Congenital heart disease

Congenital heart disease

cyanois  - most sources say 5 g deoxyHb

PDA dependent  (ductal dependent)
keep open with PGE

Top three side effects
 Apnea
 Apnea
 Apnea

Total Mixing Lesions
 All of systemic venous return and pulmonary venous return mixes at some level.
 Saturation determined by how much blue blood is mixing with the red.
 All these lesions have ability for high pulmonary blood flow.

Total Anomalous Pulmonary Venous Return
 Total Mixing at the level of the right atrium
 Common Vein never incorporated into the left atrium.
 Most of venous flow stays on the right side.
 Need PFO to maintain preload to left ventricle

Cyanotic Heart Disease 

 2 month old born term. Apgars 8/9. 
Saturation 98% at the time of discharge 

from the hospital.

 Now presenting with increasing irritability 

blueness with feedings and crying.

 Saturation in the ER is 60%.

Tetralogy of Fallot

•  The squatting child - increases peripherall vascular resistance = stops R - L shunt
•  Should never be seen in this country
•  Classic Tetralogy Spell
•  Typically in the morning
•  Sleeps all night
•  Pulls self up in the crib
•  Becomes irritable

What About ASDs? 
 Typically do not cause symptoms in childhood
 Close them to prevent right heart failure, atrial arrhythmias and pulmonary 
hypertension as an adult.
 Close around 3-4 years of age, before 8-10 years of age.
 Typical scenario
 Small child growing on their curve
 Perhaps some exercise intolerance
 SEM LUSB with radiation to the back and fixed split of S2