A precordial bulge may be palpated. The S2has a wide, fixedsplit when there is no pulmonary vein obstruction. A systolicmurmur is heard in the pulmonic area.Diagnostic TestsThe chest radiograph shows enlargement of the right atrium andventricle and increased pulmonary blood flow.The ECG reveals right ventricular hypertrophy.The echocardiogram shows a dilated right atrium and ventricle, smaller left-sided chambers, dilated pulmonary arteries, and a patent foramen ovale. It candetermine the type of pulmonary drainage and if the pulmonary venous return isobstructed.Clinical TherapyProstaglandin E1is given to maintain the patent ductus arteriosus for somenewborns.Diuretics are given to treat CHF.Surgery is performed to move or create a conduit to connect the pulmonaryveins to the left atrium.PrognosisSurgery is required for survival. Postoperative mortality ranges from 5% to 10%(Park, 2014). Children may develop pulmonary hypertension, pulmonary veinobstruction, or atrial arrhythmias.PulmonaryveinSuperiorvena cavaAtrialseptaldefectTotal anomalouspulmonary venousconnectionPulmonaryveinreasons. Conditions such as congestive heart failure and cyano-sis can affect gross motor development. Infants with complexcongenital heart defects are at risk for preoperative neurologicinsult. Inadequate nutrition during the first year of life, whenrapid brain development occurs, places the infant at greaterrisk. Some infants have structural brain abnormalities, abnor-mal cerebral blood flow, chromosomal abnormalities, cerebralischemia, and other chromosomal disorders documented priorto surgery. Infants with cyanosis who also have iron deficiencyanemia may develop a stroke. SeeEvidence-Based Practice:Neurodevelopmental Outcomes in Children With Complex CongenitalHeart Disease.Children with complex congenital heart defects need mul-tiple stages of surgery, revisions of previous surgeries, valvereplacements, or interventional catheterization to reopen valvesor vessels that have become obstructed. However, rates ofsurvival to adulthood have been improving for children withcomplex CHD. A pacemaker may be needed for children withpotential life-threatening AV block or ventricular dysfunction(Park, 2014, pp. 442).
