There are several types of congenital heart diseases that result from defects in heart structure present at birth. Cyanotic heart diseases allow deoxygenated blood to circulate systemically, while acyanotic diseases allow blood shunting between the heart's left and right sides. Common defects include atrial and ventricular septal defects, patent ductus arteriosus, coarctation of the aorta, and aortic or pulmonary valve stenosis. Signs and symptoms vary depending on the type of defect. Treatment may involve medication, cardiac catheterization, surgery such as defect closure or valve replacement, or in severe cases heart transplantation. Nursing care focuses on managing symptoms, preventing infection, and addressing needs like nutrition and development.

1. CONGENITAL HEART DISEASES
P.THIRUNAGALINGA PANDIYAN
M.Sc.,(Child Health Nursing)
Madurai Medical College
Madurai

2. CONGENITAL HEART DEFECT (CHD)
Definition
A congenital heart defect (CHD) is defined
as a defect in the structure of the heart and
great vessels which is present at birth.

3. CAUSES
Genetics
• Genetic changes, either focal mutations or deletion or
addition of segments of DNA
Environmental
Known antenatal environmental factors include maternal
infections (Rubella), drugs (alcohol, hydantoin, lithium and
thalidomide) and maternal illness (diabetes mellitus,
phenylketonuria, and systemic lupus erythematosus).
Maternal obesity

4. CLASSIFICATION OF CONGENITAL HEART DISEASES
• Cyanotic heart disease, is a condition that
deoxygenated blood moves from the right side of
the heart to the left side through abnormal
openings or defects.

5. CLASSIFICATION OF CONGENITAL HEART DISEASES
Acyanotic heart disease is a condition that
oxygenated blood moves from the left side
of the heart to the right side and then to the
lungs.

6. CLASSIFICATION OF CONGENITAL HEART DISEASES

7. ACYANOTIC HEART DISEASE
• Blood is shunted (flows) from the left side of the heart to
the right side of the heart
• Child retain normal levels of oxyhemoglobin saturation
in systemic circulation.
CommonAcyanotic heart diseases are
• Atrial septal defect, or ASD
• Ventricular septal defect, orVSD
• Patent ductus arteriosus
• Co arctation of the aorta
• Aortic valve stenosis
• Pulmonary valve stenosis

8. ATRIAL SEPTAL DEFECT
• Atrial septal defect (ASD) is a form of congenital heart
defect that enables blood flow between the left and right
atria via the interatrial septum.
• The interatrial septum is the tissue that divides the right
and left atrium.

9. ATRIAL SEPTAL DEFECT

10. Types of Atrial Septal Defects
1.Ostium Secundum – defect located in the center of the
atrial septum (most common type)
2.Ostium Primum – defect located near the lower portion
of the atrial septum, may be associated with defects in
the mitral and tricuspid valve (second most common
type)
3.SinusVenosus – defect located near the top of the atrial
septum and frequently associated with abnormal
connection of the right pulmonary vein(s) to the right
atrium instead to the left atrium (least common type)

11. ASD TYPES

12. Clinical manifestations of ASD
• Asymptomatic
• Systolic murmur with fixed split second heart
sound
• May also be a diastolic murmur
• Risk for developing dysrhythmias

13. DIAGNOSIS OF ASD
• Ultrasonography
• Auscultation:
• Echocardiography
• Transesophageal Doppler (TCD) Bubble study
• Electrocardiogram

14. TREATMENT FOR ASD
• Surgical Patch Closure-open repair
• PercutaneousASD closure is currently only indicated for
the closure of secundumASD

15. VENTRICULAR SEPTAL DEFECT
• A ventricular septal defect (VSD) is a defect in the
ventricular septum, the wall dividing the left and right
ventricles of the heart.

16. VSD

17. Signs and symptoms of VSD
• Pansystolic (Holosystolic) murmur
• Fail to thrive
• Sweaty
• Tachypnoeic (breathe faster) .

18. TREATMENT
MedicalTreatment
• Cardiac glycosides (e.g., Digoxin 10-20mcg/kg per day)
• Loop diuretics (e.g., Furosemide 1–3 mg/kg per day)
• ACE inhibitors (e.g., Captopril 0.5–2 mg/kg per day).

