Pediatric Chest

Endotracheal tube

  • Want between thoracic inlet and carina

Tubes & Lines

Umbilical Venous line

  • Want at IVC-RA junction

  • If in RA = not ok

  • Abrupt right turn toward liver —> in portal vein

Thymus

  • Spinnaker sail sign

    • Indicator of pneumomediastinum

    • Basically looks like ill defined opacity with lucent area underneath it and represents the thymus superiorly displaced by air in the mediastinum

    • Image on left

Transposition of Great Vessels

  • Cyanotic disease presenting during first day of life

  • Associated with maternal DM

  • May see cyanotic UEs and normal LEs is have other shit going on too (PDA)

  • Aorta arises from RV

  • Pulmonary artery arises from LV

  • Two types based on relationship of aortic and pulmonic valves

  • D-TGA

    • Egg on a string on CXR

    • Need additional shunt or incompatible with life (most commonly VSD)

    • Aorta is anterior and to right of pulmonary artery

    • RA—>RV —> Aorta

    • LA —> LV —> Pulmonary artery

D-TGA

  • Egg on a string on CXR

  • Need additional shunt or incompatible with life (most commonly VSD)

  • Aorta is anterior and to right of pulmonary artery

  • RA—>RV —> Aorta

  • LA —> LV —> Pulmonary artery

Major Congenital Heart Surgeries

  • Ross procedure

    • Used to treat aortic valve disease, typically stenosis

    • Pulmonic valve used to replace aortic valve

    • Prosthetic valve replaces the pulmonic valve

  • Rastelli procedure

    • Used to treat aortic valve disease, typically stenosis

    • Pulmonic valve used to replace aortic valve

    • Prosthetic valve replaces the pulmonic valve

Blalock-Taussing Shunt

  • Goal: Increase pulmonary blood flow in pts with RVOT obstruction - typically TOF

  • Subclavian artery attached to ipsilateral pulmonary artery

  • Modified B-T Shunt - synthetic graft connecting subclavian and ipsilateral pulmonary artery

  • Basically, right heart cannot pump to lungs due to obstruction and therefore cannot get back to left heart to pump to rest of the body, so you take blood from the subclavian and re-route it back to the pulmonary artery which will go to the lungs and then directly to the left heart bypassing the right heart completely. This allows for oxygenated blood to reach rest of body better.

Umbilical Arterial line

  • Superior location = T6-T9

  • Inferior = L3 ish

  • Need away from major branches

L-TGA

  • Nonspecific findings on CXR

  • Can be asymptomatic if no other concurrent abnormalities

  • Aorta is anterior and to left of pulmonary artery

  • RA—> morphological LV —> Pulmonary artery

  • LA —> morphological RV —> Aorta

  • Ross procedure

    • Used to treat aortic valve disease, typically stenosis

    • Pulmonic valve used to replace aortic valve

    • Prosthetic valve replaces the pulmonic valve

  • Jatene Switch

    • Goal: fix D-TGA via

    • Redirect RV flow to pulmonary arteries

    • Redirect LV flow to systemic pathway

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