Atrial septal defect in children .pptx

Atrial septal defect in children

1. ATRIAL SEPTAL DEFECT PRESENTED BY: M.C.KNIRANDA ASSISTANT PROFESSOR SSNSR, SU.

2. HEART CIRCULATION?

3. MEANING Congenital heart disease is a defect in the structure of the heart and great vessels that is present at birth.

4. CONGENITAL HEART DISEASE

5. ACYANOTIC Increased pulmonary Obstruction to blood blood flow flow from ventricle ASD 1. Coartation of aorta VSD 2. Aortic stenosis PDA 3. Pulmonic stenosis Atrio ventricular canal

6. CYANOTIC Increased pulmonary Mixed blood flow blood flow 1. TOF 1. Transposition of great arteries 2. Tricuspid atresia 2. Total anomalous pulmonary 3. E pstien anomaly venous return 3. Truncus arteriosus 4. Hypoplastic left heart syndrome

7. INCIDENCE . CHD affects 8 to 12 of every 1,000 neonates In spontaneously aborted and stillborn fetus, the incidence is much higher

8. ETIOLOGY 90% of the etiology of congenital cardiac defects is unknown. Most are thought to be a result of multifactorial inheritance.

9. Risk factors Fetal exposure to drugs such as phenytoin, lithium and radiation. Maternal viral infections such as rubella. Maternal metabolic disorders such as phenylketonuria and insulin-dependent diabetes mellitus. Maternal complications of pregnancy such as increased age and ante partal bleeding. Maternal dietary deficiencies . Genetic factors Chromosomal abnormalities like Turner syndrome, Down syndrome and Trisomy 13 and 18 .

10. LEFT TO RIGHT SHUNT (ACYANOTIC) RIGHT TO LEFT SHUNT (CYANOTIC)

11. ACYANOTIC HEART DISEASES

12. Acyanotic heart disease is a congenital heart defect that occurs when blood is pumped abnormally around the body, but still contains enough oxygen. DEFINITION

13. ATRIAL SEPTAL DEFECT (ASD)

14. DEFINITION An atrial septal defect (ASD) is an abnormal opening between right and left atria resulting in left-to-right shunt of blood .

15. CAUSES unknown. Atrial septal defects occur when the partitioning (at around 5 th week) process does not occur completely, leaving an opening in the atrial septum . defect in a gene – eg . TBX20 gene (T-box transcription factor 20) C hromosome abnormality – eg . Chromosome 5 Drugs – alcohol, lithium Infections- rubella

16. TYPES Ostium primum atrial septal defect - Located in the lower part of the atrial septum, and often associated with other heart defects Ostium secundum atrial septal defect - The most common type of ASD, occurring in the middle of the atrial septum Sinus venosus atrial septal defect - A rare type of ASD, occurring in the upper part of the atrial septum, and often associated with abnormal connections of the right pulmonary vein

17. TYPES OF ASD A heart with ostium secundum atrial septal defect A heart with ostium primum atrial septal defect A heart with sinus venosus atrial septal defect.

18. PATHOPHYSIOLOGY Communication between the right and left atrium Oxygenated blood in the left atrium is under high pressure Blood forced through the defect into right atrium Left to right shunting of blood Burden on the right side of heart Increased pulmonary blood flow Pulmonary congestion and right ventricular enlargement

19. CLINICAL FEATURES Asymptomatic Shortness of breath Heart Murmur Bulging of chest Poor weight gain Child tired easily when playing Fatigue Sweating CHF (Congestive heart failure) - usually not until the third or fourth decade of life .

20. DIAGNOSIS Physical assessment- murmurs Chest X-ray —heart enlarged Electrocardiogram (ECG or EKG) —shows abnormal rhythms Two-dimensional echocardiogram with Doppler study and color flow mapping - To identify the site of the ASD and associated lesions and document left-to-right flow across the atrial septum.

21. Cont.. Cardiac Catheterization Cardiac Magnetic Resonance Imaging (MRI)

22. MANAGEMENT Specific treatment for ASD will be determined by the child's physician based on : The child's age, overall health and medical history E xtent of the disease T he child's tolerance for specific medications, procedures or therapies H ow the child's doctor expects the disease to progress T he opinion or preference .

23. Medical Management -- Many children have no symptoms and require no medications, however some children may need to take medications to help the heart work better, since the right side is under strain from the extra blood passing through the ASD. Medication that may be prescribed includes the following: Digoxin - treat heart failure and abnormal heart rhythms Diuretics - reducing fluid buildup in the lungs and other parts of the body Infection Control : Children with certain heart defects are at risk for developing an infection of the inner surfaces of the heart known as bacterial endocarditis .

24. SURGICAL REPAIR Ideal age for surgery is in between 2- 5 yrs. The surgical closure of an ASD is carried out through an incision in the middle of the chest . A heart-lung machine (aka cardiopulmonary bypass (CPB) machine) is used to do the work of the heart while the heart is cooled, stopped, emptied and opened through the right atrium. The hole in the wall between the right and left atrium is closed with stitches if it is small.

25. if too large, with a patch of thin leather-like material called pericardium, which makes up the sac covering the heart, cow (bovine) pericardium, or rarely, a manmade material, Dacron patch ( polyester fiber ) . The right atrium is then closed and the heart is restarted as the heart-lung machine is withdrawn.

26. NURSING MANAGEMENT Identify symptoms Carry out investigations. Maintain intake and output chart. Monitor vital signs. Timely administration of medications. Provide rest to decrease oxygen demand. Prevention of infection. Provide psychological support

27. PROGNOSIS Although the prognosis is excellent in asymptomatic people, it's poor in those with cyanosis caused by large, untreated defects.

28. T H A N K Y O U . .