Congenital Heart Defects Flashcards
What are the risk factors for acquiring congenital heart defects
Mother has diabetes, uses illicit drugs, viral infection, down syndrome
What occurs in fetal circulation up to the right atrium
Umbilical arteries to blood to the placenta where it becomes oxygenated, the umbilical veintakes oxygenated blood to ductus venous, ductus venous takes blood to the inferior vena cava, inferior vena cava dumps blood into the right atrium
How are the two weays blood moves in the fetal right atrium
Oxygenated blood will move from the right atrium to the left atrium through the foramen ovale then the left atrium will dump to the left ventricle for systemic circulation/ oxygenated blood will move into the right ventricle to pulmonary artery but moves to the aorta through the DUCTUS ARTERIOSUS (due to high pulmonary resistance) connection for systemic circulation
How can heart defects be diagnosed
Ultrasounds/echocardiogram, heart mumur, cyanosis, hypotensive extremity, widened pulse pressure
What are the acyanotic heart defects
Atrial septic defect (ASD), ventricular septic defect (VSD), endocardial cushion defects (AV canal/AVSD), PATENT DUCTUS ARTERIOSUS (PDA), Coarctation of the aorta (CoA)
What occurs in PDA defect
The ductus arteriousus doesn’t close causing oxygenated blood to leave the aorta to the pulmonary vein causing too much blood for the lungs and right side of the heart
How are PDA treated, MOA, what is the last resort
Indomethacin OR ibuprofen to close the ductus arteriousus, prostaglandin inhibitors to cause less prostaglandins to keep DA open, surgery
What are the doses for ibuprofen or indomethacin in PDA, side effects
Indomethacin: Every 12 hours for 3 doses, Ibuprofen: every 24 hours for 3 doses/ nephrotoxicity, low platelets, GI bleed/perforation
What is Coarctation of the aorta
Narrowing of the Aorta causing increased pressure before the narrowing and lower pressure after the narrowing causing different blood pressures at higher extremeties
How is CoA treated, complication, treatment of the complication
Surgery, rebound hypertension, beta blocker or ACEi
What are the cyanotic defects
Hypoplastic left heart syndrome, tetralogy of Fallot, transposition of the great arteries, Truncus arteriosus
What is hypoplastic left heart syndrome, what defects are present
Hypoplastic (under-developed) left heart cannot support systemic circulation, foramen ovale is still open, ductus arterious is needed to stay open for oxgenated blood to get to the aorta
What is given for hypoplastic left heart syndrome, why, administration, side effects
Prostaglandin E1, keeps the DA allowing for some oxygenated blood to enter the aorta, continuous IV administration through a large vein or umbilical artery catheter/ apnea, flushing, hypotension, fever (similar to sepsis)
What are the 3 surgeries needed to fix hypoplastic left heart syndrome
Norwood procedure (1st week): ligate the DA and place the aorta where the pulmonary artery used to be and add BT shunt to provide pulmonary blood flow from the aortic arc to reach the pulmonary artery/ Hemi-Fontan procedure (4-6 months): reduces the load of the right ventricle by removing the BT shunt and connecting the superior vena cava to the pulmonary artery/ Fontan procedure (two years): connects IVC to same pulmonary artery causing no blood to enter the right atrium allowing for the atrium to only receive oxygenated blood and pump systemically
What is Tetalogy of Fallot, what is given
Four seperate defects including: Ventricular septic defect (VSD), overidding aorta, pulmonary stenosis/artesia, Right ventricular hypertrophy/ PGE1 for pulmonary blood flow
What is the surgery for ToF
Patch closure of VSD, Patch to enlarge the pulmonary artery, removal of subpulmonary obstructive tissue
What is transposition of the great arteries, what drug is given
Aorta from the right artrium and the pulmonary artery from the left atrium/ PGE to keep the DA open
What is the temporary repair for TGA
Balloon atrial septosomy: pull a catheter through the foramen ovale causing permanent opening between the atria allowing for mixing of oxgenated and dexoygenated blood (PE1 no longer required)
What is the permanent repair for TGA
The two arteries are switched (1st week of life)
What is Truncus arteriosus
Pulmonary artery and Aorta are connected for one big vessels, gives rise to coronary arteries branch pulmonary arteries and aortic arch, Large VSD along with RV hypertrophy(does not need PE1 because not DA dependant)
How is truncus arteriosus repaired, symptoms managed
Patch closure of VSD, valved homograft from RV to pulmonary artery/diuretics, digoxin and ACEi
How often must homografts be repaired
3-6 years and again in adolescence
What syndrome occurs in 25% of patients undergoing cardiopulmonary bypass, highest risk, signs and symptoms
Low Cardiac Output Syndrome, neonates/ tachycardia, poor peripheral perfusion, oliguria, cardiac arrest
What are the treatment options for Low Cardiac Output Syndrome and what is the goal for each treatment
Fluid resuscitation: maintain preload and systemic blood pressure
Inotropic agents: support myocardial contractility
Afterload reducing agents: decrease ventricular, enhance cardiac output, and improve perfusion
Extracorpeal membrane oxygenation
