Fetal Shunts
Cyanotic/ obstructive defects
Cardiogenesis
Acyanotic defects
Circulatory Changes
Mixed defects/ Misc.
100

Three shunts in the fetal circulatory system

Foramen ovale

ductus venosus

ductus areteriosis 

100

What type of shunting is characteristic of cyanotic disease?

Right to left shunting.

-right sided pressure exceed left sided pressures.

100

Cardiogenesis begins in this week of gestation.

Week 3

100

Which direction is the blood abnormally flowing through the heart. 

Left to right

100

What causes the change in fetal circulation to shift from the placenta to the lungs

The clamping of the umbilical cord.

100

true or false:

Most genetic mechanisms of causation are multifactorial

true

200

The connection of the right and left atria

foramen ovale

200

True or False:

Symptoms of obstructive defects depend on the site and severity of the stenosis.

True

200
All structures of the fetal heart and vascular system are developed by which week

Week 7

200

True or False:

Acyanotic defects decrease pulmonary blood flow.

False

- Acyanotic defects increase pulmonary blood flow because blood is shunting from the left (high pressure side) to the right into the pulmonary system.

200

True or false:

The fetal lungs are aerated prior to delivery.  

False


-Fetal lungs are not aerated until after birth.

200


Transposition of the Great Arteries

-a condition where the aorta arises from the RV and the PA arises from the LV. 

- results in two separate, parallel circuits in which unoxygenated blood is continuously flowing through the systemic and oxygenated is flowing through the pulmonary.

- incompatible with life unless a communication exists. (DA, FO, or VSD)

300

Ductus Arteriosus 

Joins the Pulmonary artery to the Aorta (conjoins the arteries)

300

What is this disease and what is its main characteristics?

Tetralogy of Fallot

-Most common cyanotic heart defect 5-10%

1.) a large Ventricular septal defect that is high in the septum 

2.) and overriding aorta that straddles the VSD

3.) pulmonary stenosis

4.) right ventricular hypertrophy

300
One of the main differences between the blood circulation in a fetal heart opposed to an adult heart

Fetal shunts


300

ASD - atrial septal defect

the abnormal communication between both atria

300

What delivers oxygenated blood and nutrients to the fetus.

The placenta
300

Acquired heart disease are abnormalities that occur after birth. The most common associated heart diseases in children are: 

- kawasaki disease

- HTN

- Rheumatic heart disease

- Myocarditis or Obesity?

400

Ductus Venosus

Connects the inferior vena cava to the umbilical vein (connects the veins) 

400

Which disease is this and is it obstructive or cyanotic?


Aortic Stenosis 

CAN LEAD TO SUDDEN DEATH!

- obstructive

- narrowing of the aortic outflow tract


400

This begins when the septum primum and the septum secundum grow towards the area of the endocardial cushions.  

Atrial septation 

400


Arterioventricular canal defect (AVC defect)

Abnormalities in both the atrial and ventricular septa and the AV valves.

400

How does resistance effect the fetal blood circulation?

Fetal blood follows the path of least resistance. Since there is high resistance in the lungs and low systemic resistance, the blood diverts through the ductus arteriosus to the aorta and throughout the body.

400


Hypoplastic Left Heart Syndrome

- abnormal development of the Left sided cardiac structures, resulting in obstruction to flow from the LV outflow tract.

- underdevelopment of Aorta, aortic arch, LV and mitral atresia/ stenosis.  

500

When does the closure of the ducts take place?

FO : functionally at birth/ anatomically several months later

DA: functionally at 15 hours/ anatomically first several weeks

DV: within one week after birth

500

What is this disease and is it cyanotic or obstructed? 


Tricuspid Atresia

- Cyanotic

- consists of an imperforate tricuspid valve, resulting in NO communication between the RA and RV

- other defects that are characteristic - septal defect, hypoplastic or absent RV, enlarged mitral valve and pulmonary stenosis.

500

This begins with the fusion of the muscular ridge at the apex, endocardial tissue and the bulbar ridges in the bulbar cordis.

Ventricular Septation

500

blood shunts from the PA to aorta.

PDA - patent ductus arteriosis 

500

What are three significant post natal changes that occur?

1.) thinning of the right ventricular myocardium

2.) systemic vascular resistance increases

3.) The left ventricular myocardium becomes thicker and more dominant. 

500

What is a symptom of heart failure that is specific to children?

Failure to thrive (FTT) - caused by poor feeding/sucking

- manifestations are otherwise the same in children and adults.

600


DA

600

What is this disease and is it obstructive or cyanotic? 

BONUS - What is the severe form of this disease called and how is it different?


Pulmonary stenosis

- obstructive

-narrowing of the pulmonary flow tract 


BONUS- pulmonary Atresia 

- involves complete blockage of the RV into the pulmonary vein. (Now blood flow is dependent on a patent ductus arteriosus) 

600

True or false: 

The heart arises from the mesenchyme and begins as an enlarged blood vessel with a large lumen and a muscular wall

True

600



VSD - Ventricular Septal Defect

Abnormal flow of blood between the ventricles. Also the most common type of congenital heart lesion.

600

Postnatal HR, cardiac output and systolic BP?

HR: 100- 180 bpm

Cardiac output: high

Systolic BP: 39- 59mmHg (reflects low SVR)

600

Total Anomalous Pulmonary Venous Connection

- occurs when the pulmonary veins abnormally connect to the right side of the heart either directly or through one or more systemic veins that drain into the RA. 

700


Foramen Ovale

700

What is the disease and is it obstructive or cyanotic?


Coarction of the aorta 

- narrowing of the lumen of the aorta that impedes  blood flow.

- obstructive

700

What are genetic risk factors associated with CHD?

Trisomy 18 (99%)

Trisomy 21

Trisomy 13

Cri du Chat syndrome

turners syndrome

Kleimfelter Syndrome

700

What is the gold standard for definitive diagnosis of structural and functional cardiac disease

ECHO - echocardiogram 

- other tools for evaluation include physical exam, plotting a child's growth, ECG and chest Xray.

700
How is oxygen consumption effected at birth?

oxygen consumption is doubled at birth.

700

Environmental risk factors and medications that could cause CHD:

maternal conditions:

viral infections (rubella), ETOH, Drugs, DM, advanced maternal age, metablic disorders (PKU and Hypercalcemia), and autoimmune disorders (lupus)

Medications:

Anticonvulsants, ACE inhibitors, lithium, retinoic acid, and warfarin

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