Pediatric Congenital Heart Conditions There are several pediatric congenital heart conditions that can occur and it is important as practitioners that each can be recognized as not to delay treatment. This article speaks of three different types of congenital heart conditions; the presentation, exam, diagnosis, treatment, and any long term effects for the patients.
Patent Ductus Arteriosus In utero the ductus arteriosus connects the aorta and pulmonary artery. It allows blood to flow from the pulmonary artery to the aorta and out to the body without going through the lung due to the fact that the fetus gets oxygenated from the mother (Ellis, 2016). After birth this artery should close in order to prevent the mixing of arterial and venous blood, if this does not close then the baby is said to have patent ductus arteriosus (PDA). Presentation According to Luke (2015), PDA can present at any age, because the child can be asymptomatic and this could present as an adult. The child may report decrease exercise tolerance, or pulmonary congestion with a murmur. Three to six week old infants may present with tachypnea, diaphoresis, difficulty with feedings, and weight loss (Luke, 2015). Adults may present with symptoms of heart failure, or cyanosis to the lower extremities. Exam PDA can be challenging to discern due to it may vary in size, presentation and may be missed at birth. Patients can look well and have normal vital signs, but a widened pulse pressure may be present, tachypnea, tachycardia and a suprasternal or carotid pulsations may be prominent; in neonates a heart murmur may be discovered within the first few days or weeks of life (Luke, 2015). The hallmark finding of PDA has been a murmur which has been described as “machinery” which is continuous and is accentuated during systole (Luke, 2015). Approximately one third of the children with PDA are also small for their gestational age. Diagnosis The diagnosis of PDA is based on physical exam and the echocardiogram which is the primary study used (Luke, 2015). Treatments There are three ways that PDA can be treated medication, catheter closure, or surgical closure. Although a spontaneous closure of the ductus arteriosus is common. If the patient delivers with respiratory distress at delivery then intravenous (IV) indomethacin or IV ibuprofen is used and is effective in closing the opening if administered within 10-14 days of life (Luke, 2015). Any patient that has PDA the opening should be closed due to the patient’s risk of bacterial endocarditis. Over time this opening causes increased pulmonary blood flow which in turn causes pulmonary vascular disease which is ultimitly fatal (Luke, 2015). After the patient’s first birthday cardiac catheterization is the most common treatment modality for PDA and over the past four decades many techniques and devices have been developed for this type of occlusion (Luke, 2015). Contraindications to this type of closure would be the size of the opening of the artery. In which the larger openings then would require the standard open surgical treatment, which is still a successful, low-risk procedure …show more content…
Other tests that can be useful but not used for a definitive diagnosis are hemoglobin and hematocrit studies, chest x-ray, magnetic resonance imaging, and electrocardiography.
Treatments
Surgical treatment is required but due to TOF being a progressive disorder the timing of the surgery may be different because of the severity of the anomaly. Currently the trend is to have the surgery before the age of one year old, in which the primary operation is usually performed under cardiopulmonary bypass and are aimed at closing the ventral septal defect, resect the area of infundibular stenosis, and relieve the right ventricular outflow obstruction (Bhimji, 2015).
Long term consequences According to Bhimji (2015), patients with TOF are surviving longer than 15-20 years after their first operation. The major complication after surgery is the development of pulmonary valve regurgitation in which they would require a pulmonary valve replacement. Most patients receive a pericardial homograft and there is no telling how long these valves will last (Bhimji, 2015). These patients also have a risk of endocarditis and will need prophylactic antibiotic for some surgical and all dental procedures for life (Bhimji,
Patent Ductus Arteriosus In utero the ductus arteriosus connects the aorta and pulmonary artery. It allows blood to flow from the pulmonary artery to the aorta and out to the body without going through the lung due to the fact that the fetus gets oxygenated from the mother (Ellis, 2016). After birth this artery should close in order to prevent the mixing of arterial and venous blood, if this does not close then the baby is said to have patent ductus arteriosus (PDA). Presentation According to Luke (2015), PDA can present at any age, because the child can be asymptomatic and this could present as an adult. The child may report decrease exercise tolerance, or pulmonary congestion with a murmur. Three to six week old infants may present with tachypnea, diaphoresis, difficulty with feedings, and weight loss (Luke, 2015). Adults may present with symptoms of heart failure, or cyanosis to the lower extremities. Exam PDA can be challenging to discern due to it may vary in size, presentation and may be missed at birth. Patients can look well and have normal vital signs, but a widened pulse pressure may be present, tachypnea, tachycardia and a suprasternal or carotid pulsations may be prominent; in neonates a heart murmur may be discovered within the first few days or weeks of life (Luke, 2015). The hallmark finding of PDA has been a murmur which has been described as “machinery” which is continuous and is accentuated during systole (Luke, 2015). Approximately one third of the children with PDA are also small for their gestational age. Diagnosis The diagnosis of PDA is based on physical exam and the echocardiogram which is the primary study used (Luke, 2015). Treatments There are three ways that PDA can be treated medication, catheter closure, or surgical closure. Although a spontaneous closure of the ductus arteriosus is common. If the patient delivers with respiratory distress at delivery then intravenous (IV) indomethacin or IV ibuprofen is used and is effective in closing the opening if administered within 10-14 days of life (Luke, 2015). Any patient that has PDA the opening should be closed due to the patient’s risk of bacterial endocarditis. Over time this opening causes increased pulmonary blood flow which in turn causes pulmonary vascular disease which is ultimitly fatal (Luke, 2015). After the patient’s first birthday cardiac catheterization is the most common treatment modality for PDA and over the past four decades many techniques and devices have been developed for this type of occlusion (Luke, 2015). Contraindications to this type of closure would be the size of the opening of the artery. In which the larger openings then would require the standard open surgical treatment, which is still a successful, low-risk procedure …show more content…
Other tests that can be useful but not used for a definitive diagnosis are hemoglobin and hematocrit studies, chest x-ray, magnetic resonance imaging, and electrocardiography.
Treatments
Surgical treatment is required but due to TOF being a progressive disorder the timing of the surgery may be different because of the severity of the anomaly. Currently the trend is to have the surgery before the age of one year old, in which the primary operation is usually performed under cardiopulmonary bypass and are aimed at closing the ventral septal defect, resect the area of infundibular stenosis, and relieve the right ventricular outflow obstruction (Bhimji, 2015).
Long term consequences According to Bhimji (2015), patients with TOF are surviving longer than 15-20 years after their first operation. The major complication after surgery is the development of pulmonary valve regurgitation in which they would require a pulmonary valve replacement. Most patients receive a pericardial homograft and there is no telling how long these valves will last (Bhimji, 2015). These patients also have a risk of endocarditis and will need prophylactic antibiotic for some surgical and all dental procedures for life (Bhimji,