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22 Cards in this Set
- Front
- Back
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truncus arteriosis
waht is always present |
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Most common associated cardiac lesion in truncus arteriosus
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Most common associated cardiac lesion in truncus arteriosus: VSD.
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A case presentation of truncus arteriosus:
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A case presentation of truncus arteriosus: child only a few months old presents with congestive heart failure (dyspnea, rales), dyspnea, no (or mild) cyanosis, recurrent respiratory infections.
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Examination reveals
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Examination reveals hyperactive precordium.... wide pulse pressure, systolic ejection murmur with thrill in (L) sternal border due to VSD, single loud 2nd heart sound with or without split, mid-diastolic apical rumbling murmur due to increased flow through mitral valve. Newborn infants appear with a murmur and minimal cyanosis without congestive heart failure. Older children appear with cyanosis, polycythemia, andclubbing. MOST LIKELY DIAGNOSIS: truncus arteriosus.
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DIAGNOSIS: CHEST x-RAY:
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DIAGNOSIS: CHEST x-RAY: moderate cardiomegaly,huge pulmonary flow after first few weeks of life,and right aortic arch(50%ofcases). EKG: (R) or (L) ventricular hypertrophy, rarely biventricular.
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HYPEROXIA TEST:
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HYPEROXIA TEST: no improvement.
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DIAGNOSIS CONFIRMED BY:
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DIAGNOSIS CONFIRMED BY: echo cardiogram. TREATMENT:
(a) (a) First few weeks of age, medical management with digoxin and lasix. (b) (b) Around 4 to 8 weeks age, surgical management: total correction (disconnect pulmonary arteries from trunk, then connect to (R) ventricle with a homograft conduit is called Rastelli repair, closure ofVSD). This conduit is replaced as cbild grows. Older patients with pulmonary vascular obstruction need heart-lung transplantation. 11 Key words: mild cyanosis, congestive heart failure, recurrent respiratory infections, hyperactive precordium, wide pulse pressure, systolic ejection murmur with thrill, single loud 2ndheart sound |
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TREATMENT:
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TREATMENT:
(a) First few weeks ofage, medical management with digoxin andlasix. (b) (b) Around 4 to 8 weeks age, surgical management: total correction (disconnect pulmonary arteries from trunk, then connect to (R) ventricle with a homograft conduit is called Rastelli repair, closure ofVSD). This conduit is replaced as cbild grows. Older patients with pulmonary vascular obstruction need heart-lung transplantation. |
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Key words:
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Key words: mild cyanosis, congestive heart failure, recurrent respiratory infections, hyperactive precordium, wide pulse pressure, systolic ejection murmur with thrill, single loud 2ndheart sound
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Most common cardiac anomaly in preterm newborns:
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Most common cardiac anomaly in preterm newborns: patent ductus arteriosus (PDA)
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PDA in full-term and premature infant:
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PDA in full-term and premature infant: In full-term: defect in muscular and mucoid endothelial layer,so it rarely closes spontaneously or with pharmacologic intervention if persists beyond 1st few weeks of life. In premature: normal ductal structure usually closes spontaneously within first 4 weeks of life if early pharmacologic or surgical intervention is notrequired.
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Most frequent complications of PDA:
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Most frequent complications of PDA: congestive cardiac failure occurs in early infancy due to large PDA; infective endocardititis may occur at any age; pulmonary or systemic emboli; pulmonary hypertension (or Eisenmenger syndrome) occurs in untreated large PDA patients.
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Most common cardiac lesion in congenital rubella:
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Most common cardiac lesion in congenital rubella: PDA
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A case presentation of PDA Examination
CHEST X-RAY EKG DIAGNOSIS CONFIRMED TREATMENT: Key words: |
A case presentation of PDA (important): a child shows signs of growth failure, recurrent pulmonary infection, gets tired from participating in outdoor sports.
or A child may be completely asymptomatic. Examination reveals harsh systolic murmur or grating or swishing type present in (L) upper sternal border around 2nd intercostal space, often associated with thrill, bounding peripheral pulses; machinery or rolling thunder murmur found in older children. Murmur may radiate to left sternal border or to left clavicle. MOST LIKELY DIAGNOSIS: PDA CHEST X-RAY: increased pulmonary flow, heart size normal or increased. EKG: normal or (L) ventricular hy-pertrophy. DIAGNOSIS CONFIRMED by echocardiogram. TREATMENT: (a) PREMATuRE: first, fluid restriction and diuretics. If these fail, give indomethacin; if this fails, then surgical ligation. (b) FUll TERM: spontaneous closure may occur in first months oflife. if this fails, then ligation after age 6 months. (c) ALL CHILDREN: surgical ligation. It should not be delayed in symptomatic patients. It should be done within 1 year in asymptomatic patients. Please remember, pulmonary hypertension is not a contraindication of operation at any age (d) UNDER INVESTIGATION: transcatheter closure of a PDA,i.e.,small PDAs are closed by intravascular coils and moderate-to large PDAs are closed by catheter-induced sac. Key words: harsh systolic murmur or grating or swishing type present in left upper sternal boarder, thrill, bounding peripheral pulses; machinery or rolling thunder murmur found in older children. |
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What improvement is seen after surgical ligation of PDA
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What improvement is seen after surgical ligation of PDA? Child gains weight; has less respiratory infection; cardiac failure disappears; machinery-like murmur disappears, pulse and BP become nonna!; chest x-ray becomes normal in several months; EKG become normal. Please remember, a functional systolic murmur over pulmonary area may be present due to turbulence in a persistently dilated pulmonary artery.
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What happened to asymptomatic PDA in term infants
:Operative complication of surgical What happened to asymptomatic PDA in term infants: |
Operative complication of surgical PDA ligation: phrenic nerve paralysis.
What happened toasymptomatic PDA inpremature: it spontaneously closes around 41weeks after conception. What happened to asymptomatic PDA in term infants: functionally closes during first day of life and anatomic closure occurs after first week of life |
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d/d ds of murmurs
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ASD- will not cause murmurs at early age( newborn)
VSD- holosystolic murmur and it is not continues murmur Peripheral pulmonary stenosis- systolic ejection murmur- irradiate to the back and axilla AS- systolic that doesnot evolve into a continuous murmur. PDA- syctolic continuous at upper left sternal border. |
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when could be expected delayed closure of Ductus arteriosus
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in P/ with low oxygen tension
pulmonary HTN congenital heart disease |
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what it is critical to check when planning for closure of PDA
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for pulmonary artery HTN or ductal dependent cardiac lesion
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if P has small DPA
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small PDA is unlikely to lead to significant L- to R shunt or volume overloading and therefore does not place the child at risk for developing heart failure
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what is the risk for endocarditis
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lifelong risk is low- no prophylaxis with AB for this condition
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if P has large PDA
shall we give oxygen /NO phenylephrine |
it could lead to significant L-R shunting >>>> pulmonary edema, shortness in breath and left ventricular volume overload.
tx -- indomethacine-- to close PDA effectiveness of Indomethacine will decrease if given after 2 weeks of age. oher option to close hemo dynamically important shunt>>>> surgery or transcatheter device closure as for O2/ NO -- will worse...will decrease the pulmonary vascular resistance>>> more shunt>> worse heart failure as for phenylephrine>>> will increase the systemic vascular resistance>>>worse the shunt>> worse heart failure |
