Congenital Heart Disease

Congenital Heart Disease - NON-CARDIAC SURGERY IN CHILDREN...

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NON-CARDIAC SURGERY IN CHILDREN WITH CONGENITAL HEART DISEASE
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CHD 8 per 1000 live births ½ million patients in the US with repaired, palliated or unoperated CHD Advances in Mx increasing survival Trend to early repair Anesthetic mx complicated by diversity of CHD and wide spectrum of surgeries performed CHD adds significantly to the mortality of non- cardiac surgery
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SPECTRUM OF CHD Other 17% TGA 5% Coarctation 5% AS 5% TOF 10% PDA 10% PS 10% ASD 10% VSD 28%
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SPECTRUM OF INTERVENTION True correction PDA, ASD, some VSD Correction with residua Some VSD, Coartation of the Aorta Correction with sequelae TOF, TGA Complications Arrhythmias or conduction abn. from incisions or sutures Palliative surgery B-T shunt, PA banding Cath lab interventions Cure or palliation
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ISSUES TO RESOLVE 1. Nature of repair 2. Age and era of repair 3. Ventricular outflow obstruction 4. Ventricular dysfunction 5. Arrhythmias and conduction abnormalities 6. Hypoxemia 7. Pulmonary Hypertension 8. Endocarditis prophylaxis 9. Extracardiac problems 10. Monitoring
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NATURE OF THE REPAIR 1. ANATOMIC – LV to aorta RV to pulm artery circulation in series cyanosis corrected a) Simple Recon – ASD, VSD, PDA treat as for normal heart b) Complex – outflow tract (TOF, AS, PS, coarct) conduits or baffles (PA) septum and AV valve repair
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This note was uploaded on 12/28/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Congenital Heart Disease - NON-CARDIAC SURGERY IN CHILDREN...

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