ALTERATIONS IN OXYGENATION

CONGENITAL HEART DISEASE

 Classification of heart disease
1. ACYANOTIC
a. INCREASED PULMONARY BLOOD FLOW
 Ventral septal defect
 Atrial septal defect
 Patent ductus arteriosus
b. OBSTRUCTION OF BLOOD FLOW LEAVING THE HEART
 Pulmonary stenosis
 Aortic stenosis
 Coarctation of aorta

2. CYANOTIC HEART DISEASE

a. DECREASED PULMONARY BLOOD FLOW
 Tricuspid atresia
 Tetralogy of fallot
b. MIXED BLOOD FLOW
 Transposition of the Great arteries
 Total anomalous Pulmonary venous return
 Hypoplastic left heart syndrome

ACYANOTIC HEART DISEASE

1. INCREASED PULMONARY BLOOD FLOW
 Moves blood from the arterial to the venous system
 Oxygenated to unoxygenated blood or LEFT-RIGHT shunts.
 Indicates the presence of a defect that permits the passage of blood from the higher pressure,
left sided cardiac chamber to a lower pressure, right sided cardiac chamber.
 Causes the heart to function as an ineffective pump and make the child prone to heart failure.

a. VENTRAL SEPTAL DEFECT

 Most common type of congenital heart disease
 Opening is present in the septum between the two ventricles
 Pressure in the left ventricle is greater than in the right ventricles
 This impairs the effort of the HEART

Right ventricular hypertrophy

Increased pressure in the pulmonary artery
Assessment
 Easy fatigue
 Dyspnea
 Swelling of extremities
 Crackles
 Sweating
 Low growth rate
 Loud, harsh pansytolic murmur ( left sterna border, 3rd or 4th interspace)
 Thrill (variation) – vibratory sensation felt on the skin overlying an area of turbulence and
indicates a loud heart murmur usually caused by an incompetent heart valve.

Diagnosis
 Echocardiography with color flow Doppler
 MRI ( reveals right ventricular hypertrophy and possibly pulmonary artery dilatation from the
increased blood flow)
 ECG ( reveal ventricular hypertrophy)

Therapeutic management
 Cardiac catheterization ( to close in moderate size)
 Open heart surgery ( large/ >3mm)
 Digoxin
 diuretics

b. ATRIAL SEPTAL DEFECT

 Abnormal communication between the two atria, allowing blood to shift from left to the right
atrium.
 More common in girls than boys

Types:
 Ostium Premium (ASD1) – opening is at the lower end of the septum
 Ostium secundum ( ASD2) – opening is near the center of the septum

Assessment:
 Harsh systolic murmur over the 2nd or 3rd interspace (pulmonic area)
 WHY? Because of the extra amount of shunted blood that crosses the pulmonic valve .
leading to the fixed splitting of second heart sound
 Enlarged right side of the heart via echocardiography
 Increased pulmonary circulation
 Separation in the atrial septum
 Increased oxygen saturation in the right atrium

Diagnosis:
 Echocardiography
  Cardiac catheterization
 Doppler

Therapeutic Management:
 Surgery – to close the defect ( the edges of the septum are approximated and sutured with
cardiac catheterization technique if the defect is small)
 Large defects may require open heart surgery and cardiopulmonary bypass—a Silastic or
Dacron patch may be sutured into place to occlude the space
 Done between 1 and 3 years of age