Alterations in Oxygenation Alterations in Oxygenation

Neonate Neonate
Congenital Heart Defects Congenital Heart Defects
1. Defects with !ncreased Pulmonary Blood flow 1. Defects with !ncreased Pulmonary Blood flow
c. ventricular Septal Defect c. ventricular Septal Defect
0 ventri0lar Septal Defe0t 0 ventri0lar Septal Defe0t
an opening is present in the sept4 an opening is present in the sept4
between the two ventri0les, the right and between the two ventri0les, the right and
the left ventri0les the left ventri0les
between forth and eight weeks between forth and eight weeks
gestation, the single ventri0lar 0ha4ber gestation, the single ventri0lar 0ha4ber
is divided into two by fsion of the is divided into two by fsion of the
4e4branos portion of the ventri0lar 4e4branos portion of the ventri0lar
sept4, the endo0ardial 0shions and sept4, the endo0ardial 0shions and
blbos 0ordis blbos 0ordis
inadeqate develop4ent of any of inadeqate develop4ent of any of
these str0tres reslts ion abnor4al these str0tres reslts ion abnor4al
0o44ni0ation between the two ventri0les 0o44ni0ation between the two ventri0les
it 4ay vary in size fro4 a s4all it 4ay vary in size fro4 a s4all
pinhole to absen0e of the sept4, pinhole to absen0e of the sept4,
reslting in a 0o44on ventri0le reslting in a 0o44on ventri0le
abot 80 of 0hildren with s4all abot 80 of 0hildren with s4all
ventri0lar septal defe0t experien0e ventri0lar septal defe0t experien0e
spontaneos 0losre of the defe0t, sally spontaneos 0losre of the defe0t, sally
at 10 years of age as a reslt of growth at 10 years of age as a reslt of growth
and proliferation of the 4s0lar sept4 and proliferation of the 4s0lar sept4
n0iden0e n0iden0e
ventri0lar septal defe0t is the 4ost ventri0lar septal defe0t is the 4ost
0o44on 0ongenital heart defe0t, it 0o44on 0ongenital heart defe0t, it
a00onts for 30 of all 0ases of all a00onts for 30 of all 0ases of all
0ongenital heart defe0ts, or abot 3 in 0ongenital heart defe0ts, or abot 3 in
every 1000 live births every 1000 live births
the 4ale to fe4ale ratio is 1:1 the 4ale to fe4ale ratio is 1:1
Altered He4odyna4i0s Altered He4odyna4i0s
the higher pressre within the left the higher pressre within the left
ventri0le and be0ase the syste4i0 arterial ventri0le and be0ase the syste4i0 arterial
0ir0lation offers 4ore resistan0e than the 0ir0lation offers 4ore resistan0e than the
pl4onary 0ir0lation, blood flow fro4 the pl4onary 0ir0lation, blood flow fro4 the
left ventri0le to the right ventri0le, into the left ventri0le to the right ventri0le, into the
pl4onary artery pl4onary artery
the in0reased blood vol4e is the in0reased blood vol4e is
p4ped into the lngs, whi0h 4ay p4ped into the lngs, whi0h 4ay
eventally reslt in in0reased pl4onary eventally reslt in in0reased pl4onary
vas0lar resistan0e vas0lar resistan0e
in0reased pressre in the right in0reased pressre in the right
ventri0le as a reslt of the left to right ventri0le as a reslt of the left to right
shnting 0ases right ventri0lar shnting 0ases right ventri0lar
hypertrophy hypertrophy
if the right ventri0le is nable to if the right ventri0le is nable to
a00o44odate the in0reased workload, the a00o44odate the in0reased workload, the
right ventri0le 4ay also enlarge as it right ventri0le 4ay also enlarge as it
atte4pts to over0o4e the resistan0e de atte4pts to over0o4e the resistan0e de
to in0o4plete ventri0lar e4ptying to in0o4plete ventri0lar e4ptying
lini0al Nanifestations lini0al Nanifestations
vSD 4ay not be evident at birth, with vSD 4ay not be evident at birth, with
