12 Questions
What is the medical treatment for closing a Patent Ductus Arteriosus (PDA)?
Administration of indomethacin
Which of the following is a common symptom of Coarctation of the Aorta (COA)?
Cool upper extremities with lower blood pressure
What is the main clinical manifestation of Tetralogy of Fallot (TOF) at birth?
Infants acutely cyanotic at birth
What is the primary surgical treatment for Coarctation of the Aorta in infants younger than 6 months?
Surgical repair by resection
What are Hyper-cyanotic Spells in Tetralogy of Fallot (TOF) characterized by?
Deep and fast breathing with cyanosis during crying or feeding
What are patients with a Patent Ductus Arteriosus (PDA) at risk for later in life?
Infective endocarditis
What is the purpose of administering intravenous prostaglandin E1 in therapeutic management of Transposition of the Great Vessels (TPGA)?
To increase blood mixing
Which procedure may be performed in TPGA to increase mixing by opening the atrial septum?
Rashkind procedure
What is a common presenting symptom of Transposition of the Great Vessels (TPGA) in infants?
Profound cyanosis
In TPGA, what does a 'egg on a string' visualization on chest x-ray indicate?
Complete repair has been successful
What is the main purpose of a TOF Shunt in palliative treatment?
To temporarily relieve symptoms
How does Cyanotic blood flow in Transposition of the Great Vessels (TPGA) affect the brain?
It leads to brain damage
Study Notes
Patent Ductus Arteriosus (PDA)
- Failure of the fetal ductus arteriosus to close within the first weeks of life, allowing blood to flow from the aorta to the pulmonary artery
- Causes a left-to-right shunt, which can lead to heart failure (HF), infective endocarditis, and pulmonary vascular obstructive disease
- Clinical manifestations: asymptomatic or widened pulse pressure, risk of HF
- Medical treatment: administration of indomethacin (prostaglandin inhibitor) to close the PDA
- Nonsurgical treatment: coils to occlude PDA placed in a catheterization laboratory
- Surgical treatment: may be necessary for some patients
Coarctation of the Aorta (COA)
- Localized narrowing near the insertion of ductus arteriosus
- Causes increased pressure proximal to the defect and decreased pressure distal to the obstruction
- Symptoms: high blood pressure in the upper arms, bounding pulses in the arms, weak or absent femoral pulses, cool lower extremities with lower blood pressure
- Signs of heart failure (HF) in infants, dizziness, headaches, fainting, epistaxis in older children
- Treatment: surgical repair is the treatment of choice for infants younger than 6 months, balloon angioplasty is the primary intervention for older children
Tetralogy of Fallot (TOF)
- Ventricular septal defect (VSD), pulmonic stenosis, right ventricular hypertrophy, and overriding aorta
- Clinical manifestations: some infants may be acutely cyanotic at birth, while others have mild cyanosis that progresses over the first year of life
- Signs and symptoms: acute episodes of cyanosis and hypoxia (blue spells or tet spells), risk of emboli, seizures, loss of consciousness, or sudden death
- Treatment: calming the baby and holding the baby in the knee-chest position to break the cycle, palliative treatment includes shunt or complete repair in the first year of life
Transposition of the Great Vessels (TGV or TPGA)
- The two great vessels of the aorta and pulmonary artery are reversed, resulting in cyanotic blood flowing to the brain
- Results in two separate circulatory systems—systemic and pulmonary
- Assessment and symptoms: poor feeding, profound cyanosis, tachypnea, signs and symptoms of CHF, chest x-ray “egg on a string” visualization
- Therapeutic management: providing intra-cardiac mixing, administration of intravenous prostaglandin E1 to keep the ductus arteriosus open, balloon atrial septostomy (Rashkind procedure) to increase mixing
Learn about Patent Ductus Arteriosus (PDA), a condition where the fetal ductus arteriosus fails to close after birth, leading to a left-to-right shunt. Understand the clinical manifestations, including symptoms of heart failure, widened pulse pressure, and associated risks.
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