Alterations in Oxygenation

Neonate Congenital Heart Defects 1. Defects with Increased Pulmonary Blood flow d. Atrioventricular Canal Defect or Endocardial Cushion Defect

d. Atrioventricular Canal Defect or Endocardial Cushion Defect

- results form incomplete fusion of the endocardial cushion or the septum of the heart at the junction of the atria and ventricles - usually there is a low atrial septal defect continuous with high ventricular septal defect and distortion of the mitral and tricuspid valves - the blood flow is left to right, but blood may flow between all four chambers

- because of the failure of the septum to from between the atria and ventricles, conduction system is affected - it leads to same manifestations as other septal defects (right ventricular hypertrophy, increased pulmonary blood flow)

 Altered Hemodynamics
- immediately after birth, while the newborns pulmonary vascular resistance is high, there is minimal shunting of blood through the defect. Once this resistance falls, left to right shunting occurs and pulmonary blood flow increases - the resultant pulmonary vascular engorgement predisposes development of congestive heart failure

 Clinical Manifestations
- at birth signs and symptoms are minimal except during crying or on exertion, when cyanosis occurs - if a complete atrioventriculoar canal defect is present, caynosis will be more severe - murmurs characteristic of an atrial septal dfect or ventricular septal dfect may be found.

 Assessment and Diagnosis

*electrocardiography - may reveal first degree heart block as impulse conduction is halted before the AV node *echocardiography - will confirm the diagnosis, revealing absence of the atrioventricular septum *cardiac catheterization - findings are characteristic of a left to right shunt and indicate the presence and location of septal defects

 Therapeutic Management
*open heart surgery - surgery may involve a valve repair (valvuloplasty) as well as septal repair because these defects are too large to close spontaneously - operative mortality depends on the severity of the defect and the age of the child at the time of surgery and varies from 10% to 35%

 Nursing Considerations
- pre-operative preparations - ensure aseptic technique in the surgical and invasive management - post-operatively observe for the following: bleeding, heart block, arrhythmias and congestive heart failure - these patients are at risk for bacterial endocarditis and require antibiotic prophylaxis

Thank You