cardiac diseases in newborn

PEER GROUP DISCUSSION ON

CARDIAC DISEASE IN NEWBORN

Presented by :Ms. Hemlata1915722M.M.C.O.N

INTRODUCTION

ANATOMY OF THE HEART

• The Heart Valves Four types of valves regulate blood flow through your heart:

1. The tricuspid valve

2. The pulmonary valve

3. The mitral valve

4. The aortic valve

FETAL CIRCULATION

INCIDENCE

• 8/1000 live births• 3-4/100 still born• 2/100 premature infants

excluding PDA• 10-25/100 abortuses• Most congenital defects are

well tolerated during fetal life

• Unknown in most cases• Genetic factors - single gene

defect• Chromosomal abnormality.• Environmental factors• Gender differences in type of

CHD

ETIOLOGY

ACYANOTIC HEART DEFECTS

Ma. Tosca Cybil A. Torres, RN

DEFINITION

a congenital disorder manifested with left to right shunting and obstructive lesions. Clinical signs are not always apparent at birth, they manifest anytime during infancy or early childhood.

PATHOPHYSIOLOGY

• Hole in the wall(septum) between right and left atria.

• Commonest type of CHD(30-40%)

• 1Child/1500 Live births

ARTERIAL SEPTAL DEFECT

PATHOPHYSIOLOGY

TYPES

TYPES

ALTERED HEMODYNAMICS

Left to right shunting

Increased blood flow

through ASD

Enlarge right Atrium and

right Ventricle

Increased Pulmonary Blood Flow

DIAGNOSTIC EVALUATION

MANAGEMENT

THERAPEUTICS MANAGEMENT• Elective Surgical Repair (2-5 years of age)MEDICAL MANAGEMENTAtrial dysrythmias (anti-dysrythmics

SYMPTOMATIC CASES

SURGICAL TREATMENT

• Surgical closure using either sutures or a pericardial prosthetic patch is performed on an elective basis early in childhood. This is an open heart procedure, through a sternal incision.

VENTRICULAR SEPTAL DEFECT

A hole in the wall between the two lower chambers is called a ventricular septal defect.

25% In all CHD

VENTRICULAR SEPTAL DEFECT

PATHOPHYSIOLOGY


L R Shunt


through VSD

Pulmonary vascular

circulation receives

increased pulmonary blood flow

Pulmonary hypertensi

on and pulmonary vascular

diseases(EISONMERG

ER’S SYNDROM

E)


20-80% closes spontaneously / no surgeryAntibiotic prophylaxis ACE inhibitors to reduce after loadNutritional supplement to increase calorie intake (infant formula)Prevent respiratory infections

MANAGEMENT

SURGICAL MANAGEMENT

PLACING THE PATCH OVER THE DEFECT THROUGH RA PATCH PLACED, TO AVOID RV

INCISION

Congestive Heart Failure

Growth failure

Irregular rhythm

Pulmonary hypertension

PATENT DUCTUS ARTERIOSUS

The vessel does not close and remains "patent" resulting in irregular transmission of blood between two of the most important arteries close to the heart, the aorta and the pulmonary artery 1 in 2000 live births

PATHOPHYSIOLOGY


L R Shunt


through PDA

Pulmonary vascular

circulation receives

increased pulmonary blood flow

Pulmonary

hypertension

SIGN AND SYMPTOMS


MANAGEMENT

Prostaglandin inhibitor

orally 0.2 mg/kg TDS at an interval of 12 to 24 hours

SURGICAL MANAGEMENT

ATRIO-VENTRICULAR CANAL DEFECT

• Complete absence of AV septum– A common atrioventricular ring– A five leaflet valve that guards

the common AV orifice– An unwedged left ventricular

outflow tract– LV mass characterized by

longer distance from apex to aortic valve than from apex to left AV valve

ENDOCARDIAL CUSHION DEFECT

• AVSDS account for 4% to 5% of congenital heart disease

PATHOPHYSIOLOGY

TYPES OF AVSD

Partial AVSD

•Asymptomatic•Dysnoea•Growth retardation

Complete AVSD

•Tachypne a•Pulmonary vascular obstructive disease


MANAGEMENT

EISENMENGER’S SYNDROME

SIGN AND SYMPTOMS• asymptomatic or have

only mild dyspnea• Reduced exercise

capacity• Dyspnea and fatigue

develop gradually as pulmonary blood flow decreases

• hypoxemia increases due to bidirectional shunting


Transplantation is an effective choice of treatment

MANAGEMENT

CYANOTIC HEART

DEFECTS

TATRALOGY OF FALLOT

1. Ventricular septal defect

2. Pulmonary stenosis

3. Overriding aorta

4. Right ventricular

hypertrophy

PATHOPHYSIOLOGY

`

CLINICAL MANIFESTATION


ON AUSCULTATION A loud harsh systolic murmur may be heard at the left middle to lower sturnal border.

MANAGEMENT

SURGICAL MANAGEMENT

COMPLETE REPAIR

PALLIATIVE SHUNT

TRICUSPID ATRESIA• Failure of the tricuspid

valve to develop consequently no communication form right atrium to right ventricle

• complete mixing of unoxygenated and oxygenated blood in the left side of the heart.

CLINICAL MANIFESTATION

MANAGEMENT

TRANSPOSITION OF THE GREAT ARTERIES

Aorta arising from the right ventricle and pulmonary artery from the left ventricle.

SIGN & SYMPTOMS

PATHOPHYSIOLOGY


MANAGEMENT• CONTROL TO CCF

• Blalock Hanlon procedure -surgical creation or enlargement of an existing arterial septal defect.

• Rash kind operation – enlargement of an existing arterial septal defect.

NURSING DIAGNOSIS1. Decreased cardiac output related to structural

defect2. Activity intolerance related to imbalance between

oxygen supply and demand.3. Altered growth and development related to

inadequate oxygen, nutrients to tissue and social isolation

4. High risk for infection related to debilitated physical status.

5. Altered family process related to having a child with a heart condition.

6. High risk for injury (complications) related to cardiac condition and therapies

RESEARCH ARTICLE• Title:I ncidence of congenital heart disease in

newborns after pulse oximetry screening introduction.

• Authors : Methlouthi J, Mahdhaoui N, Bellaleh M, Guith A, Zouari D, Ayech H, Nouri S, Séboui H.

• Objective: to determine the incidence of congenital heart diseases screened by physical examination coupled with the measure of transcutaneous saturation

• Background : CHD, most common congenital malformations in the newborn with an estimated incidence ranging between 6-9 ‰. In Tunisia, this incidence reaches 1.9 ‰. In fact, the diagnosis is based mainly on clinical examination which allows making the diagnosis only in 50 in 75 % of the cases. Several studies showed the interest of pulse oximetry oximeter in the screening of cyanogenic and duct dependent congenital heart diseases.

• Methods: A descriptive study was conducted. Total 10447 newborn children included who were born in central maternity of sousse.duration of the study was 12 months and transcutaneous saturation of all the newborn children was measured in association to routine physical examination.

• Results : Among 10447, 26 had a congenital heart defect. The incidence of the neonatal cardiac malformations in our current study was found in 2.77 ‰ of alive births. It was about 1.1 ‰ of newborns in a similar study practised in 2009 (Chi2=76.2 et p<10-4).The heart disorder was diagnosed following the grip taking of the only percutaneous saturation in5 newborn children and following the clinical examination in 21.

• Conclusion: The measure of the transcutaneous saturation in the first day of life is a little expensive and specific method for the early screening of the duct dependent cardiac malformations.

SUMMARY

CONCLUSION

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cardiac diseases in newborn