100+ Free ABTS Congenital Cardiac Practice Questions

Pass your ABTS Congenital Cardiac Surgery Subspecialty Certification exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

~80-90% first-time among congenital fellowship graduates (ABTS annual statistics) Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

A 3-year-old with a secundum ASD measuring 14 mm has right atrial and right ventricular enlargement on echocardiography. Which intervention carries the best long-term outcome profile?

Observation until symptoms develop

Percutaneous device closure

Surgical patch closure via median sternotomy

Pulmonary artery banding

to track

2026 Statistics

Key Facts: ABTS Congenital Cardiac Exam

~150-200

Part I MCQ Items

ABTS Congenital Cardiac Surgery Subspecialty Examination

Dec 7-11

2026 Part I Window

ABTS CHS Part I testing dates (Pearson VUE)

~23%

Cyanotic / Right-Sided Weight

Largest single domain on 2026 content outline

~$2,500

2026 Exam Fee

ABTS (verify current schedule)

1 yr

Congenital Fellowship

ACGME-accredited Congenital Cardiac Surgery fellowship

~80-90%

First-Time Pass Rate

ABTS annual statistics (fellowship graduates)

The ABTS Congenital Cardiac Surgery Subspecialty Examination is a two-part assessment from the American Board of Thoracic Surgery — Part I (MCQ CBT, ~150-200 single-best-answer items) is administered December 7-11, 2026 at Pearson VUE, followed by Part II (case-based). Content spans cyanotic/right-sided ~23%, single-ventricle/Fontan ~16%, left-to-right shunts ~9%, valvular/Ross-Konno ~9%, ACHD ~9%, aortic pathology ~6%, CPB/cardioplegia ~6%, left-sided obstruction ~5%, coronary anomalies ~4%, transplant/HF ~4%, genetics ~4%, arrhythmia/pacing ~3%, ethics/outcomes ~3%, and fetal ~2%. Fee is ~$2,500; requires ABTS thoracic board eligibility plus an ACGME congenital cardiac fellowship.

Sample ABTS Congenital Cardiac Practice Questions

Try these sample questions to test your ABTS Congenital Cardiac exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 3-year-old with a secundum ASD measuring 14 mm has right atrial and right ventricular enlargement on echocardiography. Which intervention carries the best long-term outcome profile?

A.Observation until symptoms develop

B.Percutaneous device closure

C.Surgical patch closure via median sternotomy

D.Pulmonary artery banding

Explanation: For suitable secundum ASDs with adequate rims (>5 mm except anterosuperior/aortic rim) and right heart enlargement, transcatheter device closure is first-line and has equivalent or better outcomes than surgical closure with shorter recovery. Surgery is reserved for ASDs with deficient rims, very large defects, or sinus venosus/primum ASDs which are not amenable to devices.

2Which type of atrial septal defect is most commonly associated with partial anomalous pulmonary venous return (PAPVR) of the right upper pulmonary vein?

A.Ostium secundum ASD

B.Ostium primum ASD

C.Superior sinus venosus ASD

D.Coronary sinus (unroofed) ASD

Explanation: Superior (SVC-type) sinus venosus defects are almost invariably associated with PAPVR of the right upper and/or middle pulmonary veins draining to the SVC or SVC-RA junction. Repair typically requires a Warden procedure or two-patch technique to redirect anomalous pulmonary venous return while avoiding SVC or sinus node dysfunction.

3A 6-month-old with a large perimembranous VSD presents with failure to thrive, tachypnea, and hepatomegaly despite maximal medical therapy. Pulmonary vascular resistance is 3 Wood units·m². The most appropriate management is:

A.Continued medical therapy and reassessment at 2 years

B.Pulmonary artery banding

C.Surgical VSD closure

D.Transcatheter device closure

Explanation: Large unrestrictive VSDs causing CHF and failure to thrive despite medical therapy require surgical closure in infancy (typically 3-6 months) before pulmonary vascular disease develops. PA banding is generally reserved for very young, small, or multiple (Swiss-cheese) VSDs not amenable to primary closure. Transcatheter closure of perimembranous VSDs carries risk of complete heart block.

