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Congenital  cardiac  defects Congenital  cardiac  defects

Congenital cardiac defects - PowerPoint Presentation

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Congenital cardiac defects - PPT Presentation

Prepared by Ayda khader April 2018 Babies born with congenital heart defects is the second largest group of babies born with abnormalities Incidence 81000 live births have some degree of congenital heart disease ID: 909803

pulmonary heart defect disease heart pulmonary disease defect defects cyanosis cardiac surgical pressure babies congenital aorta septal blood valve

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Slide1

Congenital

cardiac defects

Prepared by :

Ayda

khaderApril / 2018

Slide2

Babies born

with congenital heart defects is the second largest group of babies born with abnormalities. Incidence 8/1000 live births have some degree of congenital heart disease about one-third of these babies will be symptomatic in early infancy.The critical period of exposure to teratogens in respect of embryological development of cardiac tissue is from the 3rd to the 6th week

.

Slide3

Prenatal

detection of cardiac problems are being identified by means of detailed ultrasound scanning For babies with complex congenital heart disease this enables a multidisciplinary plan for birth and immediate neonatal care, to be made well in advance of deliverythe detection of many defects is still dependent upon accurate observations and examination during the neonatal period.

Slide4

Postnatal recognition by symptomatic and routine checkearly identification and referral of babies with significant cardiac malformations is desirablebaby with suspected congenital heart disease should not be sent home until he/she has been reviewed by an experienced paediatrician or a definitive diagnosis has been made

Slide5

babies with cardiac anomalies can be divided into two groups:

Cyanotic heart disease (right-to-left shunt) Acyanotic heart disease (left-to-right shunt)

Slide6

CausesApproximately 90% of cardiac defects cannot be attributed to a single cause. Chromosomal and genetic factors account for 8% 2% are caused by teratogens..

Slide7

Diagnostic evaluation by :

Slide8

Acyanotic Heart Disease

Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA),

coarctation of the

aortaaortic stenosis hypo plastic left heart syndrome.

Slide9

midwives may detect in these babies the first subtle

signs is: tachypnoea, tachycardia incipient cyanosis, especially following the exertion of crying or feedingseldom require medical or surgical intervention in early neonatal life, but do require careful follow-up for signs of developing heart failure and may require surgery or interventional cardiology at a later stage.

Slide10

Ventricular Septal Defect

(VSD)It is an abnormal opening between right and left ventricles, may vary in size ; small pinhole to the absence of the septum, resulting in common ventricle. Frequently associated with other defects Lt –to – Rt Shunt

30% of defects

Slide11

Ventricular septal defects are a common cause of murmurs in the term infant.

Many of these defects are small, no haemodynamic consequence and close spontaneously. Larger defects may lead to heart failure and surgical closure may be necessary although not usually in the neonatal period

Slide12

Atrial Septal Defect (ASD)

An abnormal opening between atria with a Lt-to-Rt Shunt. Blood in left atrium flows into right atrium.10% of defectsReduced blood volume in systemic circulation

Slide13

Patent Ductus Arteriosus:

(PDA)more common in preterm infantsThe fetal ductus artery connecting the aorta and the pulmonary artery fails to close within few weeks after birth, so the blood flows from the high pressure of the aorta to the lower pressure of the pulmonary artery (Lt – to –Rt ) shuntDuctus normally closes within hours of birth

Connection between the pulmonary artery (low pressure) and aorta (high pressure)

Slide14

Medical management

by using Endomethacin (Prostaglandin inhibitor) which constricts the muscle in the wall of the PDA and promotes closureSurgical Management if medical treatment with ibuprofen or indomethacin is ineffective

Slide15

Coarctation of the aorta and aortic stenosis are usually amenable to surgical correction. Hypoplastic left heart syndrome remains a major surgical challenge, requiring a number of surgical procedures in childhood

As in the duct-dependent cyanotic heart conditions, a prostaglandin infusion may be required whilst further investigations and discussions regarding the possibility of surgical correction take place

Slide16

cyanotic Heart Disease

transposition of the great arteries pulmonary atresia tetralogy of Fallot tricuspid atresia

total anomalous pulmonary venous drainage

univentricular /complex heart.

