Acyanotic Congenital Heart Defects Left-to-Right Shunting Patent Ductus Arteriosus (PDA): blood shunted from aorta to pulmonary arteries Ventricular Septal Defect (VSD): blood shunted from left ventricle into pulmonary artery Classification Clinical Manifestations Diagnostic Tests Treatment Increased pulmonary blood flow Dyspnea, tachypnea, tachycardia, bounding pulse Chest X-ray and ECG show Left ventricular hypertrophy Transcatheter closure Major: CHF, intercostal retractions, hepatomegaly, poor growth Increased pulmonary blood flow Minor: asymptomatic Major: dyspnea, tachypnea, tachycardia, CHF, poor growth, decreased exercise tolerance, risk for respiratory infections, pulmonary HTN, diaphoresis, failure to thrive, feeding difficulties Echocardiogram to visualize and measure blood flow Chest X-ray—enlarged heart and pulmonary vascular markings in major cases ECG—R/L ventricular hypertrophy Echo—size and location of defect Auscultation: Murmur, Thrill (LSB) Coarctation of the Aorta: congenital narrowing of descending aortaobstruction of blood flow Obstruction of blood flow from ventricles High blood pressure before point of coarctation Low below pressure after points of coarctation Diminished pulses in groin and leg Most will close spontaneously CHF: diuretics, ACE inhibitors, Digoxin Increased calorie content in FTT patients Prophylactic antibiotics in non-repaired defects Surgical repair PDA closure higher resistance and HF Echo—defect in aorta Prostaglandin to keep PDA open Resection of narrowed aorta with re-anastomosis Prophylactic antibiotic Anatomy Cyanotic Congenital Heart Defects Classification Clinical Manifestations Tetralogy of Fallot: Decreased VSD, pulmonary pulmonary stenosis, overriding of blood flow the aorta, hypertrophy of right ventricle Hypoplastic Left Heart Syndrome: mitral/aortic valve stenosed along with abnormally small left ventricle and small aorta Mixed blood flow Hypoxia and cyanosis as PDA closes Polycythemia, hypoxia, metabolic acidosis, poor growth, clubbing, exercise intolerance Diagnostic Tests Treatment Chest x-ray— boot shaped heart Prostaglandins to keep PDA open Echo—show all four characteristics defects Tet spells—fixed by squatting Elevated Hct and Hgb Progressive cyanosis and CHF (tachycardia, tachypnea, dyspnea, retractions, decreased peripheral pulses) Chest X-ray— cardiomegaly and increased pulmonary venous congestion Risk of cardiogenic shock after PDA closes Surgical repair done y 1-2yr (3-4mos in symptomatic infants) Closure of VSD with Dacron patch, enlargement of narrowed pulmonary valve, coronary artery repair, remodeling of heart Prostaglandins to keep PDA open Heart transplant Surgical Stages: Norwood reconstruct aorta, atrial septum removed, shunt placed, right ventricle in charge of pumping blood through pulmonary valve Glenn (3-6mos) connects superior vena cava directly to the pulmonary artery Fontan (2-3y) connects inferior vena cava to pulmonary circulation— ends mixed blood Anatomy