4Which of the following is the most common anatomic type of ventricular septal defect?

A.Muscular (trabecular)

B.Inlet (AV canal-type)

C.Outlet (conal/subarterial)

D.Perimembranous

Explanation: Perimembranous VSDs account for approximately 70-80% of all VSDs. They sit beneath the aortic valve, adjacent to the tricuspid septal leaflet, and often partially close via tricuspid leaflet tissue. Muscular VSDs (~15-20%) may be multiple, inlet VSDs (~5%) are seen with AVSD/Trisomy 21, and outlet/subarterial VSDs (~5% but up to 30% in Asian populations) risk aortic cusp prolapse and AI.

5In a complete atrioventricular septal defect (complete AVSD/AVC) with Rastelli type A, the superior bridging leaflet is:

A.Completely undivided and floats over the VSD

B.Divided over the septum and chorded to the crest of the interventricular septum

C.Attached to an anomalous papillary muscle in the RV

D.Displaced inferiorly into the right ventricle

Explanation: In Rastelli A (most common, ~75%), the superior bridging leaflet is divided over the crest of the interventricular septum and firmly attached to it, facilitating two-patch or modified single-patch repair. Type B has chordal attachments to an anomalous RV papillary muscle. Type C has a free-floating, undivided superior bridging leaflet—associated with Trisomy 21 and tetralogy of Fallot.

6The most common cardiac defect in patients with Trisomy 21 (Down syndrome) is:

A.Tetralogy of Fallot

B.Complete atrioventricular septal defect (AVSD)

C.Ventricular septal defect

D.Patent ductus arteriosus

Explanation: Approximately 40-50% of Down syndrome patients have congenital heart disease, and complete AVSD is the classic association (~40% of CHD in Down). Trisomy 21 patients also develop pulmonary hypertension earlier, so AVSD repair is performed by 3-6 months. VSD and TOF also occur but less frequently than AVSD.

7A preterm infant at 28 weeks gestation has a hemodynamically significant PDA with pulmonary overcirculation. Medical therapy (indomethacin or acetaminophen) has failed. What is the preferred next step in 2026?

A.Continued medical therapy with ibuprofen

B.Open surgical ligation via left posterolateral thoracotomy

C.Transcatheter device closure (Piccolo or similar)

D.PA banding

Explanation: Transcatheter PDA closure using the Amplatzer Piccolo Occluder is now FDA-approved and widely used even in premature infants >700 g. It has largely replaced surgical ligation in many centers due to reduced morbidity (no thoracotomy, no risk of recurrent laryngeal nerve injury, less post-ligation cardiac syndrome). Surgical ligation remains an option if catheter-based closure is contraindicated.

8During repair of a superior (SVC-type) sinus venosus ASD with PAPVR to the SVC, the Warden procedure involves:

A.Patch baffling the pulmonary veins across the ASD to the left atrium

B.Division of the SVC above the anomalous veins and reanastomosis to the right atrial appendage, with the pulmonary veins baffled to the LA

C.Direct reimplantation of anomalous veins onto the left atrium

D.Augmentation of the SVC with pericardium

Explanation: The Warden procedure transects the SVC above the highest anomalous pulmonary vein and reanastomoses the cephalad SVC end to the right atrial appendage. The distal SVC cuff containing the anomalous veins is baffled across the ASD to the LA with pericardium. This avoids SVC obstruction and reduces sinus node injury compared to the two-patch technique.

9Which of the following is NOT a component of the classic tetralogy of Fallot?

A.Ventricular septal defect

B.Right ventricular outflow tract obstruction

C.Aortic stenosis

D.Right ventricular hypertrophy

Explanation: Tetralogy of Fallot consists of: (1) VSD (malalignment type), (2) RVOT obstruction (infundibular ± valvar pulmonary stenosis), (3) overriding aorta, and (4) RV hypertrophy. All four features result from anterior deviation of the infundibular (conal) septum. Aortic stenosis is not a feature.

