20 CT Surgery

L to R shunt

path
- hole between left and right. Noncyanotic
- increased flow and O2 to lungs
  - increased pulmonary arterial pressures and resistance, PHTN, RVH, Eisenmenger

path: hole between V
pt:
- most common <1, either fixed or die
- asx but loud murmur or no murmur but FTT and CHF
- Down syndrome
diagnosis: echo
treatment
- asx: wait up to year
- CHF: surgical repair

path: aorta to PA persisting
Symptoms
- murmur not present on day 0
- continous machine like murmur or continuous multiphasic murmur
diagnosis: echo
treatment:
- closure when needed
- Indomethacin
- may need PGE for Transposition to keep open until surgery

path
- RA to RV to aorta to Vena Cava to RA
- LA to LV to PA to PV to LA
- PDA in utero allow oxygenation of systemic blood
pt
- moms already diabetic and not in gestation: heart devs at wk 8. Failure to twist
symptoms
- blue baby day 0
diagnosis: don't really have time. Echo
treatment: surgery. PGE to keep PDA open.,

path: EDC defect
- large VSD
- overriding aorta push aside PA
- pulmonic stenosis
- RVH
- Deoxygenated blood to RA/RV and to both PA and aorta. Deoxygenated blood to rest of body
- Blood to PA oxygenated and go to either PA and aorta. Result: mixed blood in both PA and Ao
pt: Down syndrome
symptoms
- blue baby dies at birth
- tet spells: blue who pinks up on squatting (more blood to RV and increased SVR)
diagnosis
- xray: boot shaped heart
- diagnosis: echo
treatment: surgery

Path
- narrowing must be descending/distal to great vessels
- blood can't get to lower extremities
- extra blood to top
- collaterals develop
pt
- HTN in upper, hypotention in low extremities
- warm upper, cool lower
- Claudications: child refuse to walk and cry
diagnosis
- echo
- no angiogram or xray for rib notching (no collaterals yet)
treatment: surgery

Last updated 5 years ago