Ventricular septal defect in children.pptx

Ventricular septal defect in children

1. CONGENITAL HEART DISEASES 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. VENTRICULAR SEPTAL DEFECT (VSD)

14. DEFINITION Ventricular Septal Defect is a congenital disorder in which blood moves from left ventricle to right ventricle through a defective ventricular septum. It may vary in size from very small defects (Roger’s defect) to very large defect.

15. INCIDENCE It is the most common congenital heart defect, occurring in approximately 30% to 40% of all children with congenital heart disease. Many VSDs (20 – 60%) are thought to close spontaneously. Spontaneous closure is most likely to occur during the first year of life in children having small or moderate defects.

16. CLASSIFICATION Membranous VSD- The most common type, accounting for about 80% of cases, and occurring in the upper section of the ventricular septum. Muscular VSD- These defects are surrounded by muscular tissue and may occur anywhere in the septum Accounts for about 20% of VSDs in infants, and often involves more than one hole. Inlet VSD - Occurs just below the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. Outlet ( conoventricular ) VSD - Creates a hole just before the pulmonary valve in the right ventricle and just before the aortic valve in the left ventricle

17. ETIOLOGY Ventricular Septal Defect (VSD) occurs when the wall that separates the heart's left and right ventricles doesn't fully form during a baby's development. 

18. The cause of VSD is often unknown, but it can be due to : Developmental abnormalities : During the heart's development, the interventricular septum may not form properly.  Genetic syndromes : Changes in chromosomes or genes can cause VSDs.  Environmental factors : A combination of genes and environmental factors, such as what a mother eats, drinks, or takes, may increase the risk of VSD. ETIOLOGY

19. Left to right shunt Portion of oxygenated blood from left ventricle enters the right ventricle Magnitude of shunt is determined by the size of VSD and amount of pulmonary vascular resistance (PVR) present High PVR in newborn It will elevate right ventricular pressure (approximate to left ventricular pressure) Decrease shunting across VSD Child may be asymptomatic As PVR decreases over the first 1-2 months of life Child become symptomatic Increased blood in RV leads to right ventricular hypertrophy PATHOPHYSIOLOGY

20. CLINICAL MANIFESTATIONS Only 15% of VSDs are large enough to cause symptoms. Small VSD usually asymptomatic; high spontaneous closure rate during the first year of life. Large VSDs. CHF: tachypnea, tachycardia, excessive sweating associated with feeding Frequent Upper Respiratory Infections. Poor weight gain, failure to thrive. Feeding difficulties. Decreased exercise tolerance.

21. DIAGNOSTIC EVALUATION Auscultation Chest X-ray ECG Two-dimensional echocardiogram with Doppler study and color flow mapping Cardiac catheterization usually not needed for initial diagnosis; may be needed to calculate the size of the shunt or to assess PVR.

22. MANAGEMENT It has been estimated that, about 70-80% of all VSD become smaller in size or disappear entirely, and is known as spontaneous closure . In almost 90% of the patient with spontaneous closure occurs by the age of 3yrs , though it may occur as late as 25 yrs or more. Treatment is conservative when no signs of congestive heart disease or pulmonary hypertension are present.

23. MANAGEMENT Infants with small VSDs require no surgery , except antibiotics. Infants with moderate to large VSDs who are symptomatic are usually medically managed with a combination of Digoxin and Diuretics. If the infant continues to show signs of congestive heart failure , early surgical repair is indicated.

24. SURGICAL MANAGEMENT Surgical repair of VSD is an Open heart procedure. Moderate to small size VSDs are closed by Purse string sutures . Large defects, a synthetic Dacron patch is used to close the defect.

25. NURSING MANAGEMENT Regular checkups Children with VSDs should have regular checkups with a cardiologist. The frequency of checkups depends on the size of the VSD and the child's age. Medications Children with VSDs may need medications to treat symptoms or help the heart work better. Surgery Nurse should give pre-operative and post operative care.

26. NURSING MANAGEMENT Nutrition Children with VSDs may need extra nutrition to help them grow. Babies who are failing to thrive may need a high-calorie formula or fortified breast milk. Antibiotics Children with VSDs may need antibiotics before certain dental or surgical procedures to prevent infection. Hygiene Children with VSDs should maintain good hygiene to minimize the risk of infection Vaccines Children with VSDs should get all the recommended vaccines . eg . Influenza vaccine

27. NURSING MANAGEMENT Avoid smoke Children with VSDs should be kept away from smoke. Monitor potassium levels Children with VSDs should be monitored for potassium levels, as low levels can lead to digoxin toxicity. Monitor heart rhythm Children with VSDs should be monitored for heart rhythm, as dysrhythmia(irregular hearbeat ) is an early sign of problems.

28. PROGNOSIS Highest risk associated with surgical repair is in the first few months of life. Children respond well to surgery and experience substantial “catch up” growth

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