BTT Shunt Occlusion

The patient is a 5-week-old baby girl with a prenatal diagnosis of hypoplastic left heart syndrome, status post-Norwood with a 3.5mm BTT shunt at DOL5. Her intraoperative and postoperative course was relatively unremarkable, and she had been in the hospital for two weeks post-op, working on feeding issues. She has now been home for about ten days, and over the past 24 hours, the mom reports the baby hasn’t been feeding as well. She’s had several episodes of emesis as well. The O2 sats on the home monitor have been in the low 80s, but the mom brought the baby in due to the emesis this morning. This scenario begins with relatively stable vital signs and a baby that appears pink. The baby needs to have a loud shunt murmur on the exam. The overall goal is to perform the objectives below and notify the CICU about a patient with a surgical emergency.

Learning Objectives

‘- Place oxygen on the patient

– Administer heparin bolus (“shunt” heparin)

– Give fluid bolus

– Start vasoactive infusion

– Notify CICU/CT surgery/cardiac cath team

MINIMUM:

OS: Windows 10
Processor: Intel Core i5-2300 | AMD FX-4350
Memory: 4 GB RAM
Graphics: Nvidia GeForce GTX 2060
DirectX: Version 11
Storage: 12 GB available space

RECOMMENDED:

OS: Windows 10
Processor: Intel Core i7-2300 | AMD FX-4350
Memory: 8 GB RAM
Graphics: Nvidia GeForce GTX 3060
DirectX: Version 11
Storage: 12 GB available space

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