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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- Spring '17