小儿先心病

Treatment
Prostaglandin infusion keeps the DA open until surgery. Start at 0.1 mcg/kg/min and titrate
CHF
Usually w/in the first 6 months when PVR has decreased allowing L to R shunt (VSD or PDA) Triad of CHF in infancy
Truncus Arteriosus
Large arterial trunk from the ventricular portion of the heart. Supplies blood to systemic and pulmonary circulation. Present with increased pulm. blood flow, dyspnea and CHF
Vent. Septal来自百度文库Defect
Most common CHD
May occur in any septal location
Hemodynamic significance depends on the size of the defect.
Spontaneous closure in the first 6 mo. In 30-40%.
Pulmonic blood flow depends on a L to R shunt from the aorta through the DA to the pulmonary art.
Defects dependent on R to L shunt via the PDA include:
Coarctation of the Aorta
Narrowing of the aortic lumen. Present with CHF and feeding difficulty. Decreased pulse amplitude in the lower ext. Hypertension in the upper ext. Older kids present with exercise intolerance and rib notching.
Transposition of Great Vessels
Appears in 1st week of life. Aorta comes from R vent. and pulmonary art. Comes from L vent. Must have a VSD or ASD for survival If suspected, start Prostaglandin E1
Ductal Dependent heart defects
Depend on a patent ductus arteriosus.
Systemic blood flow depends on a R to L shunt from the pulmonary artery through the DA to aorta.
Surgical repair required if:
CXR EKG
Cyanotic Heart Defects
Tetralogy of Fallot Transposition of the great vessels Truncus arteriosus Total anomalous pulmonary venous return Tricuspid valve Abnormalities Severe pulmonic stenosis
Critical Aortic Stenosis Hypoplastic left heart Severe coarctation
Usual Clinical Presentation
Circulatory collapse at the end of first week of life
Tachypnea Tachycardia Hepatosplenomegaly
Treatment
Supportive Lasik Digoxin except in IHSS or TOF Inotropes Pressors Vasodilators Afterload reducing drugs Head up NPO Treat infections
Pediatric Heart Disease
Infants may have one of the following:
Cyanosis (cyanotic CHD or R to L shunt)
Pulmonary and tricuspid atresia
CHF (L to R shunt) or shock Shock from outflow obstruction Diagnostic evaluation
Tetralogy of Fallot
Consists of VSD, obstructed right vent. outflow tract, dextroposed overriding aorta, RVH. TeT spells-worsening obstruction of flow in the pulmonary artery leading to greater R to L shunt. Causes cyanosis and dyspnea.
Atrial septal defects
RA and RV enlargement Pulmonary over-circulation
High pressure Low volume
ASD low morbidity and mortality Repair may be surgical or trans cath