Surgical correction is advisable in all but the mildest cases Nonsx: o BALLOON ANGIOPLASTY Sx: o Resection/removal of narrowed ends and anastomosis of both ends o Enlargement of the constricted section using a graft of prosthetic material/portion of left subclavian artery

Acyanotic heart diseases Flashcards by Rencevie Cate Bumanglag

Narrowing at the entrance of PA
IF RV failure develop – RA pressure will increase resulting to re-opening of foramen ovale
Shunting of unoxygenated blood into

Pulmonary Stenosis

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Open surgical Management of PDA

ligation of PDA thru left
thoracotomy

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Medical management of VSD with cardiac failure:

digoxin and diuretics

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type of ASD that comprises
about 5% cases of ASD. The
defect lies low in the interatrial
septum adjacent to
atrioventricular valves. There
may be cleft in the aortic leaflet
of the mitral valve producing
mitral insufficiency.

ostium primum

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nonsurgical Management of PDA

coil occlusion

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Management of PDA

Indomethacin IV (prostaglandin
inhibitor)
Digoxin
Diuretics
adequate nutrition

Surgical management:
* Open: ligation of PDA thru left
thoracotomy
* Closed: VATS (visual assisted
thoracoscopic surgery)

Nonsx: COIL OCCLUSION

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Closed surgical Management of PDA

VATS (visual assisted
thoracoscopic surgery)

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Medical management of AS: used to treat CHF

rapidly acting inotropic
agents and diuretics

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Management of ASD: prophylactic
antibiotics to prevent bacterial
endocarditis before dental
procedures and other invasive
procedures

infection control

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Type of AS: stricture caused by a fibrous
ring below the normal valve

Sub valvular stenosis

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Management of ASD: helps strengthen the
heart muscle, enabling

digoxin

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Management of AS:
o Replacing the child’s diseased aortic valve with his/her own pulmonary valve (pulmonary autograft) and the pulmonary valve replaced with homograft

Ross procedure

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Management of AS:
Additional sx for recurrent stenosis: valve replacement (artificial) may be required at the second procedure

Aortic homograft with a valve

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Other term for AVC

endocardial
cushion defects

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Management of PDA:
-the standard procedure
-The technique of video-assisted thoracoscopic clip ligation has become the standard of care for surgical management of a ductus with adequate length

ligation of PDA thru left
thoracotomy

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Management of PS:
Surgical for Infants

TRANSVENTRICULAR
VALVOTOMY/BLOCK

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Management of PS: closed surgical

TRANSVENTRICULAR
VALVOTOMY/BLOCK

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Partial atrioventricular canal defects is also called as

atrioventricular
septal defect, or AVSD.

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Type of AS: occurs
infrequently

Supra valvular stenosis

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Medical management of VSD: for complete repair of small defects

purse-string approach

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type of ASD that accounts
for about 5% cases of ASD. The
defect is located high in the
interatrial septum near the
entry of the superior vena cava.

Sinus venosus

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Type of AVC: severe defect in which there is a large hole in the septum that separates the left and right sides of the heart. The hole is in the center of the heart, where the upper chambers and the lower chambers meet.

Complete atrioventricular canal (CAVC)

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Management of PS:
o during cardiac catheterization to dilate the narrowed valve
/STENT PLACEMENT
o A doctor inserts a long, thin tube (catheter) with a balloon on the tip into an artery in the arm or groin. X-rays are used
to help guide the catheter to the narrowed valve in the heart. The doctor the inflates the balloon, which widens the opening of the valve and
separates the valve flaps. The balloon is when deflated, and the catheter and balloon are removed.

Balloon Valvuloplasty

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Management of COA

Surgical correction is advisable in all but the mildest cases
Nonsx:
o BALLOON ANGIOPLASTY
Sx:
o Resection/removal of
narrowed ends and
anastomosis of both ends
o Enlargement of the
constricted section using a
graft of prosthetic
material/portion of left
subclavian artery

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Management of PDA: help close a PDA works by stimulating the muscles inside the PDA to constrict, thereby closing the connection

Indomethacin IV (prostaglandin inhibitor)

Management of PDA: use of thoracoscope and instruments, 3 small insicion on the L side of chest to place a clip on the ductus)

VATS (visual assisted thoracoscopic surgery)

Palliative Medical management of VSD

pulmonary artery banding

* Surgical closure is contraindicated in fully developed Eisenmenger's syndrome when heart-lung transplantation may be the only effective treatment

Types of AVC

* Complete atrioventricular canal (CAVC) * Partial atrioventricular canal defects

* Abnormal opening between R&L ventricles creating pulmonary vascular resistance * Because of increase pressure at LV, blood flows through the defect into the pulmonary artery and pumps into the left * Increase pulmonary Vascular resistance, increase pressure to RV

VSD (Ventricular Septal Defect)

Type of AVC: The hole does not extend between the lower chambers of the heart and the valves are better formed.

