先心病的早期管理

Early management of congenital heart diseases Jameel A. AL-Ata Consultant nEarly recognition. nCategorizing into type nConfirm DX and size of ASD. nMost pts will not need medical treatment. nAssure parents and inform them of high likelihood of spontaneous closure. nWatch for development of PHTN at F/U. nLook for none cardiac associations. ASD nNo limitation of activity. nSBE prophylaxis not usually recommended. nScreen the family. nFollow every 612 months. nRefer for intervention or surgery at age 3-5 y. if size remains 5 mm. Early management of VSD ; nConfirm DX , type of VSD 1) FTT ,CHF 2) PHTN 3) AI 4) Endocarditis. ( usual age 612 months ) nSmall 2 mm. PDA nLarge PDA 3 mm act like large VSDs. nLook for associations cardiac or non cardiac. nSmall PDAs can be referred for intervention if still patent at age 1 year whether symptomatic or not. Early management of aortic stenosis ; nConfirm DX and severity. nLook for aortic insufficiency and other associations. nMild to moderate AS. do not require medical therapy. Avoid hypotensive agents. nAssure strict 6 m. f/u by echocardiography for grading of severity nStrict SBE prophylaxis nSBE prophylaxis is controversial. nYearly F/U for mild to moderate PS 1) Keep ductal patency by PGE through a secure venous line. 2) Maintane saturation 7580 % in RA even if ventilated to avoid induction of CHF 2nd to increased PBF with decreasing PVR. 3) Avoid pulmonary vasodilation. PDA dependant CHD 4) Avoid fluid overload . 5) Avoid infection. 6) Early intervention or surgery within 2-7 d. 7) Provide a mixing or loading site.( d-TGA & HLHS ). 8) Aggressive correction of metabolic acidosis. Conclusion nKnowing the pathophysiology and natural history of outcome is essential in the management of CHD. nMost CHD pts can be managed as OPD in the community provided there is a clear plan set between the primary pediatrician and the cardiologist. nMore exposure of ped. Trainees to CHD medical therapy & surgery and to the ICU care thes