ii.After birth, it should evolve into the ligamentum arteriosum. iii.Congestive heart failure may be the result of an untreated PDA. f.Coarctation of the aorta (CoA): Narrowing of the aorta i.The heart must work harder to keep the blood flowing past the narrowed area. ii.Signs and symptoms include: (a)Shortness of breath (b)Chest pain (c)Hypertension (d)Headaches (e)Muscle weakness iii.Treatment is usually heart surgery. g.Truncus arteriosus: The pulmonary and aorta arteries are combined as one vessel. i.Greatly increases blood flow into the lungs, causing congestive heart failure ii.Patient will have slightly lower oxygen levels early in life, eventually resulting in cyanosis. iii.Will require surgical intervention h.Tricuspid atresia: The tricuspid valve is missing. i.Results in an undersized or absent right ventricle ii.Will have a significantly decreased blood flow into the lungs, leading to severe hypoxemia and death iii.May require a Fontan procedure to redirect the inferior vena cava and hepatic vein into the pulmonary circulation i.Hypoplastic left heart syndrome (HLHS): The left side of the heart is completely underdeveloped. i.Left side of the heart is unable to fulfill circulation needs. ii.Patients present with murmur or cyanosis. iii.Heart transplant is necessary. j.Tetralogy of Fallot (ToF): Combination of four heart defects
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i.Defects: (a)Ventricular septal defect—Hole in the septum separating the right and left ventricles, allowing blood flow between the two (b)Pulmonary stenosis—Narrowing of the pulmonary valve (c)Right ventricular hypertrophy—Thickening of the right ventricle (d)Overriding aorta—Aorta connected between the left and right ventricles over the VSD ii.Results in poor oxygenation iii.Open heart surgery is required. k.Transposition of the great arteries (TGA): Blood goes to the lungs for oxygenation, then returns to the lungs, while blood from the body to the heart goes back to the body without becoming oxygenated. i.Patients present with: (a)Shortness of breath (b)Finger and toe clubbing (c)Cyanosis ii.May require surgical intervention l.Total anomalous pulmonary venous return (TAPVR): The four pulmonary veins connect to the right atrium instead of the left atrium. i.Results in diminished oxygen and increased load on the right ventricle B.Assessment and management 1.Critical CHD presents in the neonatal period. a.Rapid detection and transport are mandatory. b.Communication with medical control is critical to have adequate services available upon arrival at the emergency facility. X. Summary A.Newborn or neonate care must meet the unique needs of this population. Complication rates increase as birth weight and gestational age decrease. Approximately 10% of newborns need additional assistance to survive.
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