Congenital Heart Disease and Foetal Circulation at Birth

Question 1

What is congenital Heart Disease?

Answer 1

It is a structural abnormality of the heart.

Question 2

Describe the spectrum of CHD?

Answer 2

Mild - asymptomatic.
Moderate - requires specialist intervention.
Severe - severely ill, may die in the first year.
Major CHD - will need surgery within a year of birth.

Question 3

When is antenatal screening done in foetuses?

Answer 3

18-22 Weeks

Question 4

What appearance would a baby have it was cyanosed and why?

Answer 4

They baby may look blue because of deoxygenated blood getting into the systemic circulation.

Question 5

Describe what transposition of the great vessels is?

Answer 5

Aorta comes out of the right ventricle and the pulmonary trunk comes out of the left ventricle.

Question 6

What does it mean if a baby has a hypoplastic left heart?

Answer 6

Left side of the heart is underdeveloped.

Question 7

What is pulmonary atresia?

Answer 7

It is underdevelopment of the right ventricle outflow, often comes with a ventricular septal defect.

Question 8

What are some of the clinical signs for HF in babies

Answer 8

Babies Fail to Clap their Hand Really Slowly
Breathlessness.
Failure to thrive
Crepitations.
Hepatomegaly (abnormal enlargement of the liver).
reduced feeding
Sweating

Question 9

What will be administered to babies that need their ductus arteriosus to remain open?

Answer 9

They will be administered IV prostaglandin E2 (PGE2).

Question 10

What is persistent pulmonary hypertension of the newborn?

Answer 10

Lung resistance fails to fall leading to a blue baby.

Question 11

What vessel does the foetal heart pump blood through to get to the placenta, what does it come back through to go to the heart?

Answer 11

It goes via the umbilical arteries and goes back through the umbilical veins.

Question 12

What side of the heart does oxygenated blood go to in foetal arteries?

Answer 12

It goes to the right side of the heart.

Question 13

What are the three types of adaptations that foetal circulation has?

Answer 13

Ductus venosus.
Foramen Ovale.
Ductus arteriosus.

Question 14

Describe the ductus venosus?

Answer 14

It is a connection allowing the umbilical vein to bypass the liver and go into the inferior vena cava meaning that less oxygenated blood will be processed through the liver.

Question 15

Describe what the for foramen ovale is for?

Answer 15

It is an opening between the RA and the LA (atrial septum) that means that the best oxygenated blood can go straight from the right atrium into the left atrium.

Question 16

Describe what the ductus arteriosus is for?

Answer 16

It connects the pulmonary bifurcation to the descending aorta meaning that only 7% of blood pumped from the right ventricle goes to the lungs, the rest goes to the descending aorta.

Question 17

What keeps the ductus arteriosus patent (open)?

Answer 17

circulating prostaglandin E2 that is produced by the placenta (you don’t have it when you are born so ductus arteriosus closes within a few days of birth).

Question 18

What happens to a baby in the minutes that it is born?

Answer 18

Cries - turns from blue to pink.
Lungs inflate for the first time leading to decreased pulmonary vascular resistance - leads to more circulating oxygen.
Cord gets clamped and SVR increases.
Foramen ovale closes due to increased pressure.
Over a series of days the ductus arteriosus constricts and closes due to a lack of postgladaden E2.