LATEST CONGENITAL CARDIAC SURGERY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF THORACIC SURGERY
STYLE | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 3-day-old neonate with ductal-dependent
pulmonary blood flow (pulmonary atresia with intact
ventricular septum) is started on prostaglandin E1
(PGE1). Which is the most important adverse effect to
monitor?
A) Apnea
B) Hyperthermia
C) Bradycardia
D) Seizures
Correct answer: A
Rationale: PGE1 causes apnea in up to 10-20% of
neonates, requiring intubation and mechanical
ventilation.
2. A 6-month-old infant with tetralogy of Fallot (TOF)
develops hypercyanotic ("Tet") spells. Which is the
first-line acute intervention?
,A) Knee-chest position and supplemental oxygen
B) Intravenous propranolol
C) Emergent surgical repair
D) Phenylephrine
Correct answer: A
Rationale: Knee-chest position increases systemic
vascular resistance (SVR), reducing right-to-left
shunting. Oxygen and morphine are also first-line.
3. A 2-week-old neonate with d-transposition of the
great arteries (d-TGA) and an intact ventricular
septum undergoes balloon atrial septostomy
(Rashkind procedure). Which is the most important
postoperative management?
A) Prostaglandin E1 (PGE1) infusion
B) Propranolol for outflow obstruction
C) Furosemide for pulmonary edema
D) Indomethacin for ductal closure
Correct answer: A
Rationale: After balloon atrial septostomy, PGE1
maintains ductal patency for mixing until arterial
switch operation (ASO) at 1-2 weeks.
,4. A 4-kg infant with a large ventricular septal defect
(VSD) and failure to thrive (weight <3rd percentile)
has pulmonary artery pressure of 80% systemic.
Which is the most appropriate next step?
A) Urgent VSD closure
B) Pulmonary artery banding
C) Diuretic therapy (furosemide) and nutritional
support
D) Digoxin
Correct answer: A
Rationale: Large VSD with failure to thrive and
elevated pulmonary pressures requires early surgical
closure (3-6 months).
5. A 5-year-old child with a history of tetralogy of
Fallot (TOF) repair presents with progressive
exercise intolerance and a murmur of pulmonary
regurgitation. Cardiac MRI shows RV end-diastolic
volume index of 180 mL/m². Which is the most
appropriate next step?
A) Pulmonary valve replacement (PVR)
B) Continued observation
C) Balloon dilation of the RVOT
D) Beta-blocker therapy
, Correct answer: A
Rationale: PVR is indicated for symptomatic
pulmonary regurgitation with RVEDVi >150-160
mL/m² or RVESVi >80-90 mL/m².
6. A 2-day-old neonate with hypoplastic left heart
syndrome (HLHS) is started on PGE1. Which is the
most important additional initial management?
A) Restriction of pulmonary blood flow (titrated FiO2,
hypercapnia)
B) Immediate Norwood procedure
C) Atrial septectomy
D) Pulmonary artery banding
Correct answer: A
Rationale: In HLHS, balanced pulmonary and
systemic circulations require restricting pulmonary
blood flow (low FiO2, CO2, or PA band) before Stage I
palliation.
7. A 12-year-old with coarctation of the aorta
(repaired at age 2) presents with hypertension
(150/90). MRI shows a recurrent gradient of 40 mmHg
across the coarctation site. Which is the most
appropriate next step?
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF THORACIC SURGERY
STYLE | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 3-day-old neonate with ductal-dependent
pulmonary blood flow (pulmonary atresia with intact
ventricular septum) is started on prostaglandin E1
(PGE1). Which is the most important adverse effect to
monitor?
A) Apnea
B) Hyperthermia
C) Bradycardia
D) Seizures
Correct answer: A
Rationale: PGE1 causes apnea in up to 10-20% of
neonates, requiring intubation and mechanical
ventilation.
2. A 6-month-old infant with tetralogy of Fallot (TOF)
develops hypercyanotic ("Tet") spells. Which is the
first-line acute intervention?
,A) Knee-chest position and supplemental oxygen
B) Intravenous propranolol
C) Emergent surgical repair
D) Phenylephrine
Correct answer: A
Rationale: Knee-chest position increases systemic
vascular resistance (SVR), reducing right-to-left
shunting. Oxygen and morphine are also first-line.
3. A 2-week-old neonate with d-transposition of the
great arteries (d-TGA) and an intact ventricular
septum undergoes balloon atrial septostomy
(Rashkind procedure). Which is the most important
postoperative management?
A) Prostaglandin E1 (PGE1) infusion
B) Propranolol for outflow obstruction
C) Furosemide for pulmonary edema
D) Indomethacin for ductal closure
Correct answer: A
Rationale: After balloon atrial septostomy, PGE1
maintains ductal patency for mixing until arterial
switch operation (ASO) at 1-2 weeks.
,4. A 4-kg infant with a large ventricular septal defect
(VSD) and failure to thrive (weight <3rd percentile)
has pulmonary artery pressure of 80% systemic.
Which is the most appropriate next step?
A) Urgent VSD closure
B) Pulmonary artery banding
C) Diuretic therapy (furosemide) and nutritional
support
D) Digoxin
Correct answer: A
Rationale: Large VSD with failure to thrive and
elevated pulmonary pressures requires early surgical
closure (3-6 months).
5. A 5-year-old child with a history of tetralogy of
Fallot (TOF) repair presents with progressive
exercise intolerance and a murmur of pulmonary
regurgitation. Cardiac MRI shows RV end-diastolic
volume index of 180 mL/m². Which is the most
appropriate next step?
A) Pulmonary valve replacement (PVR)
B) Continued observation
C) Balloon dilation of the RVOT
D) Beta-blocker therapy
, Correct answer: A
Rationale: PVR is indicated for symptomatic
pulmonary regurgitation with RVEDVi >150-160
mL/m² or RVESVi >80-90 mL/m².
6. A 2-day-old neonate with hypoplastic left heart
syndrome (HLHS) is started on PGE1. Which is the
most important additional initial management?
A) Restriction of pulmonary blood flow (titrated FiO2,
hypercapnia)
B) Immediate Norwood procedure
C) Atrial septectomy
D) Pulmonary artery banding
Correct answer: A
Rationale: In HLHS, balanced pulmonary and
systemic circulations require restricting pulmonary
blood flow (low FiO2, CO2, or PA band) before Stage I
palliation.
7. A 12-year-old with coarctation of the aorta
(repaired at age 2) presents with hypertension
(150/90). MRI shows a recurrent gradient of 40 mmHg
across the coarctation site. Which is the most
appropriate next step?
