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Pediatric Cardiac Anomalies. Congenital Heart Disease NPN 200. Fetal Cardiac Circulation. inferior vena cava to the right atrium then through the foramen ovale to the left atrium

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pediatric cardiac anomalies

Pediatric Cardiac Anomalies

Congenital Heart Disease

NPN 200

fetal cardiac circulation
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
atrial septal defect
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
ventricular septal defect
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
vsd cont
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
patent ductus arteriosus
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
pulmonary stenosis aortic stenosis
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
tetralogy of fallot
Tetralogy of Fallot
  • 4 defects
    • Ventricular septal defect
    • Pulmonary stenosis
    • Overriding aorta – entrance of the aorta is close to the VSD
    • Right ventricular hypertrophy
patho
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
signs and symptoms
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
treatment
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
coarctation of the aorta
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
clinical manifestations
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
treatment1
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
transposition of the great arteries
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
correction of transposition
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%
nursing care for pediatric cardiac problems
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