DDx - five "Ts"
90% of all congenital heart defects are ToF (75%) or TGA (15%)
Treatment
TGA
PGE1 - keep PDA open
Fluids - needs volume for continued operation of atrial septal defect
(+/- BAS)
Surgery: Switch
ToF
PGE1
+/- Oxygen
Fluids
Chromosomes - deGeorge syndrome
*Irradiate & wash blood* - kill white cells to avoid graph vs. host reaction
Surgery - Shunt or Repair
Total Anomolous Pulmonary Vascular Connection (TAPVC)
When should you NOT start with PGE1? NEVER
Concerns re: PGE1
- Apnea
- Fever
- PVR
- O2 effect
PGE1 Dosing & PVR
PGE1 in obstructed TAPVC
PGE1 in TGA…& lasix. NEEDS FLUIDS
PDA
PDA Notes
#1 Determining factor – intervene or not – is…
Clinical trend line
“Severe” PAH ≠≠ elevated PVR (REMEMBER P = Q x R) inc. P due to increased Q
Indomethacin - opposite of PGE1 = closes PDA (but side effects - close renal flow)
Indometacin (INN) or indomethacin (USAN and former BAN) is a non-steroidal anti-inflammatory drug(NSAID) commonly used as a prescription medication to reduce fever, pain, stiffness, and swelling. It works by inhibiting the production of prostaglandins, molecules known to cause these symptoms
CHF = congestive heart failure: clinical
manifestations of inadequate cardiac output.
Differential Diagnosis
Primary
Myocardial
Rhythm
Blood
Secondary
Shunt*
Obstruction
Both
A-V valve regurgitation
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