10The embryologic basis for tetralogy of Fallot is:

A.Failure of endocardial cushion fusion

B.Anterior (cephalad) malalignment of the infundibular (conal) septum

C.Abnormal cardiac looping (dextrocardia)

D.Abnormal neural crest migration leading to truncal septation failure

Explanation: The unifying embryologic defect in TOF is anterior and superior deviation of the conal/infundibular septum, which creates the malalignment VSD, narrows the subpulmonary infundibulum (RVOTO), allows aortic override, and leads to RV hypertrophy. Neural crest migration issues cause the truncus arteriosus/conotruncal spectrum but are distinct.

About the ABTS Congenital Cardiac Exam

The ABTS Congenital Cardiac Surgery Subspecialty Certification validates advanced knowledge for independent practice in congenital heart surgery. Content spans cyanotic and right-sided lesions (TOF, Ebstein da Silva cone, truncus, TGA with Jatene/Lecompte, DORV), single-ventricle physiology and Fontan (HLHS Norwood Sano vs BT — SVR III 12-year follow-up, bidirectional Glenn, extracardiac Fontan, PLE/plastic bronchitis/FALD), left-to-right shunts (ASD, VSD, AVSD, Piccolo PDA in preemies), valvular congenital and Ross-Konno, 2018 AHA/ACC ACHD guideline, aortic pathology (coarctation, IAA, vascular rings), pediatric CPB and del Nido cardioplegia, left-sided obstruction (critical AS, Shone, Williams supravalvar AS), coronary anomalies (ALCAPA, AAOCA), heart transplant and Berlin EXCOR VAD, genetics/syndromes (22q11.2, Trisomy 21, Noonan, Marfan/Loeys-Dietz), arrhythmia/pacing (JET, post-AVSD heart block), ethics/outcomes (STS-CHSD, STAT, NPC-QIC), and fetal cardiology. Requires ABTS board eligibility in Thoracic Surgery and completion of an ACGME-accredited Congenital Cardiac Surgery fellowship (1 year).

Questions

175 scored questions

Time Limit

Part I CBT (Dec 7-11, 2026); Part II case-based assessment follows

Passing Score

Criterion-referenced scaled score set by ABTS (modified Angoff standard)

Exam Fee

~$2,500 Congenital Cardiac Surgery Subspecialty Examination fee (ABTS 2026 — verify current schedule) (American Board of Thoracic Surgery (ABTS) / Pearson VUE)

ABTS Congenital Cardiac Exam Content Outline

~23%

Cyanotic & Right-Sided Lesions

Tetralogy of Fallot (transannular patch vs valve-sparing, RVOT strategies, PVR timing with RVEDVi >160 mL/m², Melody/Harmony TPV), pulmonary atresia with VSD and MAPCAs (unifocalization), pulmonary atresia with intact ventricular septum, Ebstein anomaly (da Silva cone reconstruction), truncus arteriosus (Van Praagh classification, RV-PA conduit), DORV subtypes (Taussig-Bing), D-TGA (Jatene arterial switch with Lecompte maneuver, coronary transfer, legacy Senning/Mustard), ccTGA and double switch.

~16%

Single-Ventricle Physiology & Fontan

HLHS staged palliation (Norwood Sano RV-PA vs modified BT-shunt — SVR I and 12-year SVR III follow-up), hybrid stage I (bilateral PA bands + ductal stent), bidirectional Glenn, extracardiac vs lateral tunnel Fontan, fenestration, Fontan failure — PLE, plastic bronchitis, Fontan-associated liver disease (FALD, cirrhosis/HCC surveillance), NPC-QIC interstage home monitoring, Berlin EXCOR pediatric VAD as bridge in single-ventricle patients.