19. SurgicalTreatment forVSD
• Surgical treatment: -Surgical patch closure.

20. PATENT DUCTUS ARTERIOSUS
• Patent ductus arteriosus (PDA) is a congenital
disorder in the heart wherein a neonate's ductus
arteriosus(connection between Pulmonary artery
and Descending aorta ) fails to close after birth.

21. PDA

22. Signs and symptoms of PDA
• Tachycardia
• Respiratory problems
• Dyspnea - shortness of breath
• Continuous machine-like heart murmur
• Cardiomegaly - enlarged heart
• Left subclavicular thrill
• Bounding pulse

23. Diagnosis of PDA
• Echocardiography
• Electrocardiography (ECG)
• A chest X-ray

24. Treatment of PDA
• Medical treatment: Indomethacin 0.1 to 0.25 mg /kg
• Surgical treatment:
Surgical division or ligation of the patent vessel is
performed.

25. COARCTATION OFTHE AORTA
• Coarctation of the aorta is a congenital condition
whereby the aorta narrows in the area where the
ductus arteriosus
• This results in increased pressure proximal to the
defect and decreased pressure distal to the
obstruction.

26. COARCTATION OFTHE AORTA

27. Signs and symptoms of
Coarctation of aorta
• Difficulty breathing,
• Poor appetite
• Trouble feeding,
• Failure to thrive.
• Dizziness or shortness of breath,
• Faint or near-fainting episodes
• Chest pain,
• Fatigue,
• Headaches, or nosebleeds

28. Imaging and diagnosis
• A classic 'figure E sign' on x-ray
• Magnetic resonanceAngiography.
• Echocardiograms
• MR, CT
• Angiography

29. Treatment
Surgical treatment:
• Surgical repair is by resection of the coarcted portion with
an end-to-end anastomosis of the aorta
• Enlargement of the constricted section using a graft of
prosthetic material or a portion of the lift subclavian
artery.
Non surgical treatment:
• Baloon angioplasty

30. AORTICVALVE STENOSIS
•Aortic valve stenosis (AS) is a disease of the
heart valves in which the opening of the
aortic valve is narrowed.

31. Signs and symptoms
• Mild to moderate aortic stenosis do not have symptoms.
• Shortness of breath on exertion
• Syncope
• Chest Pain

32. Diagnosis
• Electrocardiogram
• Heart catheterization
• Echocardiogram.
• Chest X-ray

33. Management
Aortic valve replacement
Percutaneous (Transcatheter)AorticValve Replacement
Balloon valvuloplasty

34. PULMONIC STENOSIS
• Pulmonic stenosis is a condition of narrowing of
Pulmonary valve

35. PULMONIC STENOSIS

36. Symptoms
• Jugular vein distension
• Cyanosis
• Right ventricular hypertrophy
• Sudden fainting.
• An enlarged liver (hepatomegaly)
• Swelling in the legs (edema)

37. Treatment
• Valve replacement
• BalloonValvuloplasty

38. CYANOTIC HEART DISEASE
• Tetralogy of Fallot
• Transposition of the great vessels
• Tricuspid atresia
• Hypoplastic left heart syndrome

39. TETRALOGY OF FALLOT
• Tetralogy of Fallot (TOF) is a congenital heart defect
which has four anatomical abnormalities
Four defects are
• Pulmonary Stenosis
• Overriding aorta
• Ventricular Septal Defect (VSD)
• Right ventricular hypertrophy

40. TETRALOGY OF FALLOT

41. Signs and symptoms
• Low blood oxygen saturation causes cyanosis
• Heart murmur
• Difficulty in feeding,
• Failure to gain weight,
• Retarded growth and physical development,
• Dyspnea on exertion,
• Clubbing of the fingers and toes, and Polycythemia.

