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Congenital Heart Disease - Coggle Diagram

- - - - Aymptomatic
      - Normal growth
    - - Breathless
      - Poor feeding
      - FTT
    - - Breathless
      - Poor feeding
      - FTT
      - Falls of centile lines
      - Sweaty and pale with feeding
  - - - Pan systolic murmur
        Loud
        May have thrill
      - Otherwise normal exam
    - - FFT
      - Increased pre-cordial activity
      - Mild hepar
      - Increased RR
      - Pan systolic mumure
    - - Severe FFT
      - Very active precordium
      - Intercostal / subcostal recession
      - Hepatomegaly
      - Pallor
      - Cold sweating
      - Pan systolic murmur
      - Loud P2
    - - Exeption to clinic sequence
      - Minimal symptoms
      - Down's syndrome
  - - - No treatment
    - - Diuretic
        Frusemide + Spironolactone
      - Feeding suplementation
        Infatrini
        High energy SMA
    - - Diuretic therpay
      - High calorie feeds
        Infantrini
        High energy SMA at 130mls/kg/day
      - NG tube feeding may be required
      - Schedule for surgery of no evidence of spontaneous closure
    - - Indications
        
        Severe FFT
        Failure to sustain growth on significanctly increased calorie intake
        
        Symptomatic cardiac failure on maximal medical therapy
        
        Guided by ECHO appearance of VSD and clinical status
      - Catheter Closure
- - - - Asymptomatic
    - - Congestive cardiac failure
      - FFT
      - Failure to feed
    - - Severe FTT
      - Poor feeding
      - Neonated failure to wean from ventilation
  - - - Good probability of spontaneous closure - particularly in moderate defects
    - - Less likely to spontaneously close
      - Closure in cath lath
  - - - Ibuprofen / paracetamold for preterm
        No effective in neonates
    - - Increasing application
    - - Preterms
      - Left lateral thoracotomy
- - - - PPHN protects the pulmonary vascular bed from high flow but long term is a big problme
      - All Down's children should be screened regardless of symptoms
  - - - Systolic mumur at left sternal border
  - - - AVF negative deflection
  - - - Used to optimise growth in advance of surgery - surgery is inevitable
      - Diuretics
      - High calorie feeds
      - NG tube feeds
    - - Before 6 months to avoid permanent pulmonary vascular disease
      - ASD patched
        VSD patched
        Common AV valved divided
      - 5-10% require further surgery - left AV valve
- - - - aSymptomatic
        Soft blowing murmur
        Systolic
        left Sternal edge
- - - - Equilisation of RV and LV pressures
        Murmur not due to flow across ventricular septum
        Murmur due to accelerated flow across stenosed pulmonary valve
  - - - Due to increased RV to LV shunt due to tight right ventricular outflow obstruction (stenosis of pulmonary valve)
  - - - At >5.5kg or 6months
      - 25% will have severe RV outflow tract obstruction and require stent in arterial duct in advance of surgery
    - - Knee to chest position
      - O2
      - Propanolol - relaxes muscles
      - Morphine
      - Surgery
- - - - Balloon inflated in left atrium at atrial septal border, pulled through into the right atrium to enlarge the naturally occuring ASD (foramen ovale)
      - Maximises mixing of blood through atria - at best partion cyanosis
    - - Following stabilisation with BAS
      - Within first 7-10 DOL
      - Arterial switch including coronary re-implatation
  - - - No acclerated flow
        No pressure difference across the hole
- - - - Noorwood I
        
        At 3-5 DOL
        
        Arch reconstruction
        
        RV to PA conduit
      - Glenn Shunt
        
        3 months
        
        SVC to PA connection
      - Total Cavopulmonary Connection
        
        3 years
        
        IVC to PA connection