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


You've reached the end of your free preview.
Want to read all 23 pages?
- Spring '17