CP- Pediatric Pop

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Author:
pspuler
ID:
160018
Filename:
CP- Pediatric Pop
Updated:
2012-06-27 15:29:11
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Cardiopulmonary pediatrics population
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Description:
CPII Considerations in the Pediatric Population
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  1. Acyanotic
    • -blood shunts LEFT to RIGHT heart
    • -patients are pink
    • -normal SaO2
  2. Cyanotic
    • -blood shunts RIGHT to LEFT heart
    • -patients are blue
    • -SaO2 15-30% below normal
  3. Acyanotic Defects
    • -Atrial Septal Defect (ASD)
    • -Ventricular Septal Defect (VSD)
    • -Patent Ductus Arteriosus (PDA)
    • -Coarctation of the aorta
    • -Pulmonary stenosis
    • -Aortic stenosis
  4. Atrial Septal Defect
    • -Hole in septum between the atria (persistent foramen ovale)
    • -allows oxygenated blood to flow from L to R atria
  5. Signs and Symptoms of ASD
    • -murmur
    • -racing heart beat
    • -fatigue
  6. Surgical Intervention of ASD
    -patch placed via open heart or cath procedure
  7. problems with ASD blood flow from L to R heart
    • -mixed blood
    • -can put stress on heart and lead to congestive heart failure
    • ->80% close in first year of life without surgery
  8. Ventricular Septal Defect
    • -opening in spetum between L and R ventricle
    • -Blood flows L --> R ventricle
    • -heart works harder to pump blood to body
  9. Signs and Symptoms of VSD
    • -murmur
    • -fatigue
    • -increased HR
    • -FTT
    • -poor growth/feeding
  10. Diagnosis of VSD
    • -ECG
    • -echo
    • -cath
    • -MRI
  11. Treatment for VSD
    • -watch/wait
    • -surgery - close via patch with open heart surgery
  12. Patent Ductus Arteriosus
    • -ductus arteriosus does not close
    • -O2 rich blood from aorta mixes with deoxygenated blood from pulmonary artery
    • -blood shunts aorta to R ventricle
  13. Signs and Symptoms of Patent Ductus Arteriosus
    • -murmur
    • -increased RR
    • -increased respiratory infections
    • -increased WOB/SOB
    • -fatigue
    • -poor growth and eeding
    • -decreased endurance
  14. Diagnosis of Patent Ductus Arteriosus
    • -ECG
    • -Echo
    • -CXR
    • -murmur
  15. Treatment of Patent Ductus Arteriosus
    • -may wait 1-2 years if no other defects
    • -give meds if life threatening
    • -may close during surgical procedure for another defect
  16. Coarctation of the Aorta
    • -narrowing of the aorta just after it branches off to the upper body
    • -blood flow is obstructed to the lower body
    • -increased work on L ventricle to pump
    • -can lead to heart failure
  17. Diagnosis of Coarctation of the Aorta
    • -ECG
    • -Echo
    • -Chest Xray
    • -SaO2
    • -cath
    • -MRI
    • -murmur
  18. Treatment of Coarctation of the Aorta
    • -cath to dilate or stent open
    • -surgery - remove portion of aorta & sew back together or enlarge with a patch
  19. Pulmonary Stenosis
    • -fused, thickened or missing leaflets of pulmonary valve
    • -obstruction at pulmonary valve
    • -increase work on R ventricle to pump blood to lungs
  20. Signs and Symptoms of Pulmonary Stenosis
    • -fatigue
    • -murmur
    • -rarely chest pain
  21. Diagnosis of Pulmonary Stenosis
    • -ECG
    • -Echo
    • -Chest Xray
    • -SaO2
    • -cath
    • -MRI
  22. Treatment of Pulmonary Stenosis
    • (depends on anatomy and severity)
    • -cath
    • -surgery - valvotomy, homograft valve, or new valve
  23. Aortic Stenosis
    • -fused, thickened or missing leaflets of aortic valve
    • -obstruction from L ventricle to aorta
    • -increase work on L ventricle to pump blood to body
  24. Signs and Symptoms of Aortic Stenosis
    • -fatigue
    • -murmur
    • -rarely chest pain
    • -fainting
    • -arrythmias
  25. Treatment of Aortic Stenosis
    • (depends on anatomy and severity)
    • -balloon valvuloplasty via cath
