Name Picture Signs and Symptoms Treatment Nursing NotesVentral Septal Defect(VSD)

Most common! Abnormal connection between the R and L ventricles. Lowers Cardiac Output.Flow from L to R, pulmonary congestion.*Asymptomatic*CHF*Enlarged heart*Acyanotic

-Surgical repair-May close by 2 yrs old.

Atrial Septal Defect(ASD)

Flow from L to R, pulmonary congestion.

*Asymptomatic*CHF*Acyanotic

-Diuretics for CHF-Surgery

You can wait for surgery if asymptomatic bc it may resolve spontaneously.

As the murmur gets louder, the hole is closing.

TricuspidAtresia

Absent tricuspid valve! The Foremen Ovale is used (remember the pressure causes this). HIGH right-sided pressure. Unoxygenated blood is shunted to L. atrium into the L. ventricle then to the body and lungs.

Increase pulmonary blood flow by using the patent ductus arteriosus with Prostiglandin*Surgery -glenn procedure -atrial septostomy -shunting -fontan procedure

There is currently NO way to replace an atrial valve

Patient DuctusArteriosus

Left to right shunting. Fibers don’t respond to the increase in O2 after birth.*Continuous murmur below left clavicle*Asymptomatic or murmur*Bounding pulses*Widening pulse pressure of >20 (systolic-diastolic)

Indomethacin:*preterm only!*NSAID *prostaglandin inhibitor*only if no other defects & asymptomatic

other option:-surgery

Dx: by echo or xray

Atrio-ventricular Septal Defect

Severe left to right shunt. LUNGS ARE MOST EFFECTED*severely impaired Cardiac Output

See ASD & VSD See ASD & VSD

Aortic Stenosis

Not always the valve. Could be general area.*Hypertrophy of L. Ventricle*Enlarged heart

Meds can reduce symptoms (<BP) but cannot cure.

Surgery: valve replacements and catheterizations

This is found to be one of the reasons for kids falling dead during sports.

Coarctation of the Aorta

Pinching/stricture of the aorta. High pressure behind and in front.*BP okay in hands/arms but low in lower limbs.*Bounding pulses in upper body but weak in lower.

*Prostaglandin E1 to open artery by relaxing the muscle.*Diuretics and inotropic drugs to treat s/s*Surgical Repair*Catheterization

Always check pulses both sides and upper and lower extremities!

Transposition of the Great Arteries

Unoxygentated blood enters the R. atrium and R. Ventricle. Parallel circulation.*Initially appears normal*Cyanosis develops w/in a few hours of life

Prostiglandin immediately to keep PDA open.

Surgery

This is NOT compatible with life. You WANT another defect to help.

Can be detected by US if they receive prenatal care.

Total Anomalous Pulmonary Connection

*Cyanosis develops w/in a few hours to a few weeks of life depending on configuration*Tachypnea*Dyspnea*Snowman-figure 8 appearance on chest xray*R. Ventricular hypertrophy*Enlarged heart*Murmurs

Surgery to reconnect the pulmonary arteries to the left atrium and to close the (ASD) atrial septal defects

Sometimes can be detected in utero via ultra sound.

Truncus Arteriosus

*Cyanosis develops w/in a week or two of life*CHF s/s*Hazy chest x-ray*Possible hepatomegaly*Poor feeding*Facial swelling or neck vein distention

Medicines such as diuretics and inotropic meds to manage signs/symptoms.

Surgery: separating the pulmonary arteries from the truncus, closure of the septal defects, create connection from pulmonary arteries to the right ventricle.

Possibly not on exam

Hypoplastic Left Heart Syndrome

Left ventricle is tiny and aortic stenosis is present.*O2 sats 70-80’s*Cyanosis*Poor feeding*Tachypnea*Dyspnea*Weak/rapid pulses*Lethargy*Cool/clammy skin*Dilated pupils/lackluster stare

*Heart transplant*3 step surgical process (70-80% survive; live in the hospital)*Do nothing

Not compatible with life

Pulmonary Stenosis

*Central cyanosis*CHF s/s*Possible Right-sided hypertrophy*Back up pressure can open up Foreman Ovale

Prostiglandin given to keep PDA open

Surgery: Percutaneous balloon vulvuloplasty

Tetralogy of Fallot

Combination of pulmonic stenosis, right ventricular hypertrophy, overriding aorta and VSD. Mixed blood is sent out to system.*Cyanosis*O2 sats 80-85’s*Tachypnea*Irritability

Treat symptoms:-Decrease venous return-Conservative O2-Comfort and stop crying to minimize O2 consumption

Don’t want to put a lot of oxygen on them.

Squat knee to chest to get O2 by restricting venous return and getting O2 to main organs.

May be associated with chromosomal abnormalities