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Heart Defects

Infant heart defects
Course

Gynecology and Obstetrics (OBS12)

9 Documents
Students shared 9 documents in this course
Academic year: 2023/2024
Uploaded by:
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This document has been uploaded by a student, just like you, who decided to remain anonymous.
University of Iowa

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Ventricular Septal
Defect (VSD)

Pathophysiology: -There is a hole in the ventricle wall between the left and right ventricles. The hole can range in size from very small to large. Oxygenated blood flows from the left ventricle (area of high pressure) to the right ventricle (area of lower pressure) and recirculates to the lungs.

  • Simple terms: hole in the ventricle wall between left and right ventricle, oxygenated blood flow from left ventricle (high pressure) to right ventricle (low pressure); recirculate to lungs.

Clinical Presentation:

  • Resp: tachypnea, SOB, increased pulmonary infections, pulmonary HTN.
  • Cardiac: tachycardia, sweating while feeding, pale skin, systolic murmur.
  • Growth: failure to thrive (if large).

Nonsurgical Interventions:

  • Aimed at preventing HF or treating it if it occurs.
  • Digoxin to control rate and rhythm.
  • Lasix for diuresis and to manage fluid balance
  • ACE inhibitors to decrease aortic pressure, systemic vascular resistance, and left-to-right shunt.

Surgical Interventions:

  • Palliative pulmonary banding to reduce blood flow to the lungs until a VSD patch can be placed.
  • VSD patch, placed at 3-12 months of age.

F

Tetralogy of
Fallot

Pathophysiology: -4 defects are present: pulmonic stenosis, right ventricular hypertrophy, VSD, and overriding aorta. The outflow portion of the right ventricle is underdeveloped (hypoplasia) and not properly aligned, which leads to the 4 defects. Some children have a 5th defect, an open foramen ovale or an ASD. Elevated pressures on the right side of the heart (bc of the increased blood volume and small right ventricle) cause a right-to-left shunt. The overriding aorta and VSD allow unoxygenated blood to enter the systemic circulation, hence cyanosis occurs. The degree of right ventricular outflow tract obstruction determines the severity of the defect. When pulmonary stenosis is minimal, there may be little shunting across the VSD and thus very little unoxygenated blood enters the systemic circulation. This results in acranosis. Conversely, a tetralogy of Fallot with severe pulmonary stenosis or even pulmonary atresia will be cyanotic. -Simple terms: BLUE BABY; pulmonic stenosis cause right ventricular hypertrophy, then a VSD, and an overriding aorta which pulls blood from each side of the heart, causing backflow from the right ventricle to the left ventricle, mixing it.

Clinical Presentation:

  • Symptoms depend on the severity of the right ventricular outflow tract obstruction and whether PDA is present.
  • Resp: mild-to-severe cyanosis, tachypnea.
  • Cardiac: loud, harsh systolic ejection murmur, polycythemia, clubbing of fingers (over time), squatting in toddlers (if uncorrected).
  • Growth: failure to gain weight.

Nonsurgical Interventions:

  • Managing hypercyanotic episodes: monitor the child for prolonged unconsciousness and assess for metabolic acidosis.

Surgical Interventions:

  • Palliative surgery is performed within the first few months of life for severe tetralogy of Fallot and a Blalock-Taussig shunt is performed.
  • Closing the VSD with a synthetic patch or autograft using the pericardium.
  • Closing the ASD (if present).
  • Pulmonary stenosis is relieved by respecting the right ventricular outflow tract, a pulmonary valvotomy, or reconstruction using a patch.
Transposition of
the Great Arteries
(TGA)

Pathophysiology: -The aortic and pulmonary arteries are connected to the wrong ventricles. The pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. Therefore, oxygenated blood from the left ventricle is recirculated to the lungs via the abnormally connected pulmonary artery. Also, deoxygenated blood returning to the right heart from the body recirculates to the body via the abnormally connected aorta. Necessary blood flow occurs bc one or more of the following defects is also present: PDA, ASD, and/or VSD. The PDA allows blood to shunt between the aorta and the pulmonary artery. The ASD allows blood to flow form the right to the left atrium, and the VSD allows blood to flow between the right and left ventricles. -Simple terms: The VSD allows a little of mixing of blood, the arteries are connected to the wrong ventricles, causing HF.

Clinical Presentation:

  • Resp: cyanosis that does not improve with supplemental oxygen, hypoxia, tachypnea without signs of respiratory distress.
  • Cardiac: S2 is loud, systolic murmur if VSD is present, signs of HF, polycythemia.
  • Growth: failure to gain weight.

Nonsurgical Interventions:

  • IV prostaglandins are started soon after birth to keep the ductus arteriosus open.
  • Monitor and treat HF.

Surgical Interventions:

  • Ballon atrial septostomy is performed palliatively to make a larger ASD (by enlarging the foramen ovale) to allow more mixing of oxygen-rich and oxygen-poor blood, thus increasing O to approximately 80%.
  • Surgical repair involves an arterial switch ( the Jatene procedure). This procedure is usually performed within the first 2

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Heart Defects

Course: Gynecology and Obstetrics (OBS12)

9 Documents
Students shared 9 documents in this course

University: University of Iowa

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Ventricular Septal
Defect (VSD)
Pathophysiology:
-There is a hole in the ventricle wall between
the left and right ventricles. The hole can range
in size from very small to large. Oxygenated
blood ßows from the left ventricle (area of high
pressure) to the right ventricle (area of lower
pressure) and recirculates to the lungs.
-Simple terms: hole in the ventricle wall
between left and right ventricle, oxygenated
blood ßow from left ventricle (high pressure) to
right ventricle (low pressure); recirculate to
lungs.
Clinical Presentation:
¥ Resp: tachypnea, SOB, increased pulmonary
infections, pulmonary HTN.
¥ Cardiac: tachycardia, sweating while feeding,
pale skin, systolic murmur.
¥ Growth: failure to thrive (if large).
Nonsurgical Interventions:
¥ Aimed at preventing HF or treating it if
it occurs.
¥ Digoxin to control rate and rhythm.
¥ Lasix for diuresis and to manage ßuid
balance
¥ ACE inhibitors to decrease aortic
pressure, systemic vascular
resistance, and left-to-right shunt.
Surgical Interventions:
¥ Palliative pulmonary banding to reduce
blood ßow to the lungs until a VSD
patch can be placed.
¥ VSD patch, placed at 3-12 months of
age.
↳
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