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Study Notes Pediatrics

Study Notes Pediatrics


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Published by MedShare
Study Notes Pediatrics
Study Notes Pediatrics

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Published by: MedShare on Apr 01, 2010
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* Endocardial cushion defect is a common AV canal, an ASD and VSD. Even through left-to-right, they become
cyanotic because of increased flow to the lungs, pulmonary hypertension, then Eisenmenger syndrome.
* Endocardial cushions are where the valves come from and the septum. So ASD, VSD, and cleft mitral valve.
* Endocardial cushion defects more common in Down syndrome, trisomy 21. Since there is a huge flow to the
lungs, these patients will go into heart failure very easily (1-3mo of age). Now you’re stuck, you have to wait for the
child to be big enough so the surgery is feasible, but many times the kid can’t get big enough due to illness.
* Patients will have heart failure early in infancy, hepatomegaly indicative of right sided failure, and FTT.
* CXR shows increased pulmonary blood flow. Will have pulmonary hypertension so can develop Eisenmenger.
* Exam can show a thrill. S2 will be widely split because of increased pulmonary blood flow. Diastolic murmur can
occur due to mitral valve insufficiency.
* Best test is echocardiogram. CXR will show enlarged heart. ECG will show LAD, biventricular hypertrophy, RV
conduction delay. Color flow Doppler with echo will show blood shunting at both levels, atrium and ventricles.
* Treatment is medical management of heart failure until surgery. Surgery is patching ASD and VSD then fixing the
cleft mitral valve if possible. Technically that is easy to do, the problem is post-operatively because now you have
no pop-off valve, right side of the heart is not use to pumping against high pressures, if high pulmonary hypertension
the right side of the heart can fail.
* Just because you hear a murmur doesn’t mean jump to the echo. Do a CXR and ECG first, then echo.
* Fetal echocardiography is not a screening test. It is for diagnosis.


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