Pediatrics: CARDIOLOGY PART 2

PEDIATRICS II
PEDIATRIC CARDIOLOGY PART 2
Dr. Della G. Pelaez

CONGENITAL HEART DISEASES:  If patient is not operated, since there are lots of
ACYANOTIC: LEFT TO RIGHT SHUNT blood going to the heart, bleeding occurs, which
may lead to mild/moderate/severe
PULMONARY HYPERTENSION
VENTRICULAR SEPTAL DEFECT (VSD)  Mild hypertension – 25 %
 Moderate – 50 %
 Most common cardiac malformation  Severe – >50 %
 Factors affecting magnitude of shunt
 SIZE of the hole  Pulmonary hypertension lung pressure
 Restrictive (small VSD) - < 0.5 backward failure pressure in pulmonary
 Non restrictive (large VSD) - > 1.0 artery and RV will go up, blood will also go to
 PRESSURE of the right and left ventricles RA LV P02 80 % Frank cyanosis
blue baby EISENMENGER’S DISEASE
S/Sx Pulmonary congestion; dysphagia (no treatment)
Murmur Holosystolic murmur at left sternal 
border  Worst case in PULMONARY CONGESTION
Chambers LA and LV (volume dilatation)  Hemoptysis
Enlarged  Heal by fibrosis lumen becomes small
Apex Beat Downward/Lateral pressure Pulmonary
Chest X-ray Increase Vascularity; Inverted E sign hypertension
ECG Notched p-wave
**QP:QS  If hole is very big, even at birth
1.5:1 – small VSD  Do patching to avoid Eisenmengers do
2:1 – large VSD not operate patient Lifespan: 25 years
old
 Muscular- usually there’s no manifestations
 More blood goes to the lungs decrease  Sildenafil is sometimes given to relieve
systemic blood flow tachycardia, pulmonary hypertension
stimulation of RAAS system
vasoconstriction, sodium retention Fate of patients with VSD and no operation
increase systemic pressure (the rationale  Small VSD might close within 2 years, but it may
for giving AFTERLOADERS) also get bigger
 Large VSD may also become small or large.
MEDICAL TREATMENT  Eisenmengers
 Treat CHF first  Tetralogy of Falot
 VSD + Pulmonary stenosis
SURGICAL TREATMENT  Less blood goes to the lungs cyanotic
 PATCHING  Aneurysm
 Connect cardiopulmonary by pass  Infective Endocarditis
 Open the heart
 Patch the defect
 Connect to heart lung machine

Transcribed by: FCB 1 of 3

 Pediatrics: CARDIOLOGY PART 2
PATENT DUCTUS ARTERIOSUS (PDA) ATRIAL SEPTAL DEFECT (ASD)

 Connection between aorta and pulmonary Occur in 3 portions:

artery (spontaneous closure: 10-15 hours)  Patent Foramen Ovale
 Endocardial cushion defect
Features:  Ostium Primum (incomplete)
S/Sx CHF  AV canal (complete)
Murmur Machinery/Continuous at Left upper  Secundum - 7% of congenital heart defects
sternal border
Chambers LA and LV PATENT FORAMEN OVALE
Enlarged  Flap is on the Left side
Pulses WIDE pulse pressure  Common echocardiographic finding during
(difference of systole and diastole) infancy
Normal: 20-40  May play an important role if other structural
Narrow: <20 – Shock! heart defects are present
WIDE: >40 - PDA  If another cardiac anomaly is causing increased
Chest X-ray apex directed lateralwards right atrial pressure, venous blood may shunt
downwards across the PFO into the left atrium with
ECG Notched P wave resultant cyanosis
 Left – to – right shunting is unusual outside the
immediate newborn period
TREATMENT  In the presence of a large volume load or a
Medical Treatment hypertensive left atrium (secondary to mitral
stenosis), the foramen ovale may be sufficiently
 Prostaglandin (To open)
dilated → significant atrial left –to – right shunt
 Antiprostaglandin (To close)
 Treatment: does not require surgical tx
1. Aspirin
 Risk: Paradoxical (right to left) systemic
2. Indomethacin embolization
3. **Ibuprofen and Mefanamic  Device closure is considered in young adults
 Only given to small gestational age with a history of thromboembolic stroke
patients  Enlarged chamber: RV
 Give it in the first 2 weeks of life  Pressure on the left side is higher will keep it
 Toxicity: Liver and Kidney close but the problem here is that RA pressure
 Treat the CHF is higher
 ECG: Peak P wave
Interventional Treatment 
 Done in Phil
 Using a catheter
 Put 2 coils inside

Surgical Treatment 
 Ligation or Division
 When you operate, make sure not to touch the
phrenic nerve

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OSTIUM PRIMUM (PARTIAL ECD)
s/s +CHF
Location Lower portion of the atrial
septum and overlies the
mitral and tricuspid valves
Murmur Ejection systolic of ASD
at LUSB with fixed split
S2, holosystolic radiating
to axilla and back
Chambers enlarged RV, LA, LV
Chest Xray Goose neck appearance
ECG rSR’ pattern
Pediatrics: CARDIOLOGY PART 2
 Management: Coaptation (close) and suture
 COMPLICATIONS:
a. Partial anomalous pulmonary venous return
b. Pulmonary valvular stenosis
c. VSD
d. Pulmonary artery branch stenosis
e. Persistent left superior vena cava
f. Mitral valve prolapse and insufficiency
 most common congenital anomaly of
Mongolian: Endocardial cushion defect /Ostium
Primum

 Management: Coaptation of the openings,

Replacement of valves (Valvuloplasty)
 Surgical tx: incision in the right atrium
 2 lesions
 ASD (close the atrial septal defect)
 Murmur: Ejection systolic @ LUSB
 S2: Fixed split
 Chamber enlarged: RV
 Mitral regurgitation (Valvuloplasty)
holosystolic @ LLSB radiating to the axilla and
back
 Murmur: Holosystolic at LLSB radiating
to axilla and back
 Chambers enlarged: LA and LV

OSTIUM SECUNDUM
 Defect in the region of the fossa ovalis
 Associated with structurally normal
atrioventricular (AV) valves
 Most common form of ASD

s/s +/‐ CHF due to relative

pulmonary stenosis
Murmur Ejection systolic at LUSB with
fixed split S2 (due to relative
pulmonary stenosis
-‐ inc SV, Inc blood flow due to
pulmonary artery)
Chambers enlarged RA, RV
ECG RSR’ pattern

 Left to right shunting during ventricular

diastole
 QP:QS ratio of at least 2:1
 Pulmonic and aortic valves are affected
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