Slide17

Although cyanosis can be a presenting feature of a number of non-cardiac conditions

(As respiratory disease, persistent pulmonary hypertension of the newborn, sepsis), congenital heart disease should always be considered as a possible explanation. Administration of oxygen to babies with cyanotic heart disease may have little effect on their oxygen saturation levels. This observation, along with other routine investigations excluding other causes of cyanosis, may suggest a diagnosis of cyanotic heart disease. The definitive diagnostic investigation is Echo

Slide18

The persistence of central cyanosis

(cyanosis of the lips and mucous membranes), tachypnoea and tachycardia may be the first signsChest X-ray should be carried out to exclude abnormalities of the respiratory tract, respiratory disease and diaphragmatic hernia.Cyanosis occurs when there is more than 5 g/dl of circulating deoxygenated haemoglobin. In congenital cyanotic heart disease, abnormal anatomy leads to mixing of oxygenated and deoxygenated blood

Slide19

Pulmonary Stenosis (PS)

It is narrowing at the entrance of the pulmonary artery (pulmonary valve) leads to narrowing and obstruction between the right ventricle and the pulmonary artery.Resistance to blood flow cause Hypertrophy of right ventricleNonsurgical treatment by Cardiac catheterization to dilate the valve and open up the obstruction by using a balloon angioplastySurgical correction by Transventricular valvotomy Bock procedure

Slide20

Aortic Stenosis (AS)

Narrowing of aortic valve causing resistance to blood flow in the Lt ventricle, decrease cardiac output, Lt ventricular hypertrophy and pulmonary vascular congestion.Nonsurgical correction: Dilating narrowed valve with balloon angioplasty in the cath labSurgical correction

by valvotomy

Slide21

Coarctation of Aorta: (COA)

There is localized narrowing near the insertion of ductus arteriosus resulting in: Increased pressure in proximal structures to the defect (Head and upper extremities)Decreased pressure distal to obstruction (body and lower extremities)Congenital narrowing of the descending aorta

7 % of defects80% have aortic-valve anomalies

Difference in BP in arms and legs (severe obstruction)

Slide22

Medical Treatment:

Prostaglandin may given to keep the PDA open to reduce the pressure changes Antibiotic prophylactic need due to possible aortic valve abnormalities.

Slide23

Tetralogy of Fallot

(TOF)Most common cardiac malformation responsible for cyanosis in a child over 1 year

Slide24

Tetralogy of Fallot (TOF)

Slide25

TOF

The most common type of cyanotic heart disease its involve four ComponentsVentricular Septal defect - VSDPulmonary stenosis Overriding of the aorta – enlargment of aortic valve

Hypertrophy of right ventricle

Slide26

Clinical Manifestations: TOF

Some infants are acutely cyanosed at birth, others have mild cyanosis that progresses over the 1st year as the pulmonary stenosis worsenAcute episodes of cyanosis and hypoxia (blue spells) usually during crying or after feedingSevere irritability due to low oxygen levelsPoor growthclubbing of fingers,

Slide27

Squatting pouster

hypoxia spell (Tet spells) ccc by sudden cyanosis and syncope

Slide28

Management: (TOF)

medical or surgical intervention in early neonatal life, but do require careful follow-up for signs of developing heart failure and may require surgery or interventional cardiology at a later stage

Slide29

It is important to realize, however, that not all heart murmurs heard at this time are significant.

Equally the absence of a murmur at discharge from hospital does not exclude significant heart disease. There is therefore increased responsibility on community midwives to be observant and to communicate effectively with parents. Parents who report any changes in the baby's behaviour such as breathlessness or cyanosis should never be ignored, but rather encouraged to seek medical advice promptly.

