cardiac diseases in newborn
TRANSCRIPT
PEER GROUP DISCUSSION ON
CARDIAC DISEASE IN NEWBORN
Presented by :Ms. Hemlata1915722M.M.C.O.N
INTRODUCTION
ANATOMY OF THE HEART
• The Heart Valves Four types of valves regulate blood flow through your heart:
1. The tricuspid valve
2. The pulmonary valve
3. The mitral valve
4. The aortic valve
FETAL CIRCULATION
INCIDENCE
• 8/1000 live births• 3-4/100 still born• 2/100 premature infants
excluding PDA• 10-25/100 abortuses• Most congenital defects are
well tolerated during fetal life
• Unknown in most cases• Genetic factors - single gene
defect• Chromosomal abnormality.• Environmental factors• Gender differences in type of
CHD
ETIOLOGY
ACYANOTIC HEART DEFECTS
Ma. Tosca Cybil A. Torres, RN
DEFINITION
a congenital disorder manifested with left to right shunting and obstructive lesions. Clinical signs are not always apparent at birth, they manifest anytime during infancy or early childhood.
PATHOPHYSIOLOGY
• Hole in the wall(septum) between right and left atria.
• Commonest type of CHD(30-40%)
• 1Child/1500 Live births
ARTERIAL SEPTAL DEFECT
PATHOPHYSIOLOGY
TYPES
TYPES
ALTERED HEMODYNAMICS
Left to right shunting
Increased blood flow
through ASD
Enlarge right Atrium and
right Ventricle
Increased Pulmonary Blood Flow
DIAGNOSTIC EVALUATION
MANAGEMENT
THERAPEUTICS MANAGEMENT• Elective Surgical Repair (2-5 years of age)MEDICAL MANAGEMENTAtrial dysrythmias (anti-dysrythmics
SYMPTOMATIC CASES
SURGICAL TREATMENT
• Surgical closure using either sutures or a pericardial prosthetic patch is performed on an elective basis early in childhood. This is an open heart procedure, through a sternal incision.
VENTRICULAR SEPTAL DEFECT
A hole in the wall between the two lower chambers is called a ventricular septal defect.
25% In all CHD
VENTRICULAR SEPTAL DEFECT
PATHOPHYSIOLOGY
ALTERED HEMODYNAMICS
L R Shunt
Increased blood flow
through VSD
Pulmonary vascular
circulation receives
increased pulmonary blood flow
Pulmonary hypertensi
on and pulmonary vascular
diseases(EISONMERG
ER’S SYNDROM
E)
DIAGNOSTIC EVALUATION
20-80% closes spontaneously / no surgeryAntibiotic prophylaxis ACE inhibitors to reduce after loadNutritional supplement to increase calorie intake (infant formula)Prevent respiratory infections
MANAGEMENT
SURGICAL MANAGEMENT
PLACING THE PATCH OVER THE DEFECT THROUGH RA PATCH PLACED, TO AVOID RV
INCISION
Congestive Heart Failure
Growth failure
Irregular rhythm
Pulmonary hypertension
PATENT DUCTUS ARTERIOSUS
The vessel does not close and remains "patent" resulting in irregular transmission of blood between two of the most important arteries close to the heart, the aorta and the pulmonary artery 1 in 2000 live births
PATHOPHYSIOLOGY
ALTERED HEMODYNAMICS
L R Shunt
Increased blood flow
through PDA
Pulmonary vascular
circulation receives
increased pulmonary blood flow
Pulmonary
hypertension
SIGN AND SYMPTOMS
DIAGNOSTIC EVALUATION
MANAGEMENT
Prostaglandin inhibitor
orally 0.2 mg/kg TDS at an interval of 12 to 24 hours
SURGICAL MANAGEMENT
ATRIO-VENTRICULAR CANAL DEFECT
• Complete absence of AV septum– A common atrioventricular ring– A five leaflet valve that guards
the common AV orifice– An unwedged left ventricular
outflow tract– LV mass characterized by
longer distance from apex to aortic valve than from apex to left AV valve
ENDOCARDIAL CUSHION DEFECT
• AVSDS account for 4% to 5% of congenital heart disease
PATHOPHYSIOLOGY
TYPES OF AVSD
Partial AVSD
•Asymptomatic•Dysnoea•Growth retardation
Complete AVSD
•Tachypne a•Pulmonary vascular obstructive disease
DIAGNOSTIC EVALUATION
MANAGEMENT
