Acyanotic heart diseases Flashcards
- Narrowing at the entrance of PA
- IF RV failure develop – RA pressure will increase resulting to re-opening of foramen ovale
- Shunting of unoxygenated blood into
Pulmonary Stenosis
Open surgical Management of PDA
ligation of PDA thru left
thoracotomy
Medical management of VSD with cardiac failure:
digoxin and diuretics
type of ASD that comprises
about 5% cases of ASD. The
defect lies low in the interatrial
septum adjacent to
atrioventricular valves. There
may be cleft in the aortic leaflet
of the mitral valve producing
mitral insufficiency.
ostium primum
nonsurgical Management of PDA
coil occlusion
Management of PDA
- Indomethacin IV (prostaglandin
inhibitor) - Digoxin
- Diuretics
- adequate nutrition
Surgical management:
* Open: ligation of PDA thru left
thoracotomy
* Closed: VATS (visual assisted
thoracoscopic surgery)
- Nonsx: COIL OCCLUSION
Closed surgical Management of PDA
VATS (visual assisted
thoracoscopic surgery)
Medical management of AS: used to treat CHF
rapidly acting inotropic
agents and diuretics
Management of ASD: prophylactic
antibiotics to prevent bacterial
endocarditis before dental
procedures and other invasive
procedures
infection control
Type of AS: stricture caused by a fibrous
ring below the normal valve
Sub valvular stenosis
Management of ASD: helps strengthen the
heart muscle, enabling
digoxin
Management of AS:
o Replacing the child’s diseased aortic valve with his/her own pulmonary valve (pulmonary autograft) and the pulmonary valve replaced with homograft
Ross procedure
Management of AS:
Additional sx for recurrent stenosis: valve replacement (artificial) may be required at the second procedure
Aortic homograft with a valve
Other term for AVC
endocardial
cushion defects
Management of PDA:
-the standard procedure
-The technique of video-assisted thoracoscopic clip ligation has become the standard of care for surgical management of a ductus with adequate length
ligation of PDA thru left
thoracotomy
Management of PS:
Surgical for Infants
TRANSVENTRICULAR
VALVOTOMY/BLOCK
Management of PS: closed surgical
TRANSVENTRICULAR
VALVOTOMY/BLOCK
Partial atrioventricular canal defects is also called as
atrioventricular
septal defect, or AVSD.
Type of AS: occurs
infrequently
Supra valvular stenosis
Medical management of VSD: for complete repair of small defects
purse-string approach
type of ASD that accounts
for about 5% cases of ASD. The
defect is located high in the
interatrial septum near the
entry of the superior vena cava.
Sinus venosus
Type of AVC: severe defect in which there is a large hole in the septum that separates the left and right sides of the heart. The hole is in the center of the heart, where the upper chambers and the lower chambers meet.
Complete atrioventricular canal (CAVC)
Management of PS:
o during cardiac catheterization to dilate the narrowed valve
/STENT PLACEMENT
o A doctor inserts a long, thin tube (catheter) with a balloon on the tip into an artery in the arm or groin. X-rays are used
to help guide the catheter to the narrowed valve in the heart. The doctor the inflates the balloon, which widens the opening of the valve and
separates the valve flaps. The balloon is when deflated, and the catheter and balloon are removed.
Balloon Valvuloplasty
Management of COA
- Surgical correction is advisable in all but the mildest cases
- Nonsx:
o BALLOON ANGIOPLASTY - Sx:
o Resection/removal of
narrowed ends and
anastomosis of both ends
o Enlargement of the
constricted section using a
graft of prosthetic
material/portion of left
subclavian artery
Management of PDA: help close a PDA
works by stimulating the muscles
inside the PDA to constrict,
thereby closing the connection
Indomethacin IV (prostaglandin
inhibitor)
Management of PDA:
use of thoracoscope and instruments, 3 small insicion on the L side of chest to place a clip on the ductus)
VATS (visual assisted
thoracoscopic surgery)
Palliative Medical management of VSD
pulmonary artery
banding
- Surgical closure is contraindicated
in fully developed Eisenmenger’s
syndrome when heart-lung
transplantation may be the only
effective treatment
Types of AVC
- Complete atrioventricular canal (CAVC)
- Partial atrioventricular canal defects
- Abnormal opening between R&L ventricles creating pulmonary vascular resistance
- Because of increase pressure at LV, blood flows through the
defect into the pulmonary artery and pumps into the left - Increase pulmonary Vascular resistance, increase pressure to
RV
VSD
(Ventricular
Septal Defect)
Type of AVC: The hole does not extend between the lower chambers of the heart and the
valves are better formed.
Partial atrioventricular canal defects
Management of ASD:
o This technique involves
implantation of one of several devices (basically single or double wire frames covered by fabric) using cardiac catheterization
Transcatheter Device Closure
(NonSx)
Management of ASD: relieve pulmonary
congestion
diuretics
most common type of ASD form comprising
about 90% cases of ASD. The
defect is situated in the region
of the fossa ovalis that, in
utero, was the foramen ovale
ostium secundum
Medical management of AS: to reopen the ductus
intravenous infusion of PGE
Management of PS: open surgical
PULMONARY
VALVOTOMY
Management of ASD:
o For larger ASDs, a patch is usually used to close the hole. This patch can be taken from the pericardium (the sac that
surrounds the heart) or from synthetic materials such as Dacron or Teflon.
o Done at preschool age
Dacron Patch Closure (Sx:open)
Types of ASD
Ostium secundum
Ostium primum
Sinus venosus
Management of AS
Medical:
o balloon valvuloplasty
o use of rapidly acting inotropic agents and diuretics to treat CHF
o intravenous infusion of PGE
o Percutaneous balloon
valvuloplasty
Sx:
➢ Aortic valvotomy
1. Ross procedure
2. Aortic homograft with a valve
Narrowing of the aortic lumen specifically in the region where the ductus arteriosus joins the aorta, i.e. at the isthmus just below the origin of the left subclavian artery.
