Neonatal cardiopulmonary problems

Atrial septal defect (ASD)

is a form of congenital heart disease that enables communication between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atria. a defect in this septum,blood flows from left to right secondary to high pressure on the left. During development of the fetus, the interatrial septum develops to eventually separate the left and right atria

 The foramen ovale remains open during fetal development to allow blood from the venous system to bypass the lungs directly and enter the circulatory system. after birth, the pressure in the pulmonary circulatory system drops, thus causing the foramen ovale to close .In approximately 25% of adults, the foramen ovale does not seal to entirety

Types of atrial septal defect.

Ostium secundum: is the most common type of atrial septal defect, and comprises 6-10% of all congenital heart diseases. arises from an enlarged foramen ovale, inadequate growth of the septum secundum, or excessive absorption of the septum primum 10 to 20 percent of individuals with ostium secundum ASDs also have mitral valve prolapse.

 Ostium primum: (endocardial cushion defect) is a defect in the atrial septum at the level of the tricuspid and mitral valves. Sinus venosus: This is a defect occurring high in the septum near to the orifice of the superior venacava. Common or single atrium :It is a failure of development of the embryologic components that contribute to the Atrial septal complex. It is frequently associated with heteroxy syndrome.

Symptom:
Most often asymptomatic. Systolic ejection murmur at left lower sternal border. Widely split second heart sound. Occasionally a loud s1 and a pulmonary ejection click. Large defect may result in dyspnea, poor feeding, poor growth, profuse perspiration, Recurrent respiratory infections.

Treatment:
Surgery involves entering the right atrium through a median sternotomy or right thoracotomy And closing the defect with sutures or with Dacron patch.

Ventricular septal defect:

common congenital cardiac anomalies is a defect in the ventricular septum. The ventricular septum consists of a muscular (inferior) and membranous portion (superior). The membranous portion (which is close to the atrioventricular node) is most commonly affected.They are found in 30% of all newborns with a congenital heart defect, or about 2-3 per 1000 births. Congenital VSDs are frequently associated with other congenital conditions, such as Down's syndrome.

Symptom:
The most common signs and symptoms are trouble in eating and gaining weight, breathlessness and easy fatigability. A baby with a large VSD while eating , falls asleep, Wakes up in a short while quite hungry, tries to eat again, tires easily, and the cycle is repeated.

Treatment:
Treatment is either surgical (open or percutaneous endovascular) or conservative. Smaller congenital VSDs often close on their own (as the heart grows) and are thus treated conservatively. Open surgical procedures require a heart-lung machine and are done with a median sternotomy. Percutaneous endovascular

Patent ductus arteriosus:

is a congenital heart defect wherein a child's ductus arteriosus fails to close after birth.In the developing fetus, DA is a shunt connecting the pulmonary artery to the aortic arch that allows much of the blood from the right ventricle to bypass the fetus' fluid-filled lungs. During fetal development, this shunt protects the lungs from being overworked and allows the right ventricle to strengthen. In normal newborns, the DA is closed within 15 hours after birth, and is completely sealed after three weeks. A nonfunctional vestige of the DA, called the ligamentum arteriosum, remains in the adult heart.

Symptom:
While some cases of PDA are asymptomatic, common symptoms include tachycardia or other arrhythmia Respiratory problems Shortness of breath Systolic ejection murmur Enlarged heart Cyanosis

 Infants without adverse symptoms may simply be monitored as outpatients, while symptomatic PDA can be treated with both surgical and non-surgical methods Surgically, the DA may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils or plugs . Fluid restriction and prostaglandin inhibitors such as indometacin have also been used in successful nonsurgical closure of the DA.

Aortic valve stenosis:

Major predisposing conditions of aortic stenosis is acute rheumatic fever,& age-induced 'wear and tear.calcification of the aortic valve may occur and result in stenosis. Typically,aortic stenosis due to calcification of a bicuspid valve occurs in the 4th of 5th decade of life. Prevalence:Represents 5% of all congenital heart disease. 3:1 male to female predominance.

