Download - Congential Heart Diseases
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Cardiovascular Dysfunction By Shahzad Bashir
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Fetal Circulation Structures • Umbilical vein; umbilical arteries
• Foramen ovale
• Ductus arteriosus
• Ductus venosus
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Changes at Birth
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Pediatric Indicators of Cardiac Dysfunction• Poor feeding
• Tachypnea/ tachycardia
• Failure to thrive/poor weight gain/activity intolerance
• Developmental delays
• + Prenatal history
• + Family history of cardiac disease
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Two Types of Cardiac Defects• Congenital
– Anatomic>abnormal function
• Acquired
– Disease process • Infection• Autoimmune response• Environmental factors• Familial tendencies
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CHD• Incidence: 5-8 per 1000 live births
– About 2-3 of these are symptomatic in first year of life
– Major cause of death in first year of life (after prematurity)
– Most common anomaly is VSD– 28% of kids with CHD have another
recognized anomaly (trisomy 21, 13, 18, +++ )
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Older Classifications of CHD• Acyanotic
– May become cyanotic
• Cyanotic
– May be pink
– May develop CHF
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Newer Classification of CHD• Hemodynamic characteristics
– Increased pulmonary blood flow
– Decreased pulmonary blood flow
– Obstruction of blood flow out of the heart
– Mixed blood flow
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Increased Pulmonary Blood Flow Defects• Abnormal connection between two sides
of heart
– Either the septum or the great vessels
• Increased blood volume on right side of heart
• Increased pulmonary blood flow
• Decreased systemic blood flow
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Increased Pulmonary Blood Flow Defects• Atrial septal defect
• Ventricular septal defect
• Patent ductus arteriosus
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ASD
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VSD
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PDA
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Obstructive Defects• Coarctation of the aorta
• Aortic stenosis
• Pulmonic stenosis
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Coarctation of the Aorta
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Aortic Stenosis
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Pulmonic Stenosis and Catheter Placement
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Decreased Pulmonary Blood Flow Defects
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Tetralogy of Fallot
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Tricuspid Atresia
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Mixed Defects• Transposition of great vessels
• Total anomalous pulmonary venous connection
• Hypoplastic heart syndrome
– Right
– Left
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Transposition of Great Vessels
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Totally Anomalous Pulmonary Venous Connection
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Hypoplastic Left Heart
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CHF in Children• Impaired myocardial function
– Tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine output
• Pulmonary congestion– Tachypnea, dyspnea, respiratory distress,
exercise intolerance, cyanosis• Systemic venous congestion
– Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
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Interventional Cardiac Catheter Procedures in Children • Transposition of great vessels
• Some complex single-ventricle defects
• ASD
• Pulmonary artery stenosis
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INTERVENTION
Balloon dilation
Balloon dilation
Balloon dilation
DIAGNOSIS
Valvular pulmonic stenosis
Recurrent coarctation of aorta
Congenital mitral stenosis
Interventional Cardiac Catheter Procedures in Children (cont’d)
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Surgical Interventions• Open heart
• Closed heart procedures
• Staged procedures
• Prepare child and family for procedures
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Acquired CardiovascularDisorders
Infectious and Inflammatory Cardiac Disorders
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Endocarditis
• Subacute bacterial endocarditis
• Infective endocarditis
• Strep
• Staph
• Fungal infections
• PROPHYLAXIS: 1 hr before procedures (IV) or may use PO in some cases
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Rheumatic FeverRheumatic Heart Disease• RF
– Inflammatory disease occurs after Group A – ß-hemolytic streptococcal pharyngitis
• Affects joints, skin, brain, serous surfaces, and heart
• Rheumatic heart disease– Most common complication of RF– Damage to valves as result of RF
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Prevention of RHD • Treatment of streptococcal tonsillitis/pharyngitis
– Penicillin G—IM X 1
– Penicillin V—Oral X 10 days
– Sulfa—Oral X 10 days
– Erythromycin (if allergic to above)—Oral X 10 days
• Treatment of recurrent RF
– Same as above
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