Pediatric Cardiac Anomalies

1. Pediatric Cardiac Anomalies Congenital Heart Disease NPN 200

3. Fetal Cardiac Circulation • inferior vena cava to the right atrium then through the foramen ovale to the left atrium • Superior vena cava to the right ventricle through the pulmonary artery to the ductus arteriosus and into the descending aorta • Very little blood goes to the lung • With 1st breath the pressure increases in the pulmonary vascular system and systemic pressure increases • The foramen ovale closes and the ductus arteriosus starts to close with the ^ O2 supply

4. Atrial Septal Defect • Abnormal flowing of blood between the atrium, allowing blood to flow from the left atria into the right atrium • Allows oxygenated blood in the left atrium to communicate with unoxygenated blood in the right atrium • May not cause any problems until later in life • May have atrial atrial dysrhythmias • May repair with Dacron graft

6. Ventricular Septal Defect • Abnormal opening between the right and left ventricle • May vary in size from a pin hole to absence of the septum • Frequently associated with pulmonary stenosis, transposition of the great vessels, patent ductus, atrial defects, and coarctation of the aorta • Many will close spontaneously, during the 1st year of life • Oxygenated blood flows into the lungs and increases pulmonary vascular resistance • The right ventricle hypertrophies due to the increase in pressure • Right atrial enlargement may occur

7. VSD, cont. • CHF is common • Murmur • Risk for bacterial endocarditis, and pulmonary vascular obstructive disease • May use band around the pulmonary to decrease blood flow into the lungs • May also use Dacron graft or purse string suture

9. Patent Ductus Arteriosus • Failure of ductus to close within the first few weeks of life • Murmur will be present • Bounding pulse • At risk for endocarditis and pulmonary vascular disease in later life • Treatment – • Indocin will help close in some premature babies • Surgical repair by opening the chest or now may use laparoscope

11. Pulmonary Stenosis/Aortic Stenosis • Aortic stenosis = narrowing or stricture of aortic valve • Pulmonary stenosis = narrowing of the entrance to the pulmonary artery • Both require interventions if severe enough to cause problems of CHF and heart failure • May be repaired by replacement or ballooning

13. Tetralogy of Fallot • 4 defects • Ventricular septal defect • Pulmonary stenosis • Overriding aorta – entrance of the aorta is close to the VSD • Right ventricular hypertrophy

14. Patho • Amount of problems depend upon the amount of pulmonary stenosis and the size of the VSD • Most common defect with causes cyanosis • Defects causes the blood flow to shunt from one chamber to another and pulmonary stenosis prevents the blood from going to the heart • May have both O2 blood and no O2 blood going to the body

15. Signs and Symptoms • May have mild to sever cyanosis at birth • Murmur • May have acute episodes of hypoxia, especially at feeding and bath time • In children, you may see clubbing, and poor growth

16. Treatment • Surgical treatment may be delayed if infant unable to tolerate • Palliative treatment can be performed by shunting the blood from the subclavian artery to the pulmonary artery • Complete repair is usually done in the 1st year

18. Coarctation of the Aorta • Narrowing near the insertion of the ductus arterious, which results in increased pressure proximal to the defect and decreased pressure distal to the obstruction • This causes the development of collateral circulation in the fetus

19. Clinical Manifestations • High B/P in the arms • Weak or absent femoral pulses • Cool lower extremities with lower B/P • Signs of CHF • Rapid deterioration and death may occur with sever acidosis and hypotension • Will need ventilator and B/P support • Older children may experience dizziness, headaches, fainting, nose bleeds • Risk for hypertension, ruptured aorta, aortic aneurysm, or stroke

20. Treatment • Resection of the stricture or enlargement of the aorta using a graft • Now using a balloon angioplasty to open area • Residual hypertension may occur • 5 % mortality • Increased risks if has other cardiac defects

22. Transposition of the Great Arteries • The pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle • May also involve a patent ductus • Symptoms include sever to mild cyanosis with CHF

24. Correction of Transposition • Arterial switch • Done during 1st few weeks of life • Changes the main pulmonary artery to the aorta and the aorta to the pulmonary artery • Coronary arteries are reimplanted into the aorta • Operative mortality is 5-10%

25. Nursing Care for Pediatric Cardiac Problems • Scary time for parents • May think it is their fault • Anxiety regarding breathing difficulties and cyanosis • Usually must be taken to major medical center for treatment • Feeding difficult