Symptoms:
When symptomatic, aortic stenosis can cause dizziness, syncope, angina and congestive heart failure. More symptoms indicate a worse prognosis. Treatment: replacement of the diseased valve with a prosthetic aortic valve.

Pulmonary Valve Stenosis:

is relatively common and accounts for about 10% of heart defects diagnosed during childhood. It can occur in children with otherwise normal hearts or along with other congenital heart defects such as atrial septal defect or Tetralogy of Fallot. It occurs more frequently in children with Noonan syndrome and Williams syndrome. Oxygendepleted blood is pumped through the pulmonary valve to the lungs to pick up oxygen. Normally the pulmonary valve has three leaflets. If these leaflets are malformed, the valve may become narrowed (stenotic) or leaky (insufficient). The stenosis, insufficiency or both can be mild to severe.

Symptoms:
Mild pulmonary stenosis wont have any symptoms. Moderate or severe shows shortness of breath, or palpitation dyspnea. may not tolerate exercise well Treatment: Activity Restrictions, limit your activity because of strain or dilation of the right ventricle or arrhythmias Endocarditis Prevention by takeing antibiotics. Surgical intervention by balloon valvotomy

Tetrology of Fallot
The combination of a ventricular septal defect with pulmonary stenosis, dextroposition of aorta And with right ventricular hypertrophy is termed "Tetra logy of Fallot". Blood flow to the lungs is Obstructed and diverted through the VSD to the aorta. Blood flow to the lungs is reduced and the child appears 'Blue' (cyanosed).

Symptom:
Intensity of murmur varies, Dyspnea, poor feeding, poor growth, profuse perspiration, Recurrent respiratory infections, cyanosis. Clubbing of fingers and toes, Treatment: Palliative treatment in early years Blalock anastomosis (pulmonary A. to left subclavian A.) Waterson anastomosis (ascending A. to right pulmonary A.) Total correction- a median sternotomy followed by correction.

Transposition of the Great Arteries

An abnormality resulting in the right ventricle giving rise to the aorta and the left ventricle giving rise to the pulmonary artery. Complete separation of systemic and pulmonary circulations. Systemic circulation is desaturated (hypoxemic), while the pulmonary circulation recirculates saturated blood. Seen in 5% of congenital cardiac defects and with a predominance of 3:1 male to female.

Symptoms:
Cyanosis is the dominant finding immediately after birth, unless associated with VSD. Single loud S2. Surgical Treatment:Senning procedure: They first creates a tunnel (a baffle) between the atria. This redirects the oxygen-rich blood to the right ventricle and aorta, and the oxygen-poor blood to the left ventricle and the pulmonary artery. This operation is called an atrial or venous switch. Arterial operation: The aorta and pulmonary artery are switched back to their normal positions. The aorta is connected to the left ventricle and The pulmonary artery is connected to the right ventricle. The coronary arteries , Which carry the oxygen-rich blood that nourishes the heart muscle, also needed to be re-attached:

Eisenmenger syndrome:
refers to a lesions that result in pulmonary over circulation early in life (left to right shunting )with an irreversible elevation in PVR and reversible of intracardiac shunting. often resulted from VSD, ASD, and PDA Irreversible pathological changes, like medial hypertrophy,intimal thickening and ultimately obliteration of pulmonary arterioles, resulting in irreversible elevation in pulmonary vascular ressistance.

symptoms:
murmur varies with lesions patient develops cyanosis, fatigue, and Dyspnea late complications of CHF Treatment: Prevention of sequelae with timely surgical repair. Symptomatic medical treatment. Heart-lung transplantation.

Truncus Arteriosus:
An abnormality resulting in the formation of a single arterial trunk that gives rise to both the systemic and pulmonary circulation mostly associated with VSD receives low oxygen blood from the right ventricle and oxygen rich blood from the left ventricle. This mix of high and low oxygen blood is sent out to the body and to the lungs.

Symptoms:
cynosis present after birth. Diastolic murmur may be present if truncal valve regurgitation is present. Dyspnea, poor feeding, poor growth, profuse perspiration Treatment:
Early surgical repair (first month of life)