Tx cath repairs with patch or open heart surgery

Tx – cath repairs with patch or open heart surgery
 Dysrhythmias a problem – most complications manageable
 Early have to fix the higher the risk for pt
 PDA
o Part of fetal developemtn
o Istays opein instead of cloign within 48 hours
o NSAIDS – indomethacin & ibuprofen to close
 Prostaglandin to keep open
o Wait – all depends on GA, earlier = more
likely to stay open
o Woosh murmur – no rt syst or diastolic
o Aorta has higher pressure than pulm art–
increased blood flow to lungs
 AV Canal
o No mitral or tricuspid valve – just one
common valve
o Most blood goes to pulm circulation – shunting all over the place
 2 chamber instead of 4 chamber heart

 Common with downs syndrome
 Sx – dyspnea, ↓ appetite, poor wt
gain
 Can be cyanotic 0 start to cry,
increases pressure in pul artery &
all blood that was shunting from L
to right shunts the other way &
goes out aorta instead
 Surgery by 6mo if get to 5kg before then can do it earlier
 Septum & valves
 Prophylaxis for endocarditis
Obstructive Defects
 Mechanical obstruction of the heart
 Can be in valves or vessels
Coarctation of the aorta
 Narrowing or stricture of aorta
 After ductus arteriosus
 Can be completely asymptomatic
 Upper extremities – bounding pulses, HA, red face,
↑ ICP
 Lower extremities – weak pulses, poor circulation,
pale, mottled
 Tx – cath & put stent & balloon dilatation to keep open, deel with
complications with low BP in lower extremities for so long
Aortic stenosis
 Most asymptomatic
 Narrowing in aorta or in Aortic valve
 If find wheninfant, life threatening
 Depedsnon how narrow
 No complications when infant – mostly normally
fine
 Find when infancy & problematic = life
threatening
 Running with syncopy – echos to check for this
 Murmur possible
 Can have chest pain
 Stricture wil ↑ pressures inside of heart
 Findi n infancy – still have PDA open – give
prostaglandin E to keep open
o Does nto help oxygenated blod go to periphery but will lower
pressure in heart until you can fix a stenosis
 Ballon dialtaion & valve replacements

Pulmonic stenosis
 Pulmonic valve / arter
 Leads to Rt ventricular hypertrophy
o Harder work on RV – trying to get blood past
o Like Rt sided CHF
o Can have murmur
o SOB – cant get blood to lungs
o Want to maintain calm environment as
possible
o Monitor Bp & SX of CHF
o Balloon & dilate it & shoud be fine
o Endocarditis prophylaxis
Decreased pulmonary blood flow
 Cyanotic
 Right to left shunting of blood
 Desaturated blood mixes with oxygenated blood and is delivered
systemically
Tetrology of Fallot (TOF)
 4 defects
 In utero, when growing heart, aorta starts to
slide over to middle of VSD because pressure is
so much- pulls blood from RV, getting blood from
RV out to aorta
 Associated with downs & degeorge syndromes
 Cyanosis after PDA closes
 Murmur
 Dyspnea
 ↓ pulm blod flow have low perfusion
o Kidneys say ned more RBC  releaser
erythropoietin
o High Hct, Hgb, higher RBC – polycythemia
 Use fulter on ALL tubing – higher risk for air emboli – shunt from
vein to body system
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