Congenital Cardiac Defects Flashcards
What causes a Congenital Heart Defect?
Genetic Predisposition + an environmental factor:
- Drugs e.g. Alc, ecstasy, lithium & phenytoin
- Infection e.g. TORCH
- Maternal illness e.g. DM/SLE
Which cardiac defects present with cyanosis?
- Transposition of the great vessels
- Pulm Atresia
- Truncus Arteriosus
- TAPVD
- Tetralogy of Fallot
When doing a paediatric history & exam what do you add to it?
Feeding
Weight & height
Development
Dysmorphia
What are the types of VSD?
Subaortic
Intramembranous
Muscular
Patient has a pansystolic murmur at the Lower L SB
The baby is also sob, tachypnic and tachycardic
What’s the defect?
Ventricular Septal Defect (VSD)
Causes a L–>R shunt hence the murmur +/- thrill
Also causes HF & Pulm HTN hence SOB, tachypnoea, tachycardia & hepatomegaly
How do we spot ASDs?
Wide fixed splitting of 2nd heart sound
Pulm outflow murmur
However most don’t cause problems in childhood and so are picked up in adults with AF, HF or pulm HTN
Whats the worst form of septal defect?
AVSD
End up with a single AV valve with both ASD/VSD
How can we treat a VSD?
Close it with Amplatzer Device
Or Patch closure if necessary (required open surgery and CP bypass)
Mild stenosis of the semilunar valves is often asymptomatic.
How would more severe pulm or aortic stenosis present?
Pulm:
- SOB & Fatigue
- Ejection Systolic Murmur on upper L SB + radiates to back
Aortic:
- Low exercise tolerance, exertional chest pain & syncope
- Ejection Systolic Murmur on upper R SB + radiates to carotids
How do we treat semilunar valve stenosis?
Balloon Valvuloplasty
once past puberty you can replace the valve but if you do it too early they’ll just outgrow it
What could cause a bairn to have a Patent Ductus Arteriosus? and do you treat it?
Born pre-term
- Fluid Restriction / Diuretics
- Prostaglandin Inhibitors (NSAIDs)
- Surgical Ligation
Most PDA will close spontaneously, how do we close it if needed?
Umbrella Device
How can we spot a Coarctation of the Aorta?
Femoral Pulses will be reduced or absent and may be femoral-radial delay
Can do Angio & MRI but not everytime
How do we manage Coarctation of the Aorta?
1st reopen the DA with Prostaglandin Infusion
Then Resect with End-end Anastomosis
can also do balloon aortoplasty as a short term therapy before resection
Could do Subclavian Patch Repair if not enough material to anastomose
How do we manage Transposition of the Great Vessels?
Serious emergency
1) Prostaglandin Infusion maintains PDA
2) Switch Procedure
