Congenital Heart Disease--Severson Flashcards
What is the most common etiology of atrial septal defect?
90%
patent foramen ovale
Shunt
abnormal communication leading to blood flow diversion
Left to right shunt timeline
cyanosis several months to years after birth
Right to left shunts timeline
cyanosis early in postnatal life
Normal pulmonary artery/aortic pressure
1/6
Increased pulmonary pressure secondary to shunt leads to what in the lungs?
pulmonary fibrosis
Stenosis
narrowing of blood vessel or structure
Atresia
failure of structure to develop
What is the function of the foramen ovale in the fetus?
right –> left shunt in fetal heart
Atrial septal defect etiologies
patent forament ovale (90%)
*excessive primary septum resorption
*incompetant ovale due to hypoplastic growth of secondary septum
What percent of atrial septal defects involve the foramen ovale?
90%
Patent foramen primum etiology
inadequate development of primary septum
1˚ atrial septum does not reach endocardial cushions
leaves 1˚ atrial septum patent
High atrial septal defect etiology
sinus venosus defect
Pulmonary hypertention secondary to left to right shunting can result in
cyanosis tardive
cardiac failure
Hematological complication of atrial septal defects/left to right shunting
paradoxical embolism
Probe patent forament ovale
25% people have this
fusion of primary septum does not occur
can put probe in there
clinically benign
Ventricular septal defect normal location
membranous portion of the interventricular septum
Most common congetnital heart abnormality
ventricular septal defect
*many heal over in ~ 1 yr.
Ventricular septal defect etiology
endocardial cushion fails to respond to signals
Cyanosis etiology in ventricular septal defect etiology
right ventricular failure
ineffective pumping of blood/oxygenation of blood
Patent ductus arteriosis etiology
ductus arteriosis does not become ligamentum arteriosum
PGE2 keeps it open
give NSAID to decrease PGE2 synthesis that is normally discontinued when O2 reaches tissue
if you want to keep PDA open (like in transposition of the great arteries), give PGE2 IV to keep it open
blood flows from aorta to pulmonary artery
When does the ductus arteriosis normally close?
beginning day 1, usually by day 3
ligamentus structure by day 30
What infectious disease is associated with patent ductus arteriosus?
rubella
in first 8 weeks
after about 8 weeks, the heart is formed
Maternal rubella complications during first 8 weeks of pregnancy
PDA
congenital cataracts
deafness
pulmonary stenosis, ventricular septal defects, etc.
Murmur in patent ductus arterioris
“machinery-like” murmur
Tetralogy of fallot etiology
ventricular septal defect
pulmonary stenosis
overriding (large) aorta
right ventricular hypertrophy
- (cyanogic, right to left)*
- **basically: blood shunted from right ventricle into aorta because anatomically pushed into*
- **aorta is overriding interventricular septum*
Complications of tetralogy of fallot
paradoxical embolism
infectious endocarditis
Transposition of the great arteries etiology
aorta coming off right ventricle
pulmonary artery coming off left ventricle
*incompatible with life UNLESS atrial and ventricular septal defect and associated patent ductus arteriosus are present
*shunts save you
Transposition of great arteries occurs more often in mothers with this condition
diabetes
Persistent truncus arteriosus
absent aorticopulmonary septum
equal oxygenation
Coarctation of the aorta etiology
contriction of aorta in area of ductus arteriosis
*aorta sometimes constricts with ductus arteriosis
*constriction ofter left subclavian, left common carotid, and right brachiocephalic artery
*body compensates for this
Characteristic features of coarctation of aorta
increased BP in arms
decreased BP in legs
cyanosis in legs
increased intercostal artery size
notching of ribsm erosion of body tissue
*due to kidneys sensing low BP
Two old types of coarctation of the aorta
postductal (adult–95%)
preductal (infantile–5%)
Pulmonary/aortic stenosis and atresia etiology
asymmetrical division of spiralling of the aorticopulmonary septum
Down syndrome
congenital heart abnormality association
atrial septal defect
Rubella
congenital heart abnormality association
PDA
Known (non-maternal) diabetes
congenital heart abnormality association
transposition of the great arteries
DiGeorge Syndrome (22q11)
congenital heart abnormality association
persistant truncus arteriosis
Turner Syndrome
congenital heart abnormality association
coarcation of the aorta
