Learning Cardiology

Q. Warden’s procedure is used for? A. Sinus venosus type of ASD B. Ostium secundum ASD C. Ostium primum ASD D. Coronary sinus type ASD Answer: A. Sinus venosus type of ASD Explanation: Partial anomalous pulmonary venous connection (PAPVC) is characterized by the failure of 1-3 pulmonary veins to incorporate within the developing left atrium. Most commonly right upper pulmonary vein is affected and connects to the superior vena cava. Sinus venosus ASD is typically associated with PAPVC. Warden’s procedure is used for correction of partial anomalous pulmonary venous connection (PAPVC) to prevent the stenosis of pulmonary veins or vena cava.

Q. All of the following predict non-operability in acyanotic congenital heart diseases with increased pulmonary artery pressure except? A. Baseline saturation less than 92% B. PVRI/SVRI >0.3 C. PVRI > 6 woods units/m 2 D. Qp/Qs > 2.0 Answer: D. Qp/Qs > 2.0 Explanation: In acyanotic congenital heart diseases (ASD, VSD, PDA, Complete AVSD) with pulmonary artery hypertension, there is a great dilemma for complete repair of the defect. Because if the patient has developed Eisenmenger syndrome, then he will have a poorer prognosis after surgery. Baseline saturation of less than 92% suggests significant reversal of shunt due to increased PA pressure. During cardiac catheterization study, pulmonary vascular resistance index (PVRI) more than 6 W/m2 and PVRI/SVRI more than 0.3 suggest significantly raised pulmonary artery pressure. These patients might not do well after surgical closure of the defect. For further decision regarding surgery in these cases, vasod