Types of atrial septal defect

 Ostium secundum atrial septal defect

 Ostium primum atrial septal defect
 Sinus venosus atrial septal defect
 Coronary sinus atrial septal defect

Management

 A physician decides the best course of treatment for asd based on:
o A child’s age, overall health and medical history
o Severity of the disease
o A child’s tolerance for specific medications, procedures, or therapies
o Expectations for the course of the disease
o Parents’ opinions or preferences

Medical management

 Many children have no symptoms and require no medications

 Digoxin
 Diuretics

Complications

 Right-sided heart failure

 Heart rhythm abnormalities (arrhythmias)
 Increased risk of a stroke
 Infective endocarditis
 Less common serious: pulmonary hypertension

Tetralogy of fallot

 Boot-shaped heart
 Overriding aorta; displacement of the aorta over the ventricular septal defect
 Ventricular septal defect
 Right ventricular hypertrophy
 Pulmonary stenosis

Tetralogy of fallot (tof) – congenital heart defect which is classically understood to involve four
anatomical abnormalities of the heart

- Most common cyanotic heart defect, and the most common cause of blue baby syndrome
- Usually a right-to-left shunt, in which higher resistance to right ventricular outflow results in
more severe cyanosis symptoms
- Characterized by the combination of four defect:
o Pulmonary stenosis
o Ventricular defect
o Overriding of aorta
o Right ventricular hypertrophy
- Rare , complex heart defect that occurs in about 5 out of every 10,000 babies
- Affects boys and girls equally
 Ventricular septal defect (vsd)
Overriding aorta – aortic valve is enlarged and appears to arise from both the left and
right ventricles instead of the left ventricle as in normal hearts
Pulmonary stenosis – narrowing of the pulmonary valve and outflow tract or area below
the valve that creates an obstruction (blockage) of blood flow from the right ventricle to the
pulmonary artery
Right ventricular hypertrophy – thickening of the muscular walls of the right ventricle;
which occurs because the right ventricle is pumping at high pressure

Causes of tetralogy of fallot

 Cause is unknown
 Certain conditions or factors that occur during pregnancy may raise risk for having a child
with tetralogy of fallot; these conditions and factors inclue:
o German measles (rubella) and some other viral illnesses
o Poor nutrition
o Overuse of alcohol
o Age (being older than 40)
o Diabetes
 Heredity may play a role in causing tetralogy of fallot

Clinical manifestation

 Clinical feature of tof depend upon size of vsd and degree of right ventricular outflow
obstruction
 Blue baby or cyanosis of lips and nailbed with dyspnea is found initially with crying and
exertion in neonates especially when the ductus arteriosus beings to close
 Hypercyanotic spells
 Irritability
 Dyspnea
 Cyanosis
 Tet spell
 Flaccidity with or without unconsciousness
 Slow weight gain
 By the age of 2 year, the child usually develop clubbing
 Metabolic acidosis
 Exercise intolerance may develop

Diagnostic test

 History of illness
 Physical examination
 Chest x-ray
 Ecg
 2-d echo
 Cardiac catheterization

Management
  The child with tof should be managed for cyanosis, hypoxia spells and other associative
complication
 Oxygen therapy
 Correction of dehydration
 Anemia
 Antibiotic therapy
 Supportive nursing care and continuous monitoring of child’s condition
 Hypoxic spells should be managed
o Knee chest position
o Sedative
o Oral propranolol therapy
o Iv fluid
o Treatment of acidosis
o Oxygen therapy
 Neonate
o Prostaglandin e1

Surgical management

 Palliative surgery
 Definitive correction
 Complete intracardiac repair
 Palliative surgery is performed by different technique:
o Modified bt shunt
o Potts operations
o Waterson’s operations