Peds 2 part 2 Flashcards
Neonates with EA and TEF commonly have VACTERL syndrome. What is VACTERL?
Vertebral anomalies Anal atresia Cardiac involvement TracheoEsophageal fistula Renal malformations Limb malformations
Type C is the most common TEF (90%). What occurs in type C?
- esophagus ends in blind pouch
- distal esophagus forms a fistula w the trachea, usually above the carina
in EA and TEF, how should the bevel of the ETT be turned?
It should be turned anteriorly to allow the posterior surface of the ETT to occlude the fistula
What side are most congenital diaphragmatic hernia defects on?
Left-sided
The ipsilateral lung is affected the most.
When abdominal contents are in the abdominal space, which way are the cardiac shunts?
They can be right to left, left to right, or bidirectional
what are the signs of a congenital diaphragmatic hernia?
- dyspnea
- tachypena
- cyanosis
- absence of breath sounds on the affected side
- severe retractions
- scaphoid abdomen (sunken)
- barrel chest
cyanotic lesions
right to left shunt
- hypoplastic left heart syndrome
- pulmonary stenosis
- transposition of the great arteries
- tetralogy of fallout
- tricuspid atresia
- pulmonary atresia with intact ventricular septum
cyanotic
left to right shunt
VSD ASD AS CoA PDA complete common AV canal (CCAVC)
What happens over time if a VSD is not treated?
CHF
can be treated with dig, duirectics, and an ACE inhibitor while awaiting closure
ASDs are generally asymptomatic but if left unprepared
paradoxical emboli decompression sickness migraines pulmonary HTN increased risk of meningitis
complete common atrioventricular Canal (CCAVC)
-almost always occurs w trisomy 21
-ASD and VSD
L to R shunt at atrial and ventricular levels
-CHF in early infancy
-pulm HTN can develop
what treatment triggers the PDA to constrict and close?
indomethacin.
-usually does not work in full term infants.
what does ligation mean?
to TIE not sever. so a PDA ligation is to connect the two ends together
neonate with critical AS relies on ____ for systemic blood flow.
PDA. If it closes, circulatory shock will occur.
What is a ROSS procedure?
when the child’s own pulmonary valve is moved into the aortic position, a right ventricle to pulmonary artery homograft conduit is placed, and coronary arteries are reimplanted. (for severe AS)
In what condition do the children have a bicuspid instead of a tricuspid aortic valve?
coarctation of the aorta
What is administered to keep the PDA open until CoA is repaired?
PGE1
Cyanotic CHD conditions
hypoplastic left heart syndrome
pulmonary stenosis
tetralogy of fallot
tricuspid valve atresia
what is the most common cause of death from HCD in the first month of life?
hypoplastic left heart syndrome (HLHS)
What does HLHS consist of?
- hypoplasia (underdevelopment) of the left ventricle
- aortic valve stenosis or atresia
- mitral valve stenosis or atresia
- hypoplasia of the ascending aorta w a discrete CoA
what is the treatment for HLHS?
PGE1 started immediately to keep the PDA open
infant is prepared for urgent palliative surgery (1 of 3)
What are the 4 defects of Tetralogy of Fallot (ToF)?
VSD
R ventricular outflow obstruction (pulmonary stenosis)
subsequent right ventricular hypertrophy (from working harder to pump blood through the narrow pulmonary valve)
overriding large ascending aorta (on top of both ventricles instead of just the left)
what is the treatment of TGA L-type
child is usually not corrected surgeries
great arteries are also reversed
in TGA d-transposition, what are the two options for blood circulation?
body-heart-body
or
lungs-heart-lungs
tricuspid valve atresia
absence or hypoplasia of the right ventricle
venous return is shunted from the right atrium to the left atrium through a PFO or ASD
VSD in 90% of the cases
majority have pulmonary stenosis
phenylephrine dose to treat cyanosis
1-2 mcg/kg
used when hypoxemia not related to respiratory causes
intracardiac shunts and induction: left to right shunt
speeds induction
by rapidly decreasing A-V difference of agent in the lungs
intracardiac shunts and induction: right to left
slower d/t dilution of anesthetic agent in the left ventricle
effect of high oxygen concentrations
decrease PVR and increase SVR
effect of hypoxemia
increases PVR and decreases SVR
