ASD

• Atrial Septal Defect (hole in atrial septum)
  • If the defect is large, significant amounts of oxygenated blood gets pushed back to the right atrium from the left. It then goes to the right ventricle and is pumped to the lungs, creating extra workload for the heart.
  • Usually asymptomatic till later in life. May be repaired with open-heart surgery or during cardiac cath.

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VSD

• Ventricular Septal Defect
  • A congenital heart defect where an abnormal opening exists in the ventricular septum. Blood flows from the higher pressure left ventricle (through the defect) into the right ventricle.
  • The added workload may lead to hypertrophy.
  • Pt. is often asymptomatic till several weeks after birth. A large VSD may cause failure to thrive.
  • Pulmonary hypertension from VSD may permanently damage vessel walls.
  • VSD's are usually repaired (open-heart) in infancy.

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PDA (Patent Ductus Arteriosus)

• When the ductus arteriosus fails to close normally (within a few hours of birth), some blood that should go through the aorta to the body is returned to the lungs instead. This is common in premature babies and uncommon otherwise.
• With this problem, the child may fatigue easily, become tachypnic, and have restricted growth. Symptoms may not occur for several weeks or months after birth. 
• Indomethicin is administered to promote closure. If surgery is required, it can be performed by laproscopic tying or clipping of the ductus or occlusion during cardiac cath.

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Coarctation of the Aorta

• The aorta is constricted, slowing bloodflow to the lower body and decreasing blood pressure at the lower extremities.
• Blood pressure to upper body is elevated due to location of obstruction.
• Usually asymptomatic at birth, symptoms may develop as soon as a week later.
• The baby may develop heart failure or hypertension which require early surgery, though waiting till later in early childhood is preferred.
• Open-heart surgery is not required for repair. The aorta can be modified with a natural or synthetic graft to eliminate the constriction.
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Pulmonary Stenosis

• A narrowing of the pulmonary (pulmonic) valve or just above it results in the right ventricle pumping harder than normal. If the stenosis is severe, some cyanosis may occur, though older children are often asymptomatic.
• Treatment is required when rt. ventricle pressure is high (even is asymptomatic). Often, the obstruction can be relieved with balloon valvuloplasty/stenting. Sometimes open surgery is needed.

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• "Tet" spells
  • calm the infant
  • Knee-chest position
  • 100% oxygen by mask
  • Morphine SQ or IV

Persistent Fetal Circulation

Persistent Fetal Circulation describes continued blood flow through the ductus arteriosus AND the foramen ovale after birth.

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Tetralogy of Fallot

• Four defects (common with Down's Syndrome)
• Ventricular Septal Defect (VSD)
• Pulmonic Stenosis
• Overriding Aorta
• Right Ventricular Hypertrophy

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S&S of Tetralogy of Fallot

• Cyanosis
• Murmur
• Poor growth
• Hypercyanotic or "Tet spells"
• Clubbing of fingers
• Squatting

Nursing care for Tetralogy of Fallot

• Monitor growth pattern
• Observe for CHF
• Cyanosis and Tet spells
• Pre and post op care

Tricuspid Atresia

• An imperforated tricuspid valve
  • results in no communication between the right atrium and the right ventricle
• Foramen Ovalve (or ASD) allows blood flow to left side with enlarded mitral valve and left ventricle
• Usually have a hypoplastic or absent right ventricle
  • Often have pulmonic stenosis
• Third most common cyanotic heart defect
• Without an additional defect, possibility of survival is nil.

S&S of Tricuspid Atresia

• Central cyanosis
• Tachypnea
• Murmur
• Clubbing
• Polycthemia (too many RBC)
• Poor Growth
• Hypercyanotic spells

What medical treatment is essential for Tricuspid Atresia until surgical repair?

• Prostaglandin
  • Keeps ductus arteriosus patent (open)

Rashkind procedure

• Procedure used to increase ASD size (balloon septostomy) in Tricuspid Atresia

Nursing Care for Tricuspid Atresia

• Monitor growth pattern
• Observe for CHF
• Dehydration
• Cyanosis & hypercyanotic spells
• Pre/post op cares

Transposition of Great Arteries

• Pulmonary Artery Leaves the left ventricle and the aorta leaves the right ventricle
  • results in two parellel, separate circuits
• Septal defects or Patent Ductus Arteriosus is REQUIRED for mixing to occur
• Those with no ventricular septal defect are dependant on their patent ductus arteriosus for life.

S&S of Transposition of Great Arteries

• Varying degrees of cyanosis
• CHF
• Cardiomegaly
• Clubbing
• Poor growth
• CXR shows characteristic "egg on it's side" shape

Early treatment for Transposition of Great Arteries before surgery

• Continuous prostaglandin drip (PGE1)
• or Rashkind balloon atrial septostomy

Aortic Stenosis

• Aortic Stenosis describes a narrowing of the aortic valve or just superior to it. Valvular stenosis results from an incompletely formed valve with only one or two cusps which lack compliance.
• Most children are asymptomatic. If there are symptoms, they may include low blood pressure, faintness/dizziness, rapid pulse, and poor feeding in infancy, and exercise intolerance.
• The valve may be repaired or replaced.