foetal circulation pathologies r Flashcards
what is the ductus arteriosus
connection between the pulmonary trunk and aorta
allows blood to bypass the lungs
presentation of patent ductus arteriosus
left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat
risk factors for patent ductus arteriosus
fluid restriction
diuretics
prostaglandin inhibitors - indomethacin, ibuprofen
surgical ligation
pathology of pulmonary valve stenosis
the valve is not functioning correctly
usually because of adhesions between the cusps
presentation and management of mild pulmonary valve stenosis
usually asymptomatic if mild
follow up every 2-3 years
presentation of moderate/severe pulmonary stenosis
dyspnoea
fatigue
ejection systolic murmur
management of pulmonary stenosis
balloon valvoplasty
valve replacement
complications of balloon valvoplasty in pulmonary stenosis
can result in regurgitation
aortic valve stenosis presentation
asymptomatic if mild reduced exercise tolerance exertional chest pain syncope ejection systolic murmur that radiates to carotids
management of aortic valve stenosis
balloon valvoplasty
valve replacement
why is balloon valvoplasty harder in aortic stenosis
higher pressure
what is aortic coarctation
narrowing of a segment of the aorta
where is the most common place for coarctation
descending arch where the ductus arteriosus enters
presentation of aortic coarctation
! weak/absent femoral pulse !
radio-femoral delay is only seen in chronic coarctation
systolic murmur
sudden deterioration and collapse
what are the effects of delayed ductus arteriosus closure on a child with aortic coarctation
blood flows into the pulmonary trunk
this decreases the work for the LV
when the duct closes the pressure in the LV increases and it has to work really hard to pump against the coarctation
causes decreased cardiac output and acute dilation of LV
baby becomes suddenly unwell and collapses
investigations for aortic coarctation
echo
doppler
MRI
management of aortic coarctation
prostaglandin E1 or E2 to open ductus arteriosus
resection with end to end anastomoses
subclavian patch repair
balloon aortoplasty
what is transposition of the great arteries
aorta comes out of the right ventricle
pulmonary trunk comes out of the left ventricle
effect of transposition of the great vessels
basically creates 2 closed loops - one high O2 and one no O2
pulmonary artery comes out of LV so enters systemic circulation instead of pulmonary
the blood is returned to the RA with no oxygen
the aorta comes out of the RV and travels to the lungs where it is oxygenated and returned to the LA, very oxygenated but can’t supply anything
what defects will prevent the baby from dying in transposition of the great vessels
anything that can cause mixing of blood
septum defect
patent ductus arteriosus
management of transposition of the great vessels
often detected antenatally
prostaglandin is given as soon as the baby is born to keep the ductus arteriosus open
baby needs surgery
definitive procedure in transposition of the great vessels
switch procedure
difficult because heart is so small
risk of MI
what is tetralogy of fallot
four congenital abnormalities
- VSD
- overriding aorta
- pulmonary stenosis
- right ventricular hypertrophy
presentation of tetralogy of fallot
central cyanosis
ejection systolic murmur
clubbing
poor feeding/weight gain
what is a cyanotic spell in TOF
when the baby has an increased need for oxygen and symptoms worsen
cyanosis
SOB
O2 sats in 40s
initial management of tetralogy of fallot
prostaglandins to keep ductus arteriosus open
beta blockers
shunt between subclavian and pulmonary artery to increase blood flow through lungs
management of TOF when child reaches 5kgs
surgery: VSD is closed aorta is restored infundibulum below pulmonary valve is widened pulmonary valve surgically opened lifelong follow up
