Atrial Septal Defect (ASD)

• Incidence of congenital heart defects (CHD) is 1% (about 40,000 births annually).
• The most common congenital heart defect is Ventricular Septal Defect (VSD).
• 25% of infants with CHD require surgery or intervention in the first year.
• 15% of CHD cases are associated with genetic conditions.
• 28% of children with CHD have another recognized anomaly, such as trisomy 21.

Atrial Septal Defect (ASD)

• ASD involves an abnormal opening between the atria, allowing blood to flow from the higher pressure left atrium to the lower pressure right atrium.
• ASD leads to increased oxygenated blood in the right side of the heart.
• Individuals with ASD may experience right atrium and right ventricle enlargement.
• Cardiac failure is uncommon in uncomplicated ASD.
• ASDs can be asymptomatic if the defect is small.
• ASD can cause dyspnea.
• ASD can cause fatigue and poor growth.
• A soft systolic murmur may be heard in the pulmonic area, potentially with splitting.
• CHF may develop as a result of ASD.

ASD Diagnosis

• 2D echocardiography (ECHO) reveals an enlarged right side of the heart and increased pulmonary circulation.
• Cardiac catheterization shows separation of right atrium and increased O2 saturation in the right atrium.

ASD Treatment

• Surgical Dacron patch closure or open repair with cardiopulmonary bypass is used.
• Non-surgical closure can be achieved with devices during cardiac catheterization.

Nursing Management for CHD

• Explain tests and procedures to parents.
• Educate parents on supporting nutrition, reducing stress, promoting rest, and supporting growth during the preoperative period.
• Educate parents on the signs and symptoms of congestive heart failure and infection.
• Prepare parents and children, including visits to the intensive care unit and explanations.
• Prepare older children for what to expect after surgery, including coughing, deep breathing, and the need for movement.
• Administer antibiotic prophylaxis to prevent subacute bacterial endocarditis.

Ventricular Septal Defect (VSD)

• In VSD, pressure from the left ventricle flows to the right ventricle due to systemic arterial circulation resistance, leading to pulmonary circulation of blood flowing through the defect and into the pulmonary artery.
• Over time, the right ventricle may become enlarged (hypertrophied), and the right atrium may also become distended.

Symptoms of VSD

• Tachypnea and dyspnea can occur (rapid breathing and shortness of breath).
• Poor growth and reduced fluid intake may be observed.
• Palpable thrills can be felt.
• A systolic murmur may be auscultated at the lower sternal border.
• CHF may develop.

VSD treatments

• Furosemide is administered to remove excess fluids from the body.
• Digoxin is administered aiding the heart to pump more forcefully.
• Angiotensin-converting enzyme (ACE) inhibitors are provide to relax blood vessels and help the heart pump more easily.
• Surgical repair with bypass may be necessary.
• Pulmonary artery banding may be applied if the defect is not too large.

Patent Ductus Arteriosus (PDA)

• The ductus arteriosus should close by about 15 hours after birth.
• Shunting of blood may occur up to 24 hours after birth.
• PDA closes due to increased arterial oxygen concentration after initiating pulmonary function.
• Prostaglandin withdrawal leads to PDA closure when the effect of prostaglandin is withdrawn.
• PDA allows blood to flow from left to right, increasing pulmonary blood flow.
• Small PDAs may cause no symptoms.
• Bounding peripheral pulses can be palpated.
• Widened pulse pressure (>25 mmHg) may be observed.
• A loud machine-like murmur can be heard at the upper left sternal border.
• Large PDA can cause CHF with tachypnea, dyspnea, and a hoarse cry.

PDA Diagnosis and treatment

• ECHO provides a diagnosis.
• Medical treatment includes indomethacin for premature infants to close PDAs.
• Surgical ligation is considered if medications fail.
• Prophylactic antibiotics are administered to prevent bacterial endocarditis.
• Surgery is considered between 1-2 years of age.