Congenital Heart Defects with decreased pulmonary blood flow

S/sx for Congenital Heart Defects with decreased pulmonary blood flow

squatting

cyanosis

clubbing/hypoxia

syncope

R—> L = cyanotic

Pulmonary stenosis is what kind of flow (not shunt) and what is the description of the defect/blood flow?

R→L flow

narrowing of pulmonic valve

Right ventricular hypertrophy due to increased preload

S/sx for PS

Mild: asymptomatic

Mod/severe: dyspnea, fatigue, signs of: CHF and HF

Tx/Sx for PS

Balloon dilation

surgical valvectomy when balloon is not indicated or successful

PS prognosis in newborns

10% doesnt increase in severeity

Tetralogy of Fallot is what kind of shunt and describe the defect/blood flow

R→L

4 defects: PS, Rt venctricle hypertrophy, VSD, overriding aorta

ToF S/sx

cyanotic, dyspnea, tachypnea, knees to chest, clubbing fingers, activity intolerance, poor growth and oor feedings, metabolic acidosis, Boot heart

What lab changes occur in ToF and what are infants at high risk of

Polycythemia (H&H, WBC, PLT), Blood clots! but delayed clotting time (PT/PTT)

Report Hgb >22g

What do older children do with ToF?

Squat and tripod

Where is the mumur heard and is there a thrill in ToF

Murmur in pulmonic area and up suprasternal notch

Thrill in pulmonic area (+4,5,6)

ToF risk factors

viral illness during pregnancy (rubella)

alcoholism

Maternal age >40

Parent history of ToF

Downs or DiGeorge

Main indicator for ToF through Xray

Boot

PALLIATIVE Tx for TOF and when is it completed

Palliative shunt from aorta to pulmonic arteries

Corrective Sx: 1-2yo

Symptomatic children Sx: 3-4months

What is the nordwood procedure

Increase pulmonary blood flow

Blalock (BT shunt)

palliative, shortly after birth, aorta is rerouted to ventricles, aorta widened

Nursing assessment for BT shunt

Listen to the shunt

Failed shunt will lead to respiratory distress

Tricuspid Atresia shunt and description of the defect and blood flow

R→L

tricuspid valve fails to develop

blood flow is through ASD and VSD

Small right ventricle

Tricuspid atresia S/Sx

cyanosis

tachypnea/cardia

clubbing

Tricuspid atresia Tx

BT shunt

pulmonary artery banding

Fontan

Balloon atrial septostomy

TGA description of event/blood flow and shunt

R→L

Aorta and pulmonary flipped

RV→Aorta

LV→Pulmonic

Survival depends on patent DA or septal defect

TGA s/sx

cyanosis that doesn’t improve with O2 NC

egg on string

poor feeding

poor weight gain

Tachypnea/dyspnea

fatigue

clubbing

CHF

Polycythemia (Hgb: >22 BAD)

TGA Tx

Life threatening at birth must have surgery (atrial switch)

Prostaglandin-patent ductus arteriosis

TAPVC shunt and blood flow/structural changes

R→L

Abnormal pulmonary vein connecting R heart and L atrium

O2 is send pack to lungs instead of body

ASD necessary to suvrive

TAPVC s/sx

Mild cyanosis

tachypnea

increased pulmonary flow

pulmonary vein obstruction→pulmonary edema

TAPVC sx

required for survival

balloon atrial septostomy

connect pulmonary veins to L atrium

Truncus Arteriosus (Trunkus) type of shunt and blood flow/structural changes

R→L

“trunk” single vessel for pulmonic and aorta that has blood go into lungs and body

VSD is present

Truncus S/sx

HF

murmur

cyanosis

poor feeding

Truncus Tx

Rastelli repair within week of birth

patch septum and new pulmonary valve/artery