acyanotic congenital heart disease

Question 1

what are the classifications of ASDs? What is the epidemiology?

Answer 1

1. ostium primum. in lower portion. common in trisomy 21. defect can cause mitral regurg.
2. ostium secundum: defect in middle portion. most common asd.
3. sinus venosus: defect high in the septum near the right atrium and SVC. right pulm veins often drain into SVC instead of left atrium

Question 2

What are the clinical features of an ASD?

Answer 2

Fixed split S2
systolic ejection murmur, esp in mid and upper left sternal borders
increased RV impulse
can cause pulm htn, right heart failure

Question 3

What determines the severity of the shunt in VSD?

Answer 3

size of the defect and degree of pulmonary vascular resistance

Question 4

How do small VSDs present and what is their course?

Answer 4

• may close spontaneously
• holosystolic murmucm, esp at low left sternal border
• as VSD size decreases, murmur intensity increases

Question 5

What is the pathophysiology of a PDA?

Answer 5

blood flows through the ductus from the aorta to the pulmonary artery (left to right shunt). causes increased pulmonary blood flow

Question 6

What are some of the exam findings for PDA?

Answer 6

machine like continuous murmur at the upper left sternal border
-possible diastolic rumble of blood flow across the mitral valve, widened pulse pressure. risk of pulm htn

Question 7

how do neonates/infants with severe coarctation of the aorta present?

Answer 7

depend on a right to left shunt through the PDA to perfuse the lower aorta. they begin minimally symptomatic, but get worse as the PDA closes.

Question 8

what other anomalies are associated with coarctation of the aorta?

Answer 8

bicuspid aortic valve or aortic stenosis

Question 9

How is coarctation of the aorta managed?

Answer 9

• initially in a neonate, it is managed with PGE to keep the PDA open, and inotropic meds.
• then, corrective repair. may be excision of narrowed segment or balloon angioplasty. balloon angioplasty is treatment of choice for recurrance

Question 10

What are some complications of aortic stenosis.

Answer 10

reduced LV output. may cause ischemia (higher than average LV demand with lower output). may also lead to LV hypoplasia due to impaired fetal LV development

Question 11

What are some symptoms of pulmonary stenosis?

Answer 11

in neonate, may cause right to left shunting through patent foramen ovale. most kids have no symptoms