42. Diagnosis
•Chest X ray-The abnormal " (Boot-like)
appearance of a heart
•Echocardiogram

43. Management
• There are also simple procedures such as Squatting and
the Knee Chest Position

44. Management
• Beta-blockers such as propranolol,
• Morphine to reduce ventilatory drive
• Vasopressor such as epinephrine, phenylephrine, or
norepinephrine to increase blood pressure.
• Oxygen (100%)

45. Surgical procedures
Palliative surgery
• Blalock-Thomas-Taussig shunts
• The Potts shunt and the Waterston-Cooley shunt
Total surgical repair

46. TRANSPOSITION OFTHE GREATVESSEL
• The aorta is present at Right ventricle ( usually Left
Ventrilcle) and Pulmonary artery is present at Left
ventricle ( usually rightVentrilcle)
• The condition is also called dextro-transposition of the
great arteries.

47. TRANSPOSITION OFTHE GREATVESSEL

48. TRANSPOSITION OFTHE GREATVESSEL
Clinical manifestations
• Cyanotic
• Growth failure
• Abnormal Heart sounds
• Cardiomegaly

49. TRANSPOSITION OFTHE GREATVESSEL
Management :
Prostaglandin E1, digoxin,Lasix
Surgical treatment
• An Arterial switch procedure.
• Intra Artial baffle repairs, Rastelli procedure also
performed.

50. TRICUSPID ATRESIA
• Tricuspid atresia is a form of congenital heart disease
whereby there is a complete narrowing of the tricuspid
valve.

51. TRICUSPID ATRESIA

52. Clinical manifestations
• Progressive cyanosis
• Poor feeding
• Tachypnea over the first 2 weeks of life
• Holosystolic murmur due to theVSD
• Left ventricular hypertrophy

53. Treatment
• Prostoglandins to maintain Patent Ductus Arteriosus
• Modified Blalock-Taussig shunt to maintain pulmonary
blood flow
• Cavopulmonary anastomosis to provide stable pulmonary
flow
• Fontan procedure to redirect inferior vena cava and
hepatic vein flow into the pulmonary circulation

54. HYPOPLASTIC LEFT HEART SYNDROME
• Hypoplastic left heart syndrome (HLHS) is a birth defect
that affects normal blood flow through the heart.
• The left side of the heart does not form correctly.

55. HYPOPLASTIC LEFT HEART SYNDROME

56. Signs and symptoms
• Cyanosis
• Heart failure
• Decreased cardiac output

57. Treatment
• Multiple stage approach surgery - Norwood procedure
Anastamosis of the main pulmonary artery to the aorta
• Heart transplantation

58. Nursing Interventions
A. Provide adequate nutritional and fluid intake to maintain the
growth and developmental needs of the child
• Feed in semi-erect position
• Provide small frequent feedings
• Provide foods with high nutritional value
• Determine child’s likes and dislikes
• Strict input and output
• Daily weight

59. Nursing Interventions
B. Prevent infection
• Prevent exposure to communicable diseases
• Immunizations should be up-to-date
• Handwashing should be observed
• Be certain that the child receives prophylactic medication
for infective endocarditis

60. Nursing Interventions
• Reduce the workload of the heart since decreased activity
and expenditure of energy will decrease oxygen
requirements
• Adequate rest
• Avoid unnecessary activities
• Prevent excessive crying
• Provide diversional activities
• Relieve the respiratory distress associated with increased
pulmonary blood flow or oxygen deprivation

61. NURSING MANAGEMENT OFTHE CHILDWITH A
CONGENITAL HEART DEFECT
Nursing Diagnoses
• Impaired gas exchange related to altered pulmonary
blood flow or oxygen deprivation
• Altered cardiac output related to specific anatomic defect
• Activity intolerance related to decreased oxygenation in
blood and tissues
• Altered Nutrition: less than body requirements related to
the excessive energy demands required by increased
cardiac workload

62. NURSING MANAGEMENT OFTHE CHILD WITH A
CONGENITAL HEART DEFECT
• Increased potential for infection related to poor
nutritional status
• Anxiety related to diagnostic procedures and
hospitalization
• Developmental delay related to decreased energy,
inadequate nutrition, physical limitations and social
isolation
• Alteration in parenting related to parental perception of
the child as vulnerable