CongenHeartDisWeb - Congenital Heart Disease Greg Gordon MD...

Info iconThis preview shows pages 1–17. Sign up to view the full content.

View Full Document Right Arrow Icon
Congenital Heart Disease Greg Gordon MD 2 Feb 05 24 May 06 31 May 07
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Training for Career in  Pediatric Cardiac Anesthesia   Specific Fellowship: Rare Pediatric Anesthesia: 12 months Adult Cardiac Anesthesia: 6 months Pediatric Cardiac Anesthesia: 6 months Pediatric Critical Care: 6 months White MC & Murphy TWG. Pediatric Anesthesia 17:421, 2007
Background image of page 2
? PDA ligations Murmurs preop CHD patients for noncardiac surgery
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Adults with CHD in US today 2,140,000 Growing 5% per year Cahalan MK.  Anesthetic Management of Patients with Heart Disease.   IARS 2003 Review Course Lectures
Background image of page 4
Tammy 3 y/o  with  TOF s/p right BTS For dental restorations Turns blue with crying Scheduled to undergo cardiac repair in 3 months •SpO 2  93 Systolic ejection murmur Slight clubbing of fingers Hct 52
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
(Recent oral board case) Systolic murmur  VSD  Needs surgical closure Victor
Background image of page 6
Fran 11 y/o with tricuspid atresia s/p Fontan procedure Temporary BTS at age 3 weeks Modified Fontan at age 3 years Meds: digoxin, captopril •SpO 2  88 on RA, 98 in O 2 P 67, BP 99/42  First degree AV block For scoliosis repair
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Objectives Participants will be able to more intelligently discuss:  Newborn heart and lungs  Initial evaluation the child’s heart  Pathophysiology of selected CHDs  Anesthetic implications of CHD
Background image of page 8
CHOP “Duct Busters” The Newborn Heart Provide service to 17 area NICUs Send team of 2 each  surgeons  anesthesia providers (attending + CRNA) nurses Operate within 24 - 48 hours Monday – Friday  No weekends Reimbursement  exceeds other cardiac services Susan Nicholson and Gould DS et al: Pediatrics 2003 112:1298-1301
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Foramen Ovale Functional closure first hours as LAP > RAP Probe-patent  50% of 5-year-olds 25% of 20-year-olds Paradoxical embolus The Newborn Heart
Background image of page 10
The Newborn Heart Ventricular tissue Fewer myocytes Greater proportion of connective tissue Relative RVH So: Decreased compliance More sensitive to preload
Background image of page 11

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
The Newborn Heart Normally near peak of Starling curve Stroke volume relatively fixed C.O. relatively heart rate dependent Near peak of Starling curve Stroke volume relatively fixed C.O. relatively heart rate dependent
Background image of page 12
Ca ++ The Newborn Heart Newborn myocardium derives relatively  high fraction of  activator Ca  from the  extracellular  pool, so Beware Ca channel blockers
Background image of page 13

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
The Preterm Infant Heart More sensitive to depressant effects of inhaled agents Decreased response to catecholamines Relatively high PVR persists Pulmonary vasculature more sensitive to vasoconstriction by: Hypoxia Acidosis Hypercarbia
Background image of page 14
C HD  Pe arl murmur in newborn = benign disease
Background image of page 15

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Initial evaluation of child’s heart History:  To determine Level of function CHF
Background image of page 16
Image of page 17
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

Page1 / 84

CongenHeartDisWeb - Congenital Heart Disease Greg Gordon MD...

This preview shows document pages 1 - 17. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online