    • - surgery - artificial valve, or Ross procedure
  26. Ross Procedure
    pulmonic valve replaces aortic valve and then the pulmonic valve is replaced with an artificial valve
  27. Cyanotic Defects
    • -Tetrology of Fallot (TOF)
    • -Transposition of the great arteries (TGA)
    • -Complete A-V Canal Defect (CAVC)
    • -Pulmonary atresia
    • -Tricuspid atresia
    • -Hypoplastic Left or right heart syndrome (HLHS)
  28. Tetrology of Fallot
    • -Combination of heart defects
    •      -Ventricular spetal defect (VSD)
    •      -Aortic override
    •     -Right ventricular outflow obstruction
    •     -Right ventricular hypertrophy
    • -accounts for 50% of cyanotic defects
    • -decreased blood flow to the lungs, poorly oxygenated blood pumps out through aorta
  29. Signs and Symptoms of TOF
    • -cyanosis
    • -murmur
    • -clubbing
    • -"tet spell"
  30. tet spell
    sudden decrease in saturation and pulmonary blood flow
  31. Dignosis of TOF
    • -fetal echo
    • -cyanosis
    • -SaO2
    • -ECG
    • -Echo
    • -CXR
    • -cath
    • -MRI
  32. Treatment of TOF
    -surgical - repair VSD, dilate pulmonary valve
  33. Transposition of the Great Arteries
    • -aorta comes out of R ventricle
    • -pulmonary artery out of L ventricle
  34. Signs and Symptoms of TGA
    • -cyanosis
    • -increase RR
    • -decrease feeding/weight gain/ appetite
  35. Diagnosis of TGA
    • -fetal echo
    • -ECG
    • -Echo
    • -Cath
    • -MRI
    • -SaO2
    • -Chest Xray
  36. Treatment of TGA
    • -1/3 require urgent intervention (balloon atrial septostomy)
    • -all will need an open heart surgery for arterial switch repair
  37. Complete A-V Canal Defect
    • -hole in center of heart where atria and ventricles meet
    • -develop with one large valve
    • -mixed blood and too much blood to lungs
  38. Signs and symptoms of Complete A-V Canal Defect
    • -cyanosis
    • -decreased feeding/weight gain
    • -increased WOB
    • -murmur
  39. Diagnosis of Complete A-V Canal Defect
    • -newborn eval
    • -ECG
    • -echo
    • -chest xray
    • -cath
    • -MRI
    • -SaO2
  40. Treatment of Complete A-V Canal Defect
    • -surgery within 2-3 months of life
    • -patch closure and separate into 2 valves
  41. Pulmonary Atresia
    • -abnormally formed pulmonary valve
    • -often associated with VSD
  42. Signs and Symptoms of Pulmonary Atresia
    • -cyanosis
    • -decreased feeding/weight gain
    • -SOB
  43. Diagnosis of Pulmonary Atresia
    • -fetal US
    • -ECG
    • -Echo
    • -SaO2
    • -Chest xray
    • -MRI
  44. Treatment of Pulmonary Atresia
    • -balloon valvuloplasty via cath
    • -Open heart surgery - path and shunt
  45. Tricuspid Atresia
    • -tricuspid valve fails to develop
    • -smaller than normal R ventricle
    • -always have an ASD, sometimes have VSD
    • -only 1 functioning ventricle
  46. Signs and symptoms of Tricuspid Atresia
    • -Cyanosis
    • -clubbing
    • -decreased feeding/weight gain
    • -SOB
    • -murmur
  47. Diagnosis of Tricuspid Atresia
    • -fetal echo
    • -SaO2
    • -chest xray
    • -ECG
    • -echo
    • -cath
    • -blood
  48. Treatment of Tricuspid Atresia
    • -initially give O2 and prostaglandins (keep PDA open)
    • -3 staged surgery (Blalock Taussig Shunt or PA banding, Hemi-Fontan/Bidirectional Glenn Shunt, Fontan Procedure)
  49. Hypoplastic L Heart Syndrome
    • -underdeveloped or absent L ventricle
    • -mitral valve stenosis or atresia
    • -aortic stenosis
    • -aorta is underdeveloped and narrowed
  50. Signs and Symptoms of Hypoplastic L Heart Syndrome
    • -cyanosis
    • -decreased feeding/weight gain
    • -increased WOB
    • -lethargy
  51. Diagnosis of Hypoplastic L Heart Syndrome
    • -fetal echo
    • -ECG
    • -echo
    • -chest xray
    • -SaO2
    • -cath
    • -MRI
  52. Treatment Hypoplastic L Heart Syndrome
    -3 staged procedure - norwood procedure (blalock-taussig shunt, hemi fontan/bidirectional glenn, fontan)

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