””,”hint”:””,”answers”:{“ezl9y”:{“id”:”ezl9y”,”image”:””,”imageId”:””,”title”:”A. Hurler syndrome”},”3kz4b”:{“id”:”3kz4b”,”image”:””,”imageId”:””,”title”:”B. Pompe disease”},”xogds”:{“id”:”xogds”,”image”:””,”imageId”:””,”title”:”C. Duchenne muscular dystrophy”},”woh8c”:{“id”:”woh8c”,”image”:””,”imageId”:””,”title”:”D. Danon disease”,”isCorrect”:”1″}}}},”results”:{“gktmn”:{“id”:”gktmn”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/04\/CCAS-QOW-Posted-4-14-2022.pdf”}}}

{“questions”:{“sglw8”:{“id”:”sglw8″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Authors: Ashley Bartels, MD and Destiny F. Chau, MD – Arkansas Children\u2019s Hospital\/University of Arkansas for Medical Sciences, Little Rock, AR \r\n\r\nA 4-month-old female infant with pulmonary atresia, intact ventricular septum and right ventricle-dependent coronary circulation is listed for heart transplantation. In the interim, she remains mechanically ventilated while receiving dexmedetomidine, morphine, milrinone, and prostaglandin E_{1<\/sub> infusions. Though well-sedated, she appears irritable and has increasing swelling of the bilateral lower extremities. Bony radiographs demonstrate hyperostosis of the cortical bones. When administered on a long-term basis, which medication that the patient is currently receiving is MOST likely to cause cortical hyperostosis? “,”desc”:””,”hint”:””,”answers”:{“mgl8o”:{“id”:”mgl8o”,”image”:””,”imageId”:””,”title”:”A. Milrinone “},”85odw”:{“id”:”85odw”,”image”:””,”imageId”:””,”title”:”B. Prostaglandin E1<\/sub> “,”isCorrect”:”1″},”2tj6s”:{“id”:”2tj6s”,”image”:””,”imageId”:””,”title”:”C. Dexmedetomidine “},”r52g3”:{“id”:”r52g3″,”image”:””,”imageId”:””,”title”:”D. Morphine\r\n\r\n”}}}},”results”:{“esqip”:{“id”:”esqip”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/04\/CCAS-QOW-Posted-4-7-2022.pdf”}}}}

{“questions”:{“m53ma”:{“id”:”m53ma”,”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 two-week-old neonate with double-outlet right ventricle, ventricular septal defect, L-looping of the ventricles, and levo-transposition of the great arteries is status post complete repair. On postoperative day twelve during a cardiac catheterization, the patient converts from normal sinus rhythm to complete heart block with a ventricular escape rate of 80 beats per minute. What is the MOST LIKELY factor that predisposes this patient to complete heart block? \r\n”,”desc”:””,”hint”:””,”answers”:{“flyvn”:{“id”:”flyvn”,”image”:””,”imageId”:””,”title”:”A. Coronary artery anomaly “},”g0gow”:{“id”:”g0gow”,”image”:””,”imageId”:””,”title”:”B. Residual ventricular septal defect”},”xec4i”:{“id”:”xec4i”,”image”:””,”imageId”:””,”title”:”C. L-looped ventricles”,”isCorrect”:”1″},”ocywb”:{“id”:”ocywb”,”image”:””,”imageId”:””,”title”:”D. L-transposition of the great arteries”}}}},”results”:{“s08qm”:{“id”:”s08qm”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/ccasociety.org\/wp-content\/uploads\/2022\/03\/CCAS-QOW-Posted-3-31-2022.pdf”}}}