Multiple choice

­questions: ANSWERS
Chapter 1. Cardiac resynchronization therapy for the univentricular
heart
1. Which of the following factors is least likely to predict benefit
from cardiac resynchronization therapy (CRT) in an adult with a
structurally normal heart?
c. Need for near-100% atrial pacing
2. Imaging evidence of dyssynchrony, according to current
understanding, is...
b. An ancillary option of some potential benefit in selected
situations
3. Which of the following approaches to heart failure management
should be attempted last?
b. Implantation of permanent CRT device
4. The negative clinical effects of ventricular dyssynchrony may be
due to...
d. All of the above
5. At the time of CRT implantation in the single-ventricle pa-
tient, simultaneous implantable cardioverter defibrillator (ICD)
implantation...
d. None of the above
6. After CRT implantation in the single-ventricle patient:
c. Close clinical follow-up should be provided, with
consideration of optimization if response is suboptimal
Chapter 2. Ventricular tachycardia in patients with tetralogy of
Fallot
1. Which of the following is the most fundamental change in tetralogy
of Fallot (TOF)?
c. Deviation of the origin of the aorta to the right so that it
overrides the ventricular septal defect

© 2014 Future Medicine Ltd doi:10.2217/EBO.14.5 131

Multiple choice questions: answers

2. QRS prolongation greater than how many milliseconds identifies

patients at risk for recurrent VT?
c. 180 ms
3. Which of the following is not a critical isthmus identified on sinus
rhythm voltage mapping of the right ventricle in postoperative
TOF?
d. Cavotricuspid isthmus
4. The most common cause of premature death after TOF repair is...
b. Sudden cardiac death
5. Of the following factors, the most important risk factor for sudden
cardiac death in TOF is...
b. Pulmonary regurgitation
Chapter 3. The role of the implantable cardioverter-defibrillator
for primary prevention in the adult with congenital heart disease
1. Risk factors for sudden death in the tetralogy of Fallot population
include all of the following, except...
a. QRS duration >150 ms
2. Of the following, which is the congenital cardiac lesion associated
with the lowest risk for sudden cardiac death?
c. Tetralogy of Fallot
3. Which is the most common cause for overall mortality in the single
ventricle population?
b. Sudden arrhythmia-related death
4. Which of the following age groups is mortality in the single ventricle
population most frequently observed?
c. 21–30 years of age
5. Risk factors for sudden death in the group of adult patients with
d-TGA after atrial baffle repair includes...
d. All of the above
6. Which of the following statements is true?
c. Primary prevention ICD placement in the adult congenital
heart disease population is effective

132 www.futuremedicine.com
 Multiple choice questions: answers

7. Which of the following is the most common mechanism for sudden

death in the setting of d-TGA after atrial baffle repair?
b. Rapid conduction of atrial arrhythmia
8. Electrophysiologic evaluation with programmed stimulation is use-
ful for the risk stratification of which of the following congenital
heart lesions?
b. Tetralogy of Fallot
9. The risk of inappropriate ICD therapy in the adult congenital heart
disease population is approximately...
b. 20–40%
10. The event rate of sudden cardiac death for patients with d-TGA
repaired by atrial baffle surgery is approximately...
b. Five per 1000 patient-years
Chapter 4. Implantable cardiac device therapy in congenital heart
disease
1. The number of adults (>21 years of age) with congenital heart
defects is...
c. More than the number of children with congenital heart
defects
2. All hearts with repaired congenital defects are...
c. To be considered potentially prone to heart rhythm or
valve/vascular problems
3. The term ‘transposition of the great arteries’ can mean...
b. The antomical right and left ventricles are reversed in
location from normal
4. A device implant in patients with repaired tetralogy of Fallot...
a. Is often technically challenging
5. The best study to evaluate any vascular patency concerns in an
adult patient with repaired congenital heart is...
b. CT scan
6. A resting heart rate of 120 beats/min in an adult with repaired
single ventricle...
c. May represent intratrial re-entry tachycardia

www.futuremedicine.com 133
Multiple choice questions: answers

7. Resynchronization pacing in adults with repaired congenital

heart...
a. Can be effective therapy as a bridge to transplant
8. Coronary sinus pacing lead placement in an adult with repaired
congenital heart...
c. Is often impossible due to lack of venous access
Chapter 5. Heart transplantation in adult congenital heart ­disease:
who?
1. Which of the following prognostic indicators have been associated
with increased mortality in adults with congenital heart disease?
a. Hemoglobin
b. Sodium
c. B-type natriuretic peptide
d. Peak oxygen uptake
e. Serum uric acid
2. Which of the following interventions have been shown to improve
survival in adult congenital heart disease patients?
f. None of the above
3. Tricuspid valve replacement is commonly recommended to patients
with subaortic/systemic right ventricle dysfunction (i.e., transposi-
tion of the great arteries or congentially corrected transposition of
the great arteries) and severe tricuspid regurgitation.
b. False
4. Pulmonary valve replacement should be recommended once pa-
tients with tetralogy of Fallot develop moderate to severe pulmonary
regurgitation.
b. False

5. Younger age at repair is associated with higher mortality in patients

with tetralogy of Fallot.
b. False

134 www.futuremedicine.com
 Multiple choice questions: answers

Chapter 6. Heart transplantation in adult congenital heart ­disease:

when and why not?
1. Which of the following answers are true and which are false for
the question: compared with those with acquired heart disease,
adult congenital heart disease (ACHD) patients undergoing heart
transplantation are more likely to be?
a. Younger
c. Sensitized
2. The best source of information regarding transplant outcomes
­according to CHD subtype is from multicenter registries.
b. False
3. The most common cause of death among ACHD patients listed
for heart transplantation is...
c. Sudden death
4. Overall post-transplant mortality among ACHD heart transplant
recipients has been reported to be...
b. 10–20%
5. The largest group of ACHD patients undergoing heart
transplantation is...
d. Single ventricle patients

www.futuremedicine.com 135