21. Which of the following statements about VSDs is/are true?
A. When coarctation of the aorta is associated with VSD, it most commonly occurs in infants with large lesions who have to undergo repair before age 3 months.
B. In some patients with VSD, aortic valve incompetence develops over time and progresses.
C. In the United States doubly committed or juxta-arterial VSDs are most commonly associated with aortic insufficiency.
D. PDA is present in approximately one fourth of infants with a VSD and concomitant congestive heart failure.
Ans: A,B,D
22. Which of the following statements about VSD is/are correct?
A. A large VSD is approximately the size of the pulmonary valve orifice or larger.
B. Large VSDs associated with high pulmonary blood flow result in an enlarged left atrium on chest x-ray.
C. Patients with small (restrictive) VSDs tend to have normal right ventricular and pulmonary arterial pressures with normal pulmonary vascular resistance and no evidence of pulmonary vascular disease.
D. A pulmonary vascular resistance greater than 10 to 12 units per sq. m. is considered a contraindication to operation.
Ans: B,C,D
23. Which of the following statements about VSDs is/are correct?
A. Spontaneous closure of VSDs occurs in 25% to 50% of patients during childhood.
B. Tachypnea and failure to thrive are symptoms frequently associated with large VSDs.
C. Patients with normal pulmonary vascular resistance and left-to-right shunting across the VSD have Eisenmenger's complex.
D. Patients with a large VSD and low pulmonary vascular resistance can present with a middiastolic murmur at the apex.
Ans: A,B,D
24. Which of the following is/are true of the surgical treatment of VSDs?
A. A right ventricular approach is employed for the repair of most perimembranous VSDs.
B. Intracardiac repair is advisable for patients with intractable symptoms and for asymptomatic infants with evidence of increasing pulmonary vascular resistance.
C. Complete heart block is a common complication.
D. Hospital mortality after repair of VSD in infants approaches 20%.
Ans: B
25. Tetralogy of Fallot consists of all of the following features except:
A. ASD.
B. VSD.
C. Dextroposition of the aorta.
D. Pulmonary stenosis.
E. Right ventricular hypertrophy.
Ans: A
26. Which of the following has the greatest impact on the physiology of tetralogy of Fallot?
A. The size of the ASD.
B. The size of the VSD.
C. The degree of pulmonary stenosis.
D. The amount of aortic overriding.
Ans: C
27. Which of the following anomalies is not associated with tetralogy of Fallot?
A. Absence of the left pulmonary artery.
B. A right aortic arch.
C. A retroesophageal subclavian artery.
D. Anomalous origin of the left anterior descending coronary artery from the right coronary artery.
E. Primary pulmonary hypertension.
Ans: E
28. Surgical treatment of a patient with tetralogy of Fallot can include any of the following except:
A. Maintenance of ductal patency with prostaglandins (PGE 1) to provide pulmonary blood flow while the baby is transferred to an institution equipped to provide more definitive therapy.
B. Banding of the pulmonary artery in an acyanotic patient with tetralogy of Fallot to control pulmonary blood flow and prevent the development of pulmonary hypertension.
C. Placement of a subclavian-to-pulmonary artery shunt on the side opposite the aortic arch in a 3-day-old infant with severe cyanosis.
D. Closure of the VSD and transannular patching of the right ventricle onto the main pulmonary artery in a 2-day-old infant.
Ans: B
29. The predominant determinant of outcome for patients with pulmonary atresia and an intact ventricular septum revolves around:
A. The size of the ASD.
B. The baby's age at presentation.
C. The size of the right ventricular cavity and tricuspid valve.
D. The presence of a tricuspid\97as opposed to a bicuspid\97pulmonary valve.
E. The level of hypoxemia at presentation.
Ans: C
30. Which of the following statements about double-outlet right ventricle are true?
A. A VSD is usually present.
B. In the Taussig-Bing type of double-outlet right ventricle, the VSD is usually noncommitted.
C. Patients with double-outlet right ventricle and a subaortic VSD usually have pulmonary stenosis.
D. Patients with double-outlet right ventricle with a subpulmonary VSD (Taussig-Bing malformation) tend to mimic patients with transposition of the great arteries and VSD in their presentation and natural history.
