alterations of cardiovascular function in children

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Alterations of Cardiovascular Alterations of Cardiovascular Function in ChildrenFunction in Children

Chapter 24Chapter 24


Congenital Heart DefectsCongenital Heart Defects

Major cause of death in the first year of life Major cause of death in the first year of life other than prematurityother than prematurity

Prenatal, environmental, and genetic risk Prenatal, environmental, and genetic risk factorsfactors Maternal rubella, type 1 diabetes, alcoholism, Maternal rubella, type 1 diabetes, alcoholism,

PKU, and hypercalcemiaPKU, and hypercalcemia DrugsDrugs Chromosome aberrationsChromosome aberrations


Congenital Heart DiseaseCongenital Heart Disease

Heart defectsHeart defects Hemodynamic alterationsHemodynamic alterations

Right-to-left shunt, left-to-right shuntRight-to-left shunt, left-to-right shunt Status of tissue oxygenationStatus of tissue oxygenation

Cyanotic defectsCyanotic defects Acyanotic defectsAcyanotic defects


Obstructive DefectsObstructive Defects

Coarctation of the aortaCoarctation of the aorta Narrowing of the lumen of the aorta that Narrowing of the lumen of the aorta that

impedes blood flowimpedes blood flow Coarctation of the aorta is almost always in a Coarctation of the aorta is almost always in a

juxtaductal position, but it can occur anywhere juxtaductal position, but it can occur anywhere between the origin of the aortic arch and the between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomenbifurcation of the aorta in the lower abdomen


Coarctation of the AortaCoarctation of the Aorta



Aortic stenosisAortic stenosis Narrowing of the aortic outflow tractNarrowing of the aortic outflow tract Caused by malformation or fusion of the cuspsCaused by malformation or fusion of the cusps Causes an increased workload on the left Causes an increased workload on the left

ventricleventricle


Aortic StenosisAortic Stenosis



Valvular aortic stenosisValvular aortic stenosis Malformed or fused cusps Malformed or fused cusps Progressive obstruction with episodes of Progressive obstruction with episodes of

ischemiaischemia Strenuous activity limitedStrenuous activity limited

Subvalvular aortic stenosisSubvalvular aortic stenosis Stricture caused by a fibrous ring below a valveStricture caused by a fibrous ring below a valve Konno procedure used to correctKonno procedure used to correct



Pulmonic stenosisPulmonic stenosis Narrowing of the pulmonary outflow tractNarrowing of the pulmonary outflow tract Abnormal thickening of the valve leafletsAbnormal thickening of the valve leaflets Narrowing of the valveNarrowing of the valve Pulmonary semilunar valve atresiaPulmonary semilunar valve atresia


Pulmonic StenosisPulmonic Stenosis


Defects Increasing Pulmonary Defects Increasing Pulmonary Blood FlowBlood Flow

Patent ductus arteriosus (PDA)Patent ductus arteriosus (PDA) Failure of the ductus arteriosus to closeFailure of the ductus arteriosus to close PDA allows blood to shunt from the pulmonary PDA allows blood to shunt from the pulmonary

artery to the aorta artery to the aorta


Patent Ductus Arteriosus (PDA)Patent Ductus Arteriosus (PDA)



Atrial septal defectAtrial septal defect Abnormal opening between the atriaAbnormal opening between the atria Three major typesThree major types

• Ostium primum defectOstium primum defect

• Ostium secundum defectOstium secundum defect

• Sinus venosus defectSinus venosus defect



Ventricular septal defect (VSD)Ventricular septal defect (VSD) Abnormal communication between the Abnormal communication between the

ventriclesventricles Most common type of congenital heart lesionMost common type of congenital heart lesion TypesTypes

• Perimembranous VSDPerimembranous VSD

• Muscular VSDMuscular VSD

Eisenmenger syndromeEisenmenger syndrome



Atrioventricular canal defect (AVC)Atrioventricular canal defect (AVC) Results from nonfusion of the endocardial Results from nonfusion of the endocardial

cushionscushions Demonstrates abnormalities in the atrial and Demonstrates abnormalities in the atrial and

ventricular septa and atrioventricular valvesventricular septa and atrioventricular valves Complete, partial, and transitional AVCsComplete, partial, and transitional AVCs


Atrioventricular Canal Defect Atrioventricular Canal Defect


Defects Decreasing Pulmonary Defects Decreasing Pulmonary Blood Flow Blood Flow

Tetralogy of FallotTetralogy of Fallot Syndrome represented by four defectsSyndrome represented by four defects

• Ventricular septal defect (VSD)Ventricular septal defect (VSD)

• Overriding aortaOverriding aorta

• Pulmonary valve stenosisPulmonary valve stenosis

• Right ventricle hypertrophyRight ventricle hypertrophy


Tetralogy of FallotTetralogy of Fallot


Defects Decreasing Pulmonary Defects Decreasing Pulmonary Blood FlowBlood Flow

Tricuspid atresiaTricuspid atresia Imperforate tricuspid valveImperforate tricuspid valve Lack of communication between the right Lack of communication between the right

atrium and right ventricle atrium and right ventricle Additional defectsAdditional defects

• Septal defectSeptal defect

• Hypoplastic or absent right ventricleHypoplastic or absent right ventricle

• Enlarged mitral valve and left ventricleEnlarged mitral valve and left ventricle

