NEONATAL HEART
DISEASES
Presented by :
Ms. Hemlata
Tutor
CON,AIIMS Jodhpur
INTRODUCTION
Congenital Heart Diseases
• They are serious and have significant
impact on morbidity and mortality.
• Its incidence is 8/1000 live birth
Globally
• It is a general term for a
range of birth defects that
affect the normal way the
heart works
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
ETIOLOGY
• Unknown in most cases
• Genetic factors - single gene defect
• Chromosomal abnormality- down syndrome
• Maternal infections- rubella
• Smoking, Alcohol and statins or acne
medicines
• Diabetes in pregnancy
Clinical Classification
Acynotic Heart Cyanotic Heart
Ma. Tosca Cybil A. Torres,
Disease Disease
RN
DEFINITION
A congenital disorder
manifested with left to
right shunting and left
sided obstructive lesions.
Clinical signs are not always
apparent at birth, they
manifest anytime during
infancy or early childhood.
PATHOPHYSIOLOGY
Normal circulation is impaired
Increased pressure in left side of heart
Shunting of blood from left side to right side
Since the left side blood is oxygenated , does not
cause cyanosis
ACYNOTIC HEART DISEASE
ARTERIAL SEPTAL
DEFECT
VENTRICULAR
PATENT
SEPTAL
DUCTUS
DEFECT
ARTERIOSUS
ATRIO-VENTRICULAR
SEPTAL DEFECT
Coarctation
of aorta
Congenital Left-sided
Interrupted
aortic obstructive
aortic arch
stenosis lesions
Mitral
stenosis
ARTERIAL SEPTAL DEFECT
• Hole in the wall(septum)
between right and left
atria.
• Commonest type of
CHD(30-40%)
• 1Child/1500 Live births
PATHOPHYSIOLOGY
During fetal development, a foramen ovale left open
To allow blood bypass the lungs and take maternal circulation
Due to force from either side of atrium, it closes
If failed , and left open called
ATRIAL SEPTAL DEFECT
TYPES
TYPES
Sign and Symptoms
• Fatigue
• Tired
• Shortness of breath
• Fluid And blood in the lungs
• Fluid in feet, ankles and legs
• Sweating
• Rapid breathing
• Poor growth
ALTERED HEMODYNAMICS
Increased Enlarge
blood flow Increased
Left to right
through Pulmonary
right Atrium
ASD Blood
shunting and right
Flow
Ventricle
DIAGNOSTIC EVALUATION
MANAGEMENT
THERAPEUTICS MANAGEMENT
• Elective Surgical Repair (2-5 years of age)
MEDICAL MANAGEMENT
Atrial 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
PATHOPHYSIOLOGY
During fetal development, muscular ridge from apex
grows upward
While , membranous region grows downward from
endocardia cushion
Form 2 different chambers called right and left
ventricles
If failed to fuse form a defect, called
VENTRICULAR SEPTAL DEFECT
ALTERED HEMODYNAMICS
Pulmonary Pulmonary
Increased vascular hypertension and
blood circulation pulmonary
L R flow receives vascular
Shunt through increased diseases(EISONM
VSD pulmonary ERGER’S
blood flow SYNDROME)
TYPES
C/F OF VSD
• Poor growth and poor weight gain
• Tachycardia, tachypnoea, and
hepatomegalyy
• Pneumonia
• Sweating
• Frequent cough
DIAGNOSTIC EVALUATION
MANAGEMENT
20-80% closes spontaneously /
no surgery
Antibiotic prophylaxis
ACE inhibitors to reduce after
load
Nutritional supplement to
increase calorie intake (infant
formula)
Prevent respiratory infections
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
During fetal development, Ductus arteriosus
vessel connects the pulmonary artery and
Arota
It closes after birth and become ligament
arteriosus
If fails to close, become patent
PATENT DUCTUS ARTERIOSUS
ALTERED HEMODYNAMICS
Pulmonary
Increased vascular
L R blood flow circulation Pulmonary
through receives
Shunt PDA increased hypertension
pulmonary
blood flow
SIGN AND SYMPTOMS
DIAGNOSTIC EVALUATION
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
A hole or abnormality in septum of atrium and
ventricles
Leads to increase blood flow to lungs cause
high blood pressure
Pulmonary hypertension
EISENMENGERS SYNDROME
TYPES OF AVSD
• Asymptomatic
Partial • Dysnoea
AVSD • Growth retardation
• Tachypn a
Complete • Pulmonary vascular
AVSD obstructive disease
SIGN & SYMPTOMS
• Blue or gray skin color due to low oxygen levels
• Difficulty breathing or rapid breathing
• Excessive sweating
• Fatigue
• Irregular or rapid heartbeat
• Lack of appetite
• Poor weight gain
• Swelling in the legs, ankles and feet
• Wheezing
DIAGNOSTIC EVALUATION
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
DIAGNOSTIC EVALUATION
MANAGEMENT
Transplantation is an effective choice of treatment
HEART
DEFECTS
TATRALOGY OF FALLOT
1. Ventricular septal
defect
2. Pulmonary
stenosis
3. Overriding aorta
4. Right ventricular
hypertrophy
PATHOPHYSIOLOGY
The blood normally returns from the systemic
circulation to the right atrium and right ventricles
The outflow of blood from the right ventricles is
resisted by the pulmonary stenosis so that the blood
flows through the ventricular septal defect in to the
aorta
There is right to left shunt. Hypertrophy of the right ventricles
occurs as a result of the pressure exerted against the
pulmonary stenosis.
CYANOSIS
CLINICAL MANIFESTATION
DIAGNOSTIC EVALUATION
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
Aorta has its origin in the right ventricles and pulmonary artery
has its origins in the left ventricles.
aorta carries unoxygenated blood to the systemic circulation and
the pulmonary circuit carries oxygenated blood back to the lungs
The pulmonary venous return is to the left atrium and the
systemic veins returns to the right atrium
There is two separate circulatory systemic exist, one pulmonary
and one systemic.
CYANOSIS
DIAGNOSTIC EVALUATION
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 DIAGNOSIS
1. Decreased cardiac output related to structural
defect
2. 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
CONCLUSION
TAKE HOME MESSAGE
THANK YOU……..