EISENMENGER’S SYNDROME
SIGN AND SYMPTOMS• asymptomatic or have
only mild dyspnea• Reduced exercise
capacity• Dyspnea and fatigue
develop gradually as pulmonary blood flow decreases
• hypoxemia increases due to bidirectional shunting
DIAGNOSTIC EVALUATION
Transplantation is an effective choice of treatment
MANAGEMENT
CYANOTIC HEART
DEFECTS
TATRALOGY OF FALLOT
1. Ventricular septal defect
2. Pulmonary stenosis
3. Overriding aorta
4. Right ventricular
hypertrophy
PATHOPHYSIOLOGY
`
CLINICAL MANIFESTATION
DIAGNOSTIC EVALUATION
ON AUSCULTATION A loud harsh systolic murmur may be heard at the left middle to lower sturnal border.
MANAGEMENT
SURGICAL MANAGEMENT
COMPLETE REPAIR
PALLIATIVE SHUNT
TRICUSPID ATRESIA• Failure of the tricuspid
valve to develop consequently no communication form right atrium to right ventricle
• complete mixing of unoxygenated and oxygenated blood in the left side of the heart.
CLINICAL MANIFESTATION
MANAGEMENT
TRANSPOSITION OF THE GREAT ARTERIES
Aorta arising from the right ventricle and pulmonary artery from the left ventricle.
SIGN & SYMPTOMS
PATHOPHYSIOLOGY
DIAGNOSTIC EVALUATION
MANAGEMENT• CONTROL TO CCF
• Blalock Hanlon procedure -surgical creation or enlargement of an existing arterial septal defect.
• Rash kind operation – enlargement of an existing arterial septal defect.
NURSING DIAGNOSIS1. Decreased cardiac output related to structural
defect2. Activity intolerance related to imbalance between
oxygen supply and demand.3. Altered growth and development related to
inadequate oxygen, nutrients to tissue and social isolation
4. High risk for infection related to debilitated physical status.
5. Altered family process related to having a child with a heart condition.
6. High risk for injury (complications) related to cardiac condition and therapies
RESEARCH ARTICLE• Title:I ncidence of congenital heart disease in
newborns after pulse oximetry screening introduction.
• Authors : Methlouthi J, Mahdhaoui N, Bellaleh M, Guith A, Zouari D, Ayech H, Nouri S, Séboui H.
• Objective: to determine the incidence of congenital heart diseases screened by physical examination coupled with the measure of transcutaneous saturation
• Background : CHD, most common congenital malformations in the newborn with an estimated incidence ranging between 6-9 ‰. In Tunisia, this incidence reaches 1.9 ‰. In fact, the diagnosis is based mainly on clinical examination which allows making the diagnosis only in 50 in 75 % of the cases. Several studies showed the interest of pulse oximetry oximeter in the screening of cyanogenic and duct dependent congenital heart diseases.
• Methods: A descriptive study was conducted. Total 10447 newborn children included who were born in central maternity of sousse.duration of the study was 12 months and transcutaneous saturation of all the newborn children was measured in association to routine physical examination.
• Results : Among 10447, 26 had a congenital heart defect. The incidence of the neonatal cardiac malformations in our current study was found in 2.77 ‰ of alive births. It was about 1.1 ‰ of newborns in a similar study practised in 2009 (Chi2=76.2 et p<10-4).The heart disorder was diagnosed following the grip taking of the only percutaneous saturation in5 newborn children and following the clinical examination in 21.
• Conclusion: The measure of the transcutaneous saturation in the first day of life is a little expensive and specific method for the early screening of the duct dependent cardiac malformations.
SUMMARY
CONCLUSION
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