~9%

Left-to-Right Shunts

Secundum ASD (transcatheter device with adequate rims vs surgical patch), superior sinus venosus ASD with PAPVR (Warden, two-patch), primum ASD/partial AVSD, coronary sinus/unroofed defects, VSD types (perimembranous, muscular, inlet, outlet/supracristal), complete AVSD Rastelli classification and repair, PDA (surgical ligation, device closure, Piccolo device in preemies <700 g), aortopulmonary window.

~9%

Valvular Congenital & Ross-Konno

Congenital AS (balloon/surgical valvotomy, Ross pulmonary autograft with pulmonary homograft RVOT, Ross-Konno for aortic annular hypoplasia), congenital MS (supravalvar ring, parachute, Shone complex), congenital AR, bicuspid AV, Ebstein TV repair (da Silva cone), pulmonary valve disease and transcatheter pulmonary valve (Melody, Harmony), cleft mitral valve in AVSD, common atrioventricular valve repair in AVSD.

~9%

Adult Congenital Heart Disease (ACHD)

2018 AHA/ACC ACHD guideline (AP anatomic-physiologic classification, stages I-IV), post-TOF reintervention and PVR indications (RVEDVi thresholds, TPV considerations), Fontan failure in adults, Eisenmenger physiology, systemic RV (ccTGA, atrial-switch D-TGA), coarctation reintervention (covered stents), pregnancy risk (CARPREG II, modified WHO), Mustard/Senning baffle leak and stenosis, transition of care.

~6%

Aortic Pathology

Coarctation (neonatal end-to-end, extended end-to-end, Waldhausen subclavian flap, arch advancement; covered stents for recoarctation), interrupted aortic arch (types A/B/C; type B associated with 22q11.2 deletion), vascular rings (double aortic arch, right arch with aberrant left subclavian + ligamentum, pulmonary artery sling), connective tissue aortopathy (Marfan FBN1, Loeys-Dietz TGFBR1/2).

~6%

Cardiopulmonary Bypass & Myocardial Protection

Pediatric CPB circuit priming (reduced prime volume, hemofiltration, modified ultrafiltration MUF), deep hypothermic circulatory arrest vs antegrade cerebral perfusion for aortic arch reconstruction, del Nido pediatric cardioplegia dosing, crystalloid vs blood cardioplegia, heparin dose-response and protamine, antifibrinolytics and factor concentrates for bleeding, temperature and neurologic protection.

~5%

Left-Sided Obstruction

Critical neonatal aortic stenosis (balloon vs surgical valvotomy, Ross for failed valve), subaortic membrane (resection, septal myectomy for tunnel subaortic stenosis), supravalvar AS (Williams syndrome, ELN elastin — Doty/McGoon/Brom repair), cor triatriatum, pediatric HOCM, Shone complex staged management of multilevel left-sided obstruction.

~4%

Coronary Anomalies

ALCAPA (Bland-White-Garland) — two-coronary repair with aortic reimplantation vs Takeuchi intrapulmonary tunnel; anomalous aortic origin of a coronary artery (AAOCA) with interarterial LCA from right sinus and intramural course (unroofing/reimplantation), coronary transfer in arterial switch (trap-door, Yacoub techniques), coronary-cameral fistulae.

~4%

Heart Failure, Transplant & MCS

Pediatric heart transplant (ISHLT allocation, donor-recipient size matching, sensitization and PRA), ABO-incompatible infant transplant, Berlin EXCOR pediatric paracorporeal VAD as bridge-to-transplant, HeartMate 3/HVAD in adolescents, mechanical support for HLHS interstage and failing Fontan, heterotopic transplant in Fontan failure with elevated PVR.

~4%

Genetics & Syndromes

22q11.2 deletion / DiGeorge (IAA type B, truncus, TOF, calcium and immune disturbance), Trisomy 21 (complete AVSD), Turner syndrome (coarctation, bicuspid AV), Williams (supravalvar AS — ELN), Noonan (pulmonary stenosis, HCM — PTPN11), Marfan (FBN1), Loeys-Dietz (TGFBR1/2), Alagille (JAG1 — peripheral PA stenosis), CHARGE, heterotaxy (asplenia/polysplenia).