Partial atrioventricular canal defects

Management of ASD: o This technique involves implantation of one of several devices (basically single or double wire frames covered by fabric) using cardiac catheterization

Transcatheter Device Closure (NonSx)

Management of ASD: relieve pulmonary congestion

diuretics

most common type of ASD form comprising about 90% cases of ASD. The defect is situated in the region of the fossa ovalis that, in utero, was the foramen ovale

ostium secundum

Medical management of AS: to reopen the ductus

intravenous infusion of PGE

Management of PS: open surgical

PULMONARY VALVOTOMY

Management of ASD: o For larger ASDs, a patch is usually used to close the hole. This patch can be taken from the pericardium (the sac that surrounds the heart) or from synthetic materials such as Dacron or Teflon. o Done at preschool age

Dacron Patch Closure (Sx:open)

Types of ASD

Ostium secundum Ostium primum Sinus venosus

Management of AS

Medical: o balloon valvuloplasty o use of rapidly acting inotropic agents and diuretics to treat CHF o intravenous infusion of PGE o Percutaneous balloon valvuloplasty Sx: ➢ Aortic valvotomy 1. Ross procedure 2. Aortic homograft with a valve

Narrowing of the aortic lumen specifically in the region where the ductus arteriosus joins the aorta, i.e. at the isthmus just below the origin of the left subclavian artery.

Coarctation of Aorta

seen more often in the following: o premature infants o infants born to a mother who had rubella during the first trimester of pregnancy * Communication between PA + aorta due to failure of ductus arteriosus to close after birth (1 week of life)

PDA (Patent Ductus Arteriosus)

* Narrowing of the stricture of the aortic valve causes ↑pressure in the heart -> L ventricular hypertrophy * Causes the resistance to ejection of blood from LV > which cause the hypertrophy * LA pressure increases which causes increase pressure in pulmonary veins results to pulmonary congestion

AS (Aortic Stenosis)

* They account for about 5 percent of all congenital heart disease, and are most common in infants with down syndrome. * (About 15 percent to 20 percent of newborns with down syndrome have atrioventricular septal defects). * Incomplete Fusion of endocardial Cushions -ASD continues with VSD and Cleft of mitral and tricuspid valveCreating a large central AV valve allowing blood to flow in 4 chambers=@risk of pulmonary vascular obstructive disease

AVC (Atrioventricular Canal)

Management for AVC: Reduce pulmonary blood flow in patients with significant pulmonary over circulation secondary to significant left to- right shunting in as palliation prior to later definitive surgical repair

Pulmonary artery banding

Type of AS: most common type and is usually caused by malformed cusps

Valvular stenosis

Medical management of VSD: for complete repair of large defects

Knitted Dacron patch

o The ventricle has to work harder to try to move blood through the narrowing in the aorta left sided heart failure o BP is higher above the narrowing, and lower below the narrowing. o Older children may have headaches from too much pressure in the vessels in the head, or cramps in the legs or abdomen from too little blood flow in that region.

Coarctation of Aorta

palliative Management of AS

aortic valvotomy

Management for AVC

* Pulmonary artery banding * Complete repair: patch closure of the septal defect and reconstruction of the AV valve; mitral valve replacement if severe

Management of ASD

* digoxin * diuretics * infection control * surgical repair * Closure can be accomplished by using cardiac catheterization of implantable closure device. * Dacron Patch Closure (Sx:open) * Transcatheter Device Closure (NonSx)

* Abnormal opening between R & L auricles (Atrial allowing blood from higher pressure LA to flow into the lower pressure RA crossing the pulmonic valve) * LA pressure exceeds the RA pressure causes increase flow of oxygenated blood into the R side of the heart Management * Overloading of the RVentricle → R. Ventricular Hypertrophy * Increase pulmonary blood flow & increase pressure → murmur (harsh systolic), and extra amount of blood

Atrial septal defect

Management of COA for older children

BALLOON ANGIOPLASTY

Types of AS

* Valvular stenosis * Sub valvular stenosis * Supra valvular stenosis

Management of PS

* Balloon Valvuloplasty * Sx: ➢ TRANSVENTRICULAR VALVOTOMY/BLOCK (closed) ➢ PULMONARY VALVOTOMY (open)

Management of VSD: for small VSD

no specific treatment

treatment for Eisenmenger syndrome

heart-lung transplant

Management of AS regarded as the first step in the management of symptomatic neonates

Percutaneous balloon valvuloplasty

Medical management of VSD: o Placing a band around the pulmonary artery to decrease the pulmonary blood flow o It increases the resistance to blood flow through the pulmonary artery. Pressure increases in the right ventricle and prevents excess shunting from left to right

pulmonary artery banding

Management of ASD: involves slowly moving a catheter (a long, thin, flexible, hollow tube) into the heart. The catheter is initially inserted into a large vein through a small incision made usually in the inner thigh (groin area) and then is advanced into the heart

cardiac catheterization

when will ductus arteriosus close

72 hrs after birth

Management of AS: (valve taken from a cadaver) is then used to replace the patient's own pulmonary valve.

pulmonary allograf

Management of PS: Surgical for children

PULMONARY VALVOTOMY

Medical management of VSD

* digoxin and diuretics. * Pulmonary artery banding * purse-string approach. * Knitted Dacron patch

how to provide adequate nutrition in PDA

o high-calorie formula or breast milk o supplemental tube feedings

Management of ASD: machine in surgical repair

heart-lung machine

Management of PDA: o Ligation and division through left posterolateral thoracotomy without cardiopulmonary bypass

ligation of PDA thru left thoracotomy

extreme form of PS; total fusion of commisures; no blood flow to the left

Pulmonic Atresia

Management of AS: cardiac surgery operation where a diseased aortic valve is replaced with the person's own pulmonary valve.

The Ross-Yacoub procedure (or pulmonary autograft)

Acyanotic heart diseases Flashcards

(68 cards)