Pediatric Cardiac Anomalies

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Pediatric Cardiac Anomalies

• Congenital Heart Disease
• NPN 200

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Fetal Cardiac Circulation

• inferior vena cava to the right atrium then
  through the foramen ovale to the left atrium
• Superior vena cava to the right ventricle through
  the pulmonary artery to the ductus arteriosus and
  into the descending aorta
• Very little blood goes to the lung
• With 1st breath the pressure increases in the
  pulmonary vascular system and systemic pressure
  increases
• The foramen ovale closes and the ductus
  arteriosus starts to close with the O2 supply

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Atrial Septal Defect

• Abnormal flowing of blood between the atrium,
  allowing blood to flow from the left atria into
  the right atrium
• Allows oxygenated blood in the left atrium to
  communicate with unoxygenated blood in the right
  atrium
• May not cause any problems until later in life
• May have atrial atrial dysrhythmias
• May repair with Dacron graft

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Ventricular Septal Defect

• Abnormal opening between the right and left
  ventricle
• May vary in size from a pin hole to absence of
  the septum
• Frequently associated with pulmonary stenosis,
  transposition of the great vessels, patent
  ductus, atrial defects, and coarctation of the
  aorta
• Many will close spontaneously, during the 1st
  year of life
• Oxygenated blood flows into the lungs and
  increases pulmonary vascular resistance
• The right ventricle hypertrophies due to the
  increase in pressure
• Right atrial enlargement may occur

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VSD, cont.

• CHF is common
• Murmur
• Risk for bacterial endocarditis, and pulmonary
  vascular obstructive disease
• May use band around the pulmonary to decrease
  blood flow into the lungs
• May also use Dacron graft or purse string suture

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Patent Ductus Arteriosus

• Failure of ductus to close within the first few
  weeks of life
• Murmur will be present
• Bounding pulse
• At risk for endocarditis and pulmonary vascular
  disease in later life
• Treatment
• Indocin will help close in some premature babies
• Surgical repair by opening the chest or now may
  use laparoscope

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Pulmonary Stenosis/Aortic Stenosis

• Aortic stenosis narrowing or stricture of
  aortic valve
• Pulmonary stenosis narrowing of the entrance to
  the pulmonary artery
• Both require interventions if severe enough to
  cause problems of CHF and heart failure
• May be repaired by replacement or ballooning

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Tetralogy of Fallot

• 4 defects
• Ventricular septal defect
• Pulmonary stenosis
• Overriding aorta entrance of the aorta is close
  to the VSD
• Right ventricular hypertrophy

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Patho

• Amount of problems depend upon the amount of
  pulmonary stenosis and the size of the VSD
• Most common defect with causes cyanosis
• Defects causes the blood flow to shunt from one
  chamber to another and pulmonary stenosis
  prevents the blood from going to the heart
• May have both O2 blood and no O2 blood going to
  the body

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Signs and Symptoms

• May have mild to sever cyanosis at birth
• Murmur
• May have acute episodes of hypoxia, especially at
  feeding and bath time
• In children, you may see clubbing, and poor growth

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Treatment

• Surgical treatment may be delayed if infant
  unable to tolerate
• Palliative treatment can be performed by shunting
  the blood from the subclavian artery to the
  pulmonary artery
• Complete repair is usually done in the 1st year

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Coarctation of the Aorta

• Narrowing near the insertion of the ductus
  arterious, which results in increased pressure
  proximal to the defect and decreased pressure
  distal to the obstruction
• This causes the development of collateral
  circulation in the fetus

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Clinical Manifestations

• High B/P in the arms
• Weak or absent femoral pulses
• Cool lower extremities with lower B/P
• Signs of CHF
• Rapid deterioration and death may occur with
  sever acidosis and hypotension
• Will need ventilator and B/P support
• Older children may experience dizziness,
  headaches, fainting, nose bleeds
• Risk for hypertension, ruptured aorta, aortic
  aneurysm, or stroke

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Treatment

• Resection of the stricture or enlargement of the
  aorta using a graft
• Now using a balloon angioplasty to open area
• Residual hypertension may occur
• 5 mortality
• Increased risks if has other cardiac defects

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Transposition of the Great Arteries

• The pulmonary artery leaves the left ventricle
  and the aorta exits from the right ventricle
• May also involve a patent ductus
• Symptoms include sever to mild cyanosis with CHF

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Correction of Transposition

• Arterial switch
• Done during 1st few weeks of life
• Changes the main pulmonary artery to the aorta
  and the aorta to the pulmonary artery
• Coronary arteries are reimplanted into the aorta
• Operative mortality is 5-10

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Nursing Care for Pediatric Cardiac Problems

• Scary time for parents
• May think it is their fault
• Anxiety regarding breathing difficulties and
  cyanosis
• Usually must be taken to major medical center for
  treatment
• Feeding difficult