Avsd picu

Editor's Notes

• #7: UNPALANCED AVSD, represent 10%–15% of all AVSD. This defect is characterized by underdevelopment of one of the ventricles and varying degrees of malalignment of the common AV valve, over the hypoplastic ventricle and associated hypoplasia of the outflow valve related to decreased flow. Management strategy includes single ventricle (SV) palliation, and primary or staged biventricular SV palliation, and primary or staged biventricular repair. More recently, biventricular conversion from SV palliation has been advocated, particularly in patients with trisomy 21 and heterotaxy, who tolerate SV palliation poorly. Staged biventricular recruitment has also been advocated for complete biventricular repair.
• #8: -result in a left-toright intracardiac shunt --- increased pulmonary blood flow. ASDs - volume overload of the right ventricle---uncorrected may  lead to right heart failure and atrial arrhythmias (at the ventricular or great vessel level )Vsd  left-to-right shunts -- volume load on the left ventricle. If large ventricular or great vessel left-to-right shunts  the substantial increase in pulmonary venous return - increase in left ventricular end-diastolic pressure and pulmonary venous hypertension - resulting in symptoms of congestive heart failure, - S&S include failure to thrive, feeding difficulties, and diaphoresis. Common signs are tachypnea, tachycardia, and hepatomegaly. If unrestrictive and left untreated, all of these left-to-right shunts can - irreversible pulmonary vascular obstructive disease. The change in the ratio of systemic-to-pulmonary vascular resistance over time as a result of pulmonary vascular obstructive changes reverses the direction of the shunt, making it right to left. The patient becomes cyanotic and develops what is called “Eisenmenger syndrome patients with an ASD will have a fixed split second heart sound and may have a systolic murmur of physiologic pulmonary stenosis
• #10: early infancy conventionally carried greater morbidity and mortality than repair performed later in life however improved surgical techniques myocardial protection, and postoperative care has led to a progressive reduction in operative mortality to <3%
• #11: :combining the disciplines of cardiology, cardiac surgery, cardiacanesthesia, neonatology, intensive care, and nursing
• #15: high incidence of extracardiac anomalies including abnormalities of the CNS, hypotonia, seizures, gut abnormalities, thyroid disorders, and airway abnormalities such as tracheal stenosis and laryngotracheomalacia, also there may be sedation issues, pulmonary arterial hypertension, and vascular access concerns, higher right-sided cardiac pressures and pulmonary vascular resistanc cohort of patients is known to develop early severe pulmonary hypertension (PH) and pulmonary vascular obstructive disease (PVOD); the pathophysiological mechanisms underlying the development of these complications are yet to be determined -Preoperative screening for thyroid function is essential, as hypothyroidism has been linked to decreased myocardial contractility and cardiac output
• #19: .
• #20: Indications for early shunt procedure:  Cyanosis secondary to inadequate pulmonary blood flow after neonatal palliation Congestive heart failure from an excessive volume load caused by severe atrioventricular valve regurgitation or by an elevated Qp:Qs
• #22: Factors that increase PVR: -­‐Hypoxia -­‐Hypercarbia -­‐HyperinflaEon -­‐High hematocrit
• #26: These patients may benefit from a 1- to 3-day period of sedation and careful ventilator management to minimize the chances of a pulmonary hypertensive crisis, which may be accomplished by maintaining a normal CO2/blood pH, and adequate sedation and oxygenation. Inhaled nitric oxide may be used to prevent or treat severe postoperative pulmonary hypertension. (In the current era with most patients undergoing repair at approximately 4 months old is usually in the postoperative period) reactive pulmonary arterial bed. (not a major problem ) .
• #30: . Dexmedetomidine, an a2-adrenergic agonist, is a sedative with both anxiolytic and analgesic properties S.F hypo-BP, bradycardia found that dexmedetomidine may prevent or treat postoperative tachyarrhythmias, including junctional ectopic tachycardia, accelerated junctional rhythm, re-entrant supraventricular tachycardia, and ectopic atrial tachycardia
• #34: -most commonly junctional ectopic tachycardia, followed by complete AV block, ventricular tachycardia and reentrant SVT and nonsustained SVT. At present, intravenous amiodarone is the recommended pharmacological treatment for most postoperative tachyarrhythmias to control the rate and restore AV synchrony. - -Pulmonary arterial hypertension: occurring in approximately 2% of children with hypertensive crisis occurring in 0.75%. This results in prolonged mechanical ventilation and increased the length of ICU stay and mortality of 20%. The incidence has reduced after the introduction of nitric oxide and earlier age at surgery. -Management would include pulmonary vasodilators (nitric oxide) sedation and analgesia, judicious use of PEEP to prevent atelectasis, and sodium bicarbonate to buffer acidosis. Rebound pulmonary hypertension after stopping nitric oxide requires sildenafil;