先心病的早期管理

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1、EarlymanagementofcongenitalheartdiseasesJameelA.AL-AtaConsultant&assistantprofessorofpediatrics&pediatriccardiology.IntroductionOutcomeofCHDhasimprovedmainlyduetoimprovedSurgical&Interventionalcare,speciallyforneonates.InKSAoverallCHDsurgicalmortalityin4largecentersis3—6%.Pre-surgicalmorbidity&mor

2、talityremainshighformanydifferentreasons.IntroductionPoorearlyrecognition.(pre,natal&postnatal).Delayedpresentation.NonefamiliarityofpathophysiologyandnaturalhistoryofCHD.Delayedinitiationoftreatment.LimitedNICU/PICUfacilities.LimitedPGEavailability.Limitedmedivacservices.Others.Pediatricianscanma

3、kethedifferenceby;Earlyrecognition.Categorizingintotype&severity.Timelyinitiationofpropermedicaltreatment.Timelyreferralforinterventionalorsurgicaltreatment.=EARLYMANAGEMENTEarlymanagementofsecondumAtrialSeptalDefect;ConfirmDXandsizeofASD.Mostptswillnotneedmedicaltreatment.Assureparentsandinformth

4、emofhighlikelihoodofspontaneousclosure.WatchfordevelopmentofPHTNatF/U.Lookfornonecardiacassociations.ASDNolimitationofactivity.SBEprophylaxisnotusuallyrecommended.Screenthefamily.Followevery6—12months.Referforinterventionorsurgeryatage3-5y.ifsizeremains>5mm.EarlymanagementofVSD;ConfirmDX,typeofVSD

5、&size.Examineforpresenceordevelopmentofcoarctationoraorticinsufficiency.Medicaltherapy(diuretics+/-ACE)usuallyneededfor>5mmdefects.Digoxinnotusuallyneeded.Treatrespiratoryinfectionsaggressively.VSDEnsureoptimumcaloricintake.HighriskofdevelopmentofPHTN.LargeVSDscanbesilent.(PHTN)Nolimitationofactiv

6、ity.SBEprophylaxisisamust.VSDFollowmonthly<4m.o&every2—4m.forage>4m.o.Refertosurgeryorinterventionif;1)FTT,CHF2)PHTN3)AI4)Endocarditis.(usualage6—12months)Small<5mmmuscular&PmVSDshaveagoodchanceforspontaneousclosure,soassureparentsbutfollowthePmVSDforAI.Inlet&SubarterialVSDsdonotclosespontaneously

7、.EarlymanagementofPDAConfirmDXandsize.Spontaneousclosureistheruleinthe1styearoflife,soassureparents.Limitationofactivitynotneeded.Medicaltherapy(diuretics+/-ACE)canbeneededusuallyifsize>2mm.PDALargePDA>3mmactlike