Você está na página 1de 19

DECREASED

PULMONARY
BLOOD FLOW
(cyanotic)

PRAVIN PRAKASH. P
NCON
Tricuspid Atresia
 It is characterized by absence of the
tricuspid valve, a small right ventricle,
and usually diminished pulmonary
circulation
 Openings are also present in the
atrial and ventricular walls
 PDA
Causes
 Exact cause – unknown
 Associated factors-
a. Fetal or maternal infection during 1st trimester
(rubella)
b. Maternal insulin dependent diabetes
c. Teratogenic effects of drugs and alcohol
d. Chromosomal abnormalities (trisomy 21, 18,
13 etc)
S/S
 Cyanosis
 Tachypnea
 Feeding difficulties
D/E
 History collection
 Physical examination- auscultation:
murmurs vary
 Chest X-ray: pulmonary vascular
marking and may be heart size vary
 ECG
 Echocardiogram
Mgt
 Stabilize with PGE1 infusion
 Inotropic support
 Intubation and ventilation as needed
Surgical mgt
 The ductus arteriosus (the normal connection
between the aorta and the pulmonary valve) will
likely close if the prostaglandin E1 infusion is
stopped. Another pathway for blood to reach the
lungs to receive oxygen must be surgically
created.
 A series of operations are performed in the first
two years of life that will re-route blood so that
enough oxygen is added to the bloodstream to
meet the child's needs.
 There are two surgery type: first surgery
(neonates) and second surgery (6to9months) and
third surgery (18 months to 3 years)
 Blalock-Taussig shunt (BT shunt) (1st surgery)
The first operation creates a pathway for blood to
reach the lungs. A connection is made between
the first artery that branches off the aorta (called
the right subclavian artery) and the right
pulmonary artery. Some of the blood traveling
through the aorta towards the body will "shunt"
through this connection and flow into the
pulmonary artery to receive oxygen. However, the
child will still have some degree of cyanosis since
oxygen-poor (blue) blood from the right atrium and
oxygen-rich (red) blood from the left side of the
heart mix and flow through the aorta to the body.
 Pulmonary artery band: if pulmonary blood flow is
excessive
 Glenn shunt (2nd surgery)
A second operation, often performed at about 4 to 12
months of age, replaces the Blalock-Taussig shunt with
another connection to the pulmonary artery. In this
operation, the Blalock-Taussig shunt is removed, and the
superior vena cava (the large vein that brings oxygen-poor
blood from the head and arms back to the heart) is
connected to the right pulmonary artery. Blood from the
head and arms passively flows into the pulmonary artery
and proceeds to the lungs to receive oxygen. However,
oxygen-poor (blue) blood returning to the heart from the
lower body through the inferior vena cava will still mix with
oxygen-rich (red) blood in the left heart and travel to the
body, so the child will remain mildly cyanotic. This operation
helps create some of the connections necessary for the final
operation, the Fontan procedure.
 Fontan procedure (third surgery)
This operation is often performed at about 18 to
36 months of age, and allows all the oxygen-poor
(blue) blood returning to the heart to flow into the
pulmonary artery, greatly improving the
oxygenation of the blood. The Glenn shunt,
connecting the superior vena cava to the right
atrium, is left in place. A second connection is
made directing blood from the inferior vena cava
to the right pulmonary artery. This connection can
be created in slightly different variations,
depending on the method your child's surgeon
prefers, and what is best for your child.
TGA
TGA means what?
 Occurs when the PA arises off the LV
and aorta arises off the RV.
 Associated lesions include ASD,
VSD, PDA, PS and CoA
Causes
 Same as previous
S/S
 Cyanosis
 Tachypnea
 Metabolic acidosis
 CHF
 Feeding difficulty
D/E
 Same as previous
Mgt
 Stabilize with PGE1 infusion
 Inotropic support
 Intubation and ventilation as needed
 Antibiotics
 Digoxin and diuretics
Surgical mgt
 Arterial switch operation
 Rastelli operation: performed for
TGA, VSD and PS
 Atrial switch operation: RA-mitral
valve-LV-PA and LA-tricuspid-RV-Ao

Você também pode gostar