in0o4plete opening of the alveoli, there is in0o4plete opening of the alveoli, there is
still high pl4onary resistan0e, 0asing still high pl4onary resistan0e, 0asing
little blood to be shnted throgh the little blood to be shnted throgh the
defe0t defe0t
at abot 4 to 8 weeks of age, the at abot 4 to 8 weeks of age, the
infant begins to de4onstrate easy infant begins to de4onstrate easy
fatigability, and a lod, harsh systoli0 fatigability, and a lod, harsh systoli0
4r4r is evident along the left sternal 4r4r is evident along the left sternal
border at the third or forth inter0ostal border at the third or forth inter0ostal
spa0e spa0e
a thrill also 4ay be palpable a thrill also 4ay be palpable
Assess4ent and Diagnosis Assess4ent and Diagnosis
*e0ho0ardiography *e0ho0ardiography
the diagnosis of vSD is based on the diagnosis of vSD is based on
exa4ination by e0ho0ardiography with 0olor flow exa4ination by e0ho0ardiography with 0olor flow
Doppler whi0h reveals right ventri0lar Doppler whi0h reveals right ventri0lar
ventri0lar hypertrophy and possibly pl4onary ventri0lar hypertrophy and possibly pl4onary
artery dilatation fro4 the in0reased blood flow artery dilatation fro4 the in0reased blood flow
*ele0tro0ardiography *ele0tro0ardiography
an E will reveal right ventri0lar and an E will reveal right ventri0lar and
pl4onary artery hypertrophy pl4onary artery hypertrophy
*radiography *radiography
ardia0 0atheterization 4ay be done to ardia0 0atheterization 4ay be done to
deter4ine the exa0t lo0ation of the defe0t deter4ine the exa0t lo0ation of the defe0t
'herapeti0 Nanage4ent 'herapeti0 Nanage4ent
if the defe0t is s4all and the 0hild is if the defe0t is s4all and the 0hild is
asy4pto4ati0, the defe0t 0loses spontaneosly asy4pto4ati0, the defe0t 0loses spontaneosly
Antibioti0 prophylaxis are given to prevent ba0terial Antibioti0 prophylaxis are given to prevent ba0terial
endo0arditis endo0arditis
0losre is ne0essary be0ase if the defe0t is left 0losre is ne0essary be0ase if the defe0t is left
open, infe0tios endo0arditis and 0ardia0 failre 0an open, infe0tios endo0arditis and 0ardia0 failre 0an
o00r o00r
*interventional 0ardia0 0atheterization *interventional 0ardia0 0atheterization
*open heart srgery *open heart srgery
0ardiopl4onary bypass is done, then the 0ardiopl4onary bypass is done, then the
edges of the opening are approxi4ated and stred edges of the opening are approxi4ated and stred
if the defe0t is ex0eptionally large, a if the defe0t is ex0eptionally large, a
Silasti0 or Da0ron pat0h is stred into pla0e to Silasti0 or Da0ron pat0h is stred into pla0e to
o00lde the opening o00lde the opening
done for defe0t over 344,before 2 years done for defe0t over 344,before 2 years
of age to prevent pl4onary artery hypertension of age to prevent pl4onary artery hypertension
!rsing onsiderations !rsing onsiderations
pre preoperative preparations operative preparations
ensre asepti0 te0hniqe in the srgi0al ensre asepti0 te0hniqe in the srgi0al
and invasive 4anage4ent and invasive 4anage4ent
postoperatively, be alert of arrhyth4ia postoperatively, be alert of arrhyth4ia
be0ase ede4a in the sept4 4ay interfere be0ase ede4a in the sept4 4ay interfere
with ventri0lar 0ond0tion with ventri0lar 0ond0tion
0hildren 4ay re0eive prophyla0ti0 0hildren 4ay re0eive prophyla0ti0
antibioti0s to prevent ba0terial endo0arditis for 6 antibioti0s to prevent ba0terial endo0arditis for 6
4onths after the srgery 4onths after the srgery
'hank Yo 'hank Yo