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HEART DISEASE
Cyanosis
(form the Greek word meaning dark blue)
What is cyanosis?
Blue discolouration of lips / tongue / extremeties
Oxygenated Hb is bright red
Reduced Hb is blue / purple
Lees
1970
2.
3.
CHEST XRAY:
ECG:
4.
HYPEROXIA TEST
5.
6.
PROSTAGLANDIN E1:
1)Cyanosis with
PBF
a)TOF
b)Pulm. Atresia
c)Tricuspid Atresia
d)Critical PS
arteriosus
2) Cyanosis with
PBF
a) D-TGA
b) DORV
c) TAPVC
d) Truncus
Tetraology of Fallot
1. VSD
2. RVOT Obstruction
3. RVH
4. Overriding aorta
TETRALOGY OF FALLOT
Infundibular PS
Aorta
overrides
septum
LA
VSD
RA
LV
RV
RVH
Degree of RVOT
TETRALOGY
OF FALLOT
Ejection systolic
systolic
Ejection
murmur
murmur
Single S2
S2
Single
RV
HYPERTROPHY
NO RV
RV heave
heave
NO
INFUNDIBULAR
STENOSIS
AORTIC OVERRIDE
VSD
NO
NO CYANOSIS
CYANOSIS
MILD
MILD CYANOSIS
CYANOSIS
Hypoxic Spell
(TET Spell)
?
Spasm
of
RVOT
Decrease
d SVR
crying
Increased
R-L shunt
Hypoxic spell
Increased
systemic
venous return
Hyperapnea
Decreased
pO2
Increased
pCo2
Decreased pH
TETRALOGY
OF FALLOT
HYPERCYANOTIC
SPELL
POSITIVE
FEEDBACK
CYANOSIS
ACIDOSIS
Tachypnoea
Tachypnoea
NO ejection
ejection
NO
systolic murmur
murmur
systolic
Death
Death
Cyanotic Spells
Increasesystemicvascularresistance
Squat/Kneechestposition
Ketamine1-2mg/kgIV
Neosynephrine0.02mg/kgIV
TachycardiaPropranolol0.1mg/KgIV
Releaseofinfundibularspasm
Irritability
Morphine0.2mg/KgS.CorIM
HypoxiaOxygen
DehydrationVolume
Acidosis
NaHco3 1mEq/ Kg IV
PALLIATED TETRAOGY
Blalock-Taussig shunt
LA
RA
LV
RV
Treatment
Early surgical repair depending
on pts weight
VSD is closed and obstructing
ventricular muscle is removed
Aorta from RV
LA
RA
RV
LV
Complete
separation
of the 2
circuits
Hypoxemic
blood
circulating in
the body
Hyperoxemic
blood
circulating in
the pulmonary
circuit
TGA
RA
RV
RA
RV
BOD
Y
PA
BOD
Y
PA
AOR
TA
LUN
GS
AOR
TA
LUN
GS
LV
LA
LV
LA
TGA
LA
ENLARGEMENT
RV
Aorta
SEVERE
CYANOSIS
LV
PA
CCF
LV
ENLARGEMENT
Two separate
separate
Two
parallel circuits
circuits
parallel
Incompatible with
with
Incompatible
life
life
No murmurs
murmurs
No
Clinical Symptoms
Depend on anatomy present
No mixing lesion and restrictive PFO
Profound hypoxia, deeply cyanotic baby
Rapid deterioration
Death in first hours of life
Absent respiratory symptoms or limited
to tachypnea
Single second heart sound (aortic),
cardiomegaly, no murmurs
Clinical Symptoms
Mixing lesion present (VSD or
large PDA)
Large vigorous infant
Cyanotic, a VSD murmer may be
audible
Little to no resp distress
Most likely to develop CHF(LHF) in
first few weeks of life
excessive sweating (a cold, clammy
sweat often noted during feeding);
poor feeding, slow weight gain,
CXR
Egg shaped
cardiac
silhouette
Narrow
superior
mediastinu
m
Management
Prostaglandin to
establish patency of the
ductus arteriosus
Increases shunting from aorta
into the pulmonary artery
Increases pulmonary venous
return distending the left
atrium
Facilitates shunting from the
left to the right atrium of fully
saturated blood across the
foramen ovale.
Management
Therapeutic balloon atrial
septostomy (Rashkind
Procedure) if surgery is not
going to be performed
immediately
Improves mixing and pulmonary
venous return at the atrial level
TGA
IVC
Rashkind
atrial
septostomy
PDA
Followed by
by ::
Followed
Arterial switch
switch or
or
Arterial
Mustard operation
operation
Mustard
Treatment
4 Types
1. Supracardiac
Common pulmonary vein drains
into the SVC via the left SVC and
left innominate vein.
2. Cardiac
The common PV drains into the
coronary sinus
3. Infracardiac
The common PV drains into the
portal vein, ductous venosus,
hepatic vein, or IVC.
4. Mixed
A combination of the other types
Like
ASD
Like
MS
Treatment
Digitalis and diuretics to treat
heart failure
Intubation and inc PEEP for
those with severe pulm over load
Corrective surgery
Tricuspid Atresia
Tricuspid valve is absent
RV and PA are hypoplastic
Associated defects- PFO/ASD/
VSD or PDA (necessary for
survival)
Dilation of LA and LV
Essentially single
ventricle physiology
TRICUSPID ATRESIA
LA
RA
VSD
LV
Atretic TV
Clinical Signs
Severe cyanosis, poor feeding,
tachypnea
Single S2, grade 3/6 systolic murmur
at LLSB if VSD is present, PS murmer
may present
Superior QRS axis, with RAH, LVH
CXR- boot shaped heart
Treatment
PGE IV infusion
1. Blalock-Taussig shunt in infancy
systemic to pulmonary arterial shunt
Provide stable blood flow to the lungs
A gortex tube is sewen between the
subclavian artery and the right
pulmonary artery
2. Bidirectional Glenn
(till age of
4-6yrs)
3. Fontan Procedure
(final procedure)
TRUNCUS ARTERIOSUS
Aorta
Pulmonary
artery
Truncus
VSD
RA
LV
RV
Clinical Signs
Cyanosis immediately after birth
Early signs of CHF
2-4/6 systolic murmur at LSB suggestive of
VSD
In single ventricle there
is poor QRS progression
Treatment
Anticongestive medications (diuretics
and digitalis)
Corrective surgery
VSD is closed
Pulmonary artery is separated from the
truncus
Continuity is then established between the
right ventricle and the pulmonary artery
utilizing a valved homograft conduit
Thank you