Congenital Heart Diseases Flashcards
How does a bicuspid aortic valve differ from normal?
two cusps instead of three
What happens as result of bicuspid aortic valve?
turbulent blood flow which results in the valve thickening and stiffening (is a common cause of aortic stenosis)
What is an Atrial Septal Defect caused by and thus what’s the effect?
Patent foramen ovale in the septum –> higher pressure in the LHS than RHS –> L to R shunting of the blood –> RH deals with more blood than its meant to –> RH dilates
Two treatment options for Atrial Septal Defect?
- Percutaneous closure
2. Surgical closure
4 classical characteristics of a Tetralogy of Fallot?
- ventricular septal defect
- overriding aorta (takes blood in from both L outflow and some deoxygenated from RV)
- Pulmonary stenosis
- Right ventricular hypertrophy (Caused by the pulmonary stenosis)
Clinical presentation of tetralogy of fallot?
Infants: cyanosis,
Children: have ‘tetralogy spells’ of cyanotic, tired & sleepy –> unresponsive, irritable
spells are relieved by SQUATTING
What is coarctation of aorta?
narrowing of the descending aorta.
Can present in infancy or present later in life as hypertension with a murmur
4 Treatment options of heart failure
- Medical therapy (ACE inhibitors, beta blockers, diuretics)
- Cardiac resynchronisation therapy (CRT)
- Left ventricular assist device (mechanically takes blood out of LH and pumps it into aorta)
- Transplant
Which valvular dysfunction is commonly seen in patients POST-REPAIR of tetralogy of fallot?
pulmonary regurgitation: have to put a patch over where the (ventricular septal) valve is - sometimes this stretches the valve annulus and causes regurgitation
Example of atrial arrhythmia (3)
Atrial fibrillation
Atrial flutter
supraventricular tachycardia
Medication given for tachyarrythmias
beta blockers
digoxin
amiodarone
Heavy weights are specifically advised against in which congenital heart defect
Aortopathy: Dilated aorta (can increase the risk of dissection)
Sports involving breath holding are specifically advised against in which congenital heart defect
Fontan circulation (reliant on breathing)
Risks of maternal death in ACHD
Severe obstructive lesions (17% maternal mortality)
Severe pulmonary hypertension (50% mortality)
Associations with bicuspid aortic valve
aortic dilatation
coarctation
Treatment for bicuspid aortic valve
same as degenerative artic valve disease
AVR +/- aortic surgery
when would closure of an atrial septal defect be indicated?
if the right heart is dilated (and they are becoming breathless on exertion)
when would closure of ventricular septal defect by indicated?
if evidence of decompensation (dilated ventricles)
SAME two closure options as atrial (percutaneous or surgical)
Repair of tetralogy of fallot
patch the ventricularseptal defect (this can stretch the valve annulus –> pulmonary regurgitation)
widen the R ventricular outflow tract
adults who have tolerated coarctation of the aorta may present with what?
high BP
a murmur
2 ways to repair coarctation of aorta?
stenting (but may require further stenting later in life)
surgical repair
why do we follow up these defects?
surgery is repair not cure
some defects are progressive…
LT complications: HF, valvular dysfunction, arrythmias
what does a melody valve replace?
the pulmonary
2 types of ventricular arrythmia
ventricular tachycardia
ventricular fibrillation
how do valvular dysfunction lead to arrythmias
atrial dilatation
ventricular dilatation
scar tissue following surgery
treatment for bradyarrhythias
pacemaker
what contraceptions are a problem for Fontan circulation?
IUCD as intense vasovagal (drop in HR or BP)
oestrogen-containing preps could be thrombogenic