Coarctation of Aorta
seen more
often in the following:
o premature infants
o infants born to a mother
who had rubella during
the first trimester of
pregnancy
* Communication between PA +
aorta due to failure of ductus
arteriosus to close after birth (1
week of life)
PDA
(Patent Ductus
Arteriosus)
- Narrowing of the stricture of the aortic valve causes ↑pressure in the heart -> L ventricular hypertrophy
- Causes the resistance to
ejection of blood from LV > which cause the hypertrophy - LA pressure increases which causes increase pressure in pulmonary veins results to pulmonary congestion
AS
(Aortic Stenosis)
- They account for about 5 percent of all congenital heart disease, and are most common in infants with down syndrome.
- (About 15 percent to 20
percent of newborns with
down syndrome have
atrioventricular septal defects). - Incomplete Fusion of
endocardial Cushions -ASD continues with VSD and Cleft of mitral and tricuspid valveCreating a large central AV valve allowing blood to flow in
4 chambers=@risk of pulmonary vascular obstructive disease
AVC
(Atrioventricular
Canal)
Management for AVC:
Reduce pulmonary blood flow in patients with significant pulmonary over circulation secondary to significant left to- right shunting in as palliation prior to later
definitive surgical repair
Pulmonary artery banding
Type of AS: most
common type and is usually caused by malformed cusps
Valvular stenosis
Medical management of VSD: for complete repair of large defects
Knitted Dacron patch
o The ventricle has to work harder to try to move blood through the
narrowing in the aorta left sided heart failure
o BP is higher above the narrowing, and lower below the narrowing.
o Older children may have headaches from too much pressure in the vessels in the head, or cramps in the legs or abdomen from too little blood flow in that region.
Coarctation of Aorta
palliative Management of AS
aortic valvotomy
Management for AVC
- Pulmonary artery banding
- Complete repair: patch closure of the septal defect and reconstruction of the AV valve;
mitral valve replacement if severe
Management of ASD
- digoxin
- diuretics
- infection control
- surgical repair
- Closure can be accomplished by
using cardiac catheterization of
implantable closure device. - Dacron Patch Closure (Sx:open)
- Transcatheter Device Closure
(NonSx)
- Abnormal opening between R &
L auricles (Atrial allowing blood
from higher pressure LA to
flow into the lower pressure RA
crossing the pulmonic valve) - LA pressure exceeds the RA
pressure causes increase flow
of oxygenated blood into the R
side of the heart Management - Overloading of the RVentricle
→ R. Ventricular Hypertrophy - Increase pulmonary blood flow
& increase pressure → murmur
(harsh systolic), and extra
amount of blood
Atrial septal defect
Management of COA for older children
BALLOON ANGIOPLASTY
Types of AS
- Valvular stenosis
- Sub valvular stenosis
- Supra valvular stenosis
Management of PS
- Balloon Valvuloplasty
- Sx:
➢ TRANSVENTRICULAR
VALVOTOMY/BLOCK (closed)
➢ PULMONARY
VALVOTOMY (open)
Management of VSD:
for small VSD
no specific treatment
treatment for Eisenmenger syndrome
heart-lung transplant
Management of AS regarded as the first step in the management of symptomatic neonates
Percutaneous balloon
valvuloplasty
Medical management of VSD:
o Placing a band around the pulmonary artery to decrease the pulmonary blood flow
o It increases the resistance to blood flow through the pulmonary artery. Pressure increases in the right ventricle
and prevents excess shunting from left to right
pulmonary artery
banding
Management of ASD: involves slowly moving a
catheter (a long, thin, flexible,
hollow tube) into the heart.
The catheter is initially
inserted into a large vein
through a small incision made
usually in the inner thigh
(groin area) and then is
advanced into the heart
cardiac catheterization
when will ductus arteriosus close
72 hrs after birth
Management of AS:
(valve taken from a cadaver) is then used to replace the patient’s own pulmonary valve.
pulmonary allograf
Management of PS:
Surgical for children
PULMONARY
VALVOTOMY
Medical management of VSD
- digoxin and
diuretics. - Pulmonary artery
banding - purse-string approach.
- Knitted Dacron patch
how to provide adequate nutrition in PDA
o high-calorie formula or breast milk
o supplemental tube feedings
Management of ASD: machine in surgical repair
heart-lung machine
Management of PDA:
o Ligation and division through
left posterolateral
thoracotomy without
cardiopulmonary bypass
ligation of PDA thru left
thoracotomy
extreme
form of PS; total fusion of
commisures; no blood flow to
the left
Pulmonic Atresia
Management of AS:
cardiac surgery operation
where a diseased aortic valve is replaced with the person’s own pulmonary valve.
The Ross-Yacoub procedure
(or pulmonary autograft)