~3%

Arrhythmia & Pacing

Postoperative junctional ectopic tachycardia (JET — cooling, dexmedetomidine, amiodarone), complete heart block after VSD/AVSD/outflow surgery with permanent pacemaker indication, intra-atrial reentrant tachycardia in Fontan and Mustard/Senning patients, WPW in Ebstein anomaly, surgical cryoablation/modified Maze for ACHD arrhythmia, epicardial vs transvenous pacing.

~3%

Ethics, Outcomes & Quality

STS Congenital Heart Surgery Database (STS-CHSD) and STAT mortality categories, IMPACT registry, NPC-QIC collaborative interstage monitoring, shared decision-making in HLHS (comfort care vs Norwood vs transplant), informed consent in complex congenital care, QI methodology, public reporting, equity and outcome disparities.

~2%

Fetal Cardiology & Intervention

Fetal echocardiography indications and segmental analysis, fetal aortic valvuloplasty for evolving HLHS with endocardial fibroelastosis, maternal hyperoxygenation testing, delivery planning for ductal-dependent lesions, neonatal transport and prostaglandin E1 management.

How to Pass the ABTS Congenital Cardiac Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABTS (modified Angoff standard)
Exam length: 175 questions
Time limit: Part I CBT (Dec 7-11, 2026); Part II case-based assessment follows
Exam fee: ~$2,500 Congenital Cardiac Surgery Subspecialty Examination fee (ABTS 2026 — verify current schedule)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABTS Congenital Cardiac Study Tips from Top Performers

1SVR trial pearls: The Single Ventricle Reconstruction trial compared the Norwood procedure with an RV-PA (Sano) conduit vs a modified Blalock-Taussig shunt in HLHS. At 12 months, the Sano group had better transplant-free survival, but by the SVR III 12-year follow-up the survival benefit attenuated and the Sano group showed more ventricular dysfunction and reinterventions. Expect questions that pivot on these long-term findings — know both short- and long-term trade-offs.

2Tetralogy of Fallot PVR indications: In repaired TOF with pulmonary regurgitation, consider PVR when RVEDVi exceeds ~160 mL/m² (or RVESVi ~80 mL/m²), with symptoms, progressive RV dysfunction, arrhythmia, or QRS >180 ms. Transcatheter pulmonary valves (Melody in small conduits, Harmony for native/patched RVOT) have expanded non-surgical options. Valve-sparing TOF repair at index operation reduces later PVR burden.

322q11.2 deletion / DiGeorge syndrome: Classic pentad (CATCH-22) — Cardiac defects, Abnormal facies, Thymic hypoplasia, Cleft palate, Hypocalcemia — with 22q11.2 deletion. High-yield cardiac associations: interrupted aortic arch type B, truncus arteriosus, TOF with absent pulmonary valve, and aortic arch anomalies. Always check ionized calcium, CBC for lymphopenia, and use irradiated CMV-negative blood products for neonatal surgery.

4Arterial switch (Jatene) operation for D-TGA: Performed in the neonatal period (ideally within the first 2 weeks of life before LV deconditioning). The Lecompte maneuver brings the pulmonary artery anterior to the aorta, and coronary transfer with trap-door or Yacoub techniques handles variable coronary anatomy. Key late complications: neo-aortic root dilation and neo-aortic regurgitation, supravalvar pulmonary stenosis at anastomosis sites, and coronary ostial stenosis.

5Ebstein anomaly and the da Silva cone: In Ebstein, the septal and posterior tricuspid leaflets are apically displaced with atrialization of the right ventricle. The da Silva cone reconstruction mobilizes the anterior leaflet circumferentially to form a cone-shaped valve that is attached to the true tricuspid annulus — providing a more durable repair than prior Carpentier-type repairs. Know the indications, contraindications (severe RV dysfunction may warrant 1.5-ventricle repair with bidirectional Glenn), and associated WPW needing ablation.