Ans: A,C,D
A. When coarctation of the aorta is associated with VSD, it most commonly occurs in infants with large lesions who have to undergo repair before age 3 months.
B. In some patients with VSD, aortic valve incompetence develops over time and progresses.
C. In the United States doubly committed or juxta-arterial VSDs are most commonly associated with aortic insufficiency.
D. PDA is present in approximately one fourth of infants with a VSD and concomitant congestive heart failure.
Ans: A,B,D
22. Which of the following statements about VSD is/are correct?
A. A large VSD is approximately the size of the pulmonary valve orifice or larger.
B. Large VSDs associated with high pulmonary blood flow result in an enlarged left atrium on chest x-ray.
C. Patients with small (restrictive) VSDs tend to have normal right ventricular and pulmonary arterial pressures with normal pulmonary vascular resistance and no evidence of pulmonary vascular disease.
D. A pulmonary vascular resistance greater than 10 to 12 units per sq. m. is considered a contraindication to operation.
Ans: B,C,D
23. Which of the following statements about VSDs is/are correct?
A. Spontaneous closure of VSDs occurs in 25% to 50% of patients during childhood.
B. Tachypnea and failure to thrive are symptoms frequently associated with large VSDs.
C. Patients with normal pulmonary vascular resistance and left-to-right shunting across the VSD have Eisenmenger's complex.
D. Patients with a large VSD and low pulmonary vascular resistance can present with a middiastolic murmur at the apex.
Ans: A,B,D
24. Which of the following is/are true of the surgical treatment of VSDs?
A. A right ventricular approach is employed for the repair of most perimembranous VSDs.
B. Intracardiac repair is advisable for patients with intractable symptoms and for asymptomatic infants with evidence of increasing pulmonary vascular resistance.
C. Complete heart block is a common complication.
D. Hospital mortality after repair of VSD in infants approaches 20%.
Ans: B
25. Tetralogy of Fallot consists of all of the following features except:
A. ASD.
B. VSD.
C. Dextroposition of the aorta.
D. Pulmonary stenosis.
E. Right ventricular hypertrophy.
Ans: A
26. Which of the following has the greatest impact on the physiology of tetralogy of Fallot?
A. The size of the ASD.
B. The size of the VSD.
C. The degree of pulmonary stenosis.
D. The amount of aortic overriding.
Ans: C
27. Which of the following anomalies is not associated with tetralogy of Fallot?
A. Absence of the left pulmonary artery.
B. A right aortic arch.
C. A retroesophageal subclavian artery.
D. Anomalous origin of the left anterior descending coronary artery from the right coronary artery.
E. Primary pulmonary hypertension.
Ans: E
28. Surgical treatment of a patient with tetralogy of Fallot can include any of the following except:
A. Maintenance of ductal patency with prostaglandins (PGE 1) to provide pulmonary blood flow while the baby is transferred to an institution equipped to provide more definitive therapy.
B. Banding of the pulmonary artery in an acyanotic patient with tetralogy of Fallot to control pulmonary blood flow and prevent the development of pulmonary hypertension.
C. Placement of a subclavian-to-pulmonary artery shunt on the side opposite the aortic arch in a 3-day-old infant with severe cyanosis.
D. Closure of the VSD and transannular patching of the right ventricle onto the main pulmonary artery in a 2-day-old infant.
Ans: B
29. The predominant determinant of outcome for patients with pulmonary atresia and an intact ventricular septum revolves around:
A. The size of the ASD.
B. The baby's age at presentation.
C. The size of the right ventricular cavity and tricuspid valve.
D. The presence of a tricuspid\97as opposed to a bicuspid\97pulmonary valve.
E. The level of hypoxemia at presentation.
Ans: C
30. Which of the following statements about double-outlet right ventricle are true?
A. A VSD is usually present.
B. In the Taussig-Bing type of double-outlet right ventricle, the VSD is usually noncommitted.
C. Patients with double-outlet right ventricle and a subaortic VSD usually have pulmonary stenosis.
D. Patients with double-outlet right ventricle with a subpulmonary VSD (Taussig-Bing malformation) tend to mimic patients with transposition of the great arteries and VSD in their presentation and natural history.
Ans: A,C,D
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