Slide30

Transposition of Great Arteries (TGA)

Pulmonary artery leaves the Lt ventricle Aorta exits from the Rt ventricle With no communication between systemic and pulmonary circulationMales are affected more than femalesAssociated defects such as Septal defects or patent ductus arteriosus permits blood to enter the systemic circulation and or pulmonary circulation for mixing of saturated and non saturated blood

Slide31

Management: (TGA)

Surgical Palliative treatment Administration of IV prostaglandin E1 to keep the ductus arteriosus openRashkin procedure: Enlarge septal defect Complete repair:Switching the great vessels to their correct anatomic position.

Slide32

Central nervous system abnormalities

Slide33

Central nervous system abnormalities

Ingestion of folic acid supplements prior to conception and during the early stages of pregnancy has helped prevent such abnormalities. In addition, the ability to recognize these anomalies prenatally has resulted in some parents choosing selective termination of pregnancies where severe neural tube defects are found.

Slide34

Anencephaly

This major abnormality describes the absence of the forebrain and vault of the skull. It is a condition that is incompatible with sustained life but occasionally such a baby is born alive.The midwife should wrap the baby carefully before showing him to the mother.

Slide35

It may be beneficial for the parents then to see the full extent of the abnormality, unpleasant though it is.

Seeing the whole baby will help them to accept the reality of the situation and prevent imagination of an even more gruesome picture.

Slide36

Spina

bifidaSpina bifida results from failure of fusion of the vertebral columnThere is no skin covering the defect, which allows protrusion of the meninges, hence the term meningocele The meningeal membrane may be flat or appear as a membranous sac, with or without cerebrospinal fluid, but it does not contain neural tissue

Slide37

Meningomyelocele

Is a more serious defect in which the spinal cord and / or nerve roots as well as meningocele covering protrude through the spina bifida. Meningomyelocele usually gives rise to neural damage, producing paralysis distal to the defect, and impaired function of urinary bladder and bowel.

Slide38

Slide39

The lumbosacral area is the most common site for these to present, but they may appear at any point in the vertebral

columnEncephalocele is a congenital anomaly characterized by herniation of the brain and/or meninges through a defect in the skull.

Slide40

.

Surgical intervention for myelomeningocele carries a high rate of success of skin closure, but has no impact on any damage already present in the cord or more distallyIt is seldom necessary to close the back within 24 hrs of birthFollowing examination of the baby, discussion with the parents will allow them to make an informed choice about whether or not they wish their baby to have surgery.

Slide41

Spina bifida occulta

Usually the 5th lumber and 1st sacral vertebrae are affected with no protrusion of interspinal contents the spinal cord and its cover the skin over the defect may reveal a dimple, small fatty mass or a tuft of hair.

Slide42

Hydrocephalus

The abnormal increase in cerebrospinal fluid volume within the intracranial cavity due to a defect in the cerebrospinal fluid drainage system, intracranial pressure increases, the scalp veins dilate, and the cranial suture begin to separatehydrocephalus may either be present at birth or develop following surgical closure of a myelomeningocele

Slide43

The risk of cerebral impairment may be minimized by the insertion of a

ventriculoperitoneal shuntAttendant risks with these devices are that the line blocks and that the shunt is a portal for infection leading to meningitis

Slide44

The midwife must be alert for the signs of increased intracranial pressure:

large tense anterior fontanelle splayed skull sutures inappropriate increase in occipitofrontal circumference sun-setting appearance to the eyes irritability, or abnormal movements.

Slide45

Microcephaly

This is where the occipitofrontal circumference is more than two standard deviations below normal for gestational age.The disproportionately small head may be the result of intrauterine infection (e.g. rubella), a feature of fetal alcohol syndrome, or part of a number of defects in some trisomic disorders. Most babies will have learning difficulties with evidence of cerebral palsy and often seizures.

Slide46

Parents who have a baby

with a neural tube defect should beoffered genetic counselling since the risk of recurrence is

one in 25.

Slide47

Thank You!

With best wishes

,

Ayda khader