Frequently Asked Questions

What is the ABTS Congenital Cardiac Surgery Subspecialty Examination?

The ABTS Congenital Cardiac Surgery Subspecialty Certification is awarded by the American Board of Thoracic Surgery and validates advanced knowledge for independent practice in congenital heart surgery. The exam has two parts — Part I is a computer-based multiple-choice examination and Part II is a case-based assessment. Content spans the full congenital spectrum from fetal cardiology through adult congenital heart disease (ACHD), including single-ventricle palliation, cyanotic lesions, Ross/Ross-Konno, coronary anomalies, pediatric heart transplant, and mechanical circulatory support.

Who is eligible to take the ABTS Congenital Cardiac exam?

Candidates must be ABTS board-eligible in Thoracic Surgery (Part I passed) AND have completed an ACGME-accredited Congenital Cardiac Surgery fellowship (1 year) with documented case volume. A valid unrestricted medical license is required, and the fellowship program director must attest to satisfactory performance and ethics.

What is the format of the ABTS Congenital Cardiac Surgery exam?

Part I is a computer-based multiple-choice examination administered at Pearson VUE with approximately 150-200 single-best-answer items; the 2026 Congenital Cardiac Surgery Part I testing window is December 7-11, 2026. Part II is a case-based assessment administered separately for candidates who pass Part I. Items commonly include echocardiographic images, angiography, intraoperative photographs, and outcome data from STS-CHSD.

How much does the 2026 ABTS Congenital Cardiac exam cost?

The 2026 ABTS Congenital Cardiac Surgery Subspecialty Examination fee is approximately $2,500 — always verify the current schedule on the ABTS website. Cancellation and refund policies follow the ABTS schedule with decreasing refunds as the exam date approaches. Retakes require re-registration and full fee payment within the allowed qualification window.

When is the 2026 exam administered?

The 2026 ABTS Congenital Cardiac Surgery Part I examination is scheduled for December 7-11, 2026 at Pearson VUE test centers. Applications generally open earlier in the year with a submission deadline several months before the testing window. Candidates schedule specific appointments with Pearson VUE after application approval. Exact dates should be confirmed on the ABTS examinations page.

How is the exam scored?

ABTS uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports include domain-level feedback. Candidates must pass Part I before becoming eligible for Part II.

What are the highest-yield topics?

Highest-yield topics include the SVR trial (Norwood Sano vs modified BT-shunt — SVR III 12-year follow-up), Fontan physiology and failure modes (PLE, plastic bronchitis, FALD), tetralogy of Fallot management including PVR indications (RVEDVi >160 mL/m², Melody/Harmony TPV), arterial switch with Lecompte maneuver and coronary transfer, Ebstein da Silva cone reconstruction, Ross-Konno for annular hypoplasia, IAA type B with 22q11.2 deletion, ALCAPA and AAOCA management, Berlin EXCOR pediatric VAD, NPC-QIC interstage monitoring, the 2018 AHA/ACC ACHD guideline, and STS-CHSD STAT mortality categories.

How should I study for this exam?

Use a structured 12-18 month plan during fellowship and early attending practice. Map to the ABTS congenital content outline: begin with segmental anatomy, shunts, and pediatric CPB, then cyanotic/right-sided and single-ventricle physiology, then valvular/Ross-Konno and aortic pathology, then ACHD, transplant/MCS, genetics, and arrhythmia/ethics. Integrate core textbooks (Jonas' Comprehensive Surgical Management of Congenital Heart Disease, Kouchoukos Kirklin/Barratt-Boyes Cardiac Surgery, Mavroudis-Backer Pediatric Cardiac Surgery), the 2018 AHA/ACC ACHD guideline, CHSS and NPC-QIC collaborative publications, and high-volume MCQ practice. Complete 2-3 full-length timed mock exams.