Congenital Heart Defects

Patent Ductus Arteriosis

Tetralogy of Fallot

Transportations of the Great Vessels

Coarctation of the Aorta

Low cardiac output

S/S

Treatment

When commonly noticed:

What is it

Shunts blood from pulmonary arteries to aorta through combined arteries and a bridge between them. Sends oxygenated blood back to pulmonary arteries. Think of pressures, moving from high to low pressure.

Shock

The hole is commonly closed in full-term infants within several weeks after birth

8-10% of all Congenital heart defects

Can cause secondary HTN in children

Prevalence

5-10% of infants with Congenital Heart Disease (CHD)

More common in preterm infants

Pathophysiology

Failure of the PDA to close results in persistent opennes of the ductus arteriosus. The shunting increases over time as PVR(peripheral vascular resistance) falls and SVR(systemic) does not, the aortic blood begins to enter the pulmonary aortic artery.

Increases risk of ventricular hypertrophy

The hemodynamic effect is increased pulmonary blood flow, resulting in increased pulmonary venous return to the LA and LV with increased workload on the left side of the heart

The increased workload is caused by increased pulmonary venous return to the LA and, potentially, an increase in right ventricular pressure if pulmonary vascular changes occur in response to the increased blood flow, leading to an increase in pulmonary vascular pressure.

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Coarctation of the aorta (COA) is a narrowing of the lumen of the aorta that impedes blood flow. (pg. 1115)

Continuous machinery-like murmur (heard best at upper left sternum border)

Significant PDA: bounding pulse

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COA is almost always in a juxtaductal position,
although it can occur anywhere between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen.
(pg, 1115)

Active precordium (chest moves too much over heart)

Thrill on chest palpitation (vibration)

S/S of pulmonary circulation

Infants with small PDA usually remain asymptomatic

Exams to test PDA

Echocardiography

Auscultation for continuous "machine-like" sounds

Mixed Lesions

Premature infants who develop respiratory distress are initially given indomethacin or ibuprofen (both prostaglandin inhibitors) to close the duct.

Caused by blood flow in both directions

Many specialists perform transcatheter closure of the PDA during cardiac catheterization

Causes either cyanotic and cyanotic conditions

thoracoscopic surgery

Lesions decreasing pulmonary blood flow

Cyanotic right to left shunt

Blood flows from the left side of the heart to the right