• Pulmonic stenosisPulmonic stenosis


Tricuspid AtresiaTricuspid Atresia


Mixed DefectsMixed Defects

Transposition of the great arteriesTransposition of the great arteries Aorta arises from the right ventricle and the Aorta arises from the right ventricle and the

pulmonary artery arises from the left ventriclepulmonary artery arises from the left ventricle



Transposition of the great arteries Transposition of the great arteries Results in two separate, parallel circuitsResults in two separate, parallel circuits

• Unoxygenated blood circulates continuously through Unoxygenated blood circulates continuously through the systemic circulationthe systemic circulation

• Oxygenated blood circulates continuously through Oxygenated blood circulates continuously through the pulmonary circulationthe pulmonary circulation

Extrauterine survival requires communication Extrauterine survival requires communication between the two circuits between the two circuits


Transposition of the Great Transposition of the Great ArteriesArteries



Total anomalous pulmonary venous Total anomalous pulmonary venous connection (TAPVC)connection (TAPVC) Pulmonary veins connect to the right side of the Pulmonary veins connect to the right side of the

heart, directly or indirectly through one or more heart, directly or indirectly through one or more systemic veins that drain into the right atriumsystemic veins that drain into the right atrium

Classified by point of attachmentClassified by point of attachment• SupracardiacSupracardiac

• CardiacCardiac

• InfracardiacInfracardiac


Total Anomalous Pulmonary Total Anomalous Pulmonary Venous Connection (TAPVC)Venous Connection (TAPVC)



Truncus arteriosusTruncus arteriosus Failure of the embryonic artery and the truncus Failure of the embryonic artery and the truncus

arteriosus to divide into the pulmonary artery arteriosus to divide into the pulmonary artery and the aortaand the aorta

The trunk straddles an always present VSDThe trunk straddles an always present VSD Types I, II, and IIITypes I, II, and III


Truncus ArteriosusTruncus Arteriosus



Hypoplastic left heart syndromeHypoplastic left heart syndrome Abnormal development of the left-sided cardiac Abnormal development of the left-sided cardiac

structuresstructures• Obstruction to blood flow from the left ventricular Obstruction to blood flow from the left ventricular

outflow tractoutflow tract

Under development of the left ventricle, aorta Under development of the left ventricle, aorta and aortic arch, and mitral atresia or stenosisand aortic arch, and mitral atresia or stenosis


Hypoplastic Left Heart SyndromeHypoplastic Left Heart Syndrome


Congestive Heart FailureCongestive Heart Failure

Heart is not able to maintain cardiac output Heart is not able to maintain cardiac output at level that meets demands of bodyat level that meets demands of body

Result from poor ventricular functionResult from poor ventricular function


Acquired Cardiovascular Acquired Cardiovascular DisordersDisorders

Kawasaki diseaseKawasaki disease Also known as mucocutaneous lymph node Also known as mucocutaneous lymph node

syndromesyndrome Acute, self-limiting systemic vasculitis that may Acute, self-limiting systemic vasculitis that may

result in cardiac sequelaeresult in cardiac sequelae


Kawasaki DiseaseKawasaki Disease

StagesStages Acute: capillaries, venules, arterioles, and the Acute: capillaries, venules, arterioles, and the

heart become inflamedheart become inflamed Subacute: inflammation of larger vessels; coronary Subacute: inflammation of larger vessels; coronary

aneurysms appearaneurysms appear Convalescent: medium-sized arteries begin Convalescent: medium-sized arteries begin

granulation process; small vessel inflammation granulation process; small vessel inflammation decreasesdecreases



StagesStages Post convalescent: scarring of vessels, Post convalescent: scarring of vessels,

thickening of tunica intima, calcification, thickening of tunica intima, calcification, coronary artery stenosiscoronary artery stenosis



Diagnosis (5 of 6 major findings)Diagnosis (5 of 6 major findings) Fever for 5 or more days (unresponsive to Fever for 5 or more days (unresponsive to

antibiotics)antibiotics) Bilateral conjunctivitis without exudationBilateral conjunctivitis without exudation Erythema of oral mucosa (strawberry tongue)Erythema of oral mucosa (strawberry tongue)



Diagnosis (5 of 6 major findings)Diagnosis (5 of 6 major findings) Changes in the extremities, such as peripheral Changes in the extremities, such as peripheral

edema and erythema with desquamation of edema and erythema with desquamation of palms and solespalms and soles

Polymorphous rashPolymorphous rash Cervical lymphadenopathyCervical lymphadenopathy


Acquired Cardiovascular Acquired Cardiovascular Disorders Disorders

Systemic hypertensionSystemic hypertension Hypertension in children differs from adult Hypertension in children differs from adult

hypertensionhypertension• Often have an underlying diseaseOften have an underlying disease

Renal disease or coarctation of the aortaRenal disease or coarctation of the aorta

• A cause of the hypertension in children is almost A cause of the hypertension in children is almost always foundalways found

• Children with hypertension are commonly Children with hypertension are commonly asymptomaticasymptomatic


Acquired Cardiovascular Acquired Cardiovascular DisordersDisorders

Childhood obesityChildhood obesity Multivariable and multidimensionalMultivariable and multidimensional Risk factorsRisk factors

• Obesity, insulin resistance, diabetes, cardiovascular Obesity, insulin resistance, diabetes, cardiovascular diseasedisease

• Childhood nutrition, level of physical activity, and Childhood nutrition, level of physical activity, and engagement of sedentary activities (TV, computer engagement of sedentary activities (TV, computer use, etc.)use, etc.)

Association with parental obesityAssociation with parental obesity

alterations of cardiovascular function in children

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