Cyanotic heart defect

Classification	D
External resources	MedlinePlus: 001104;

Cyanotic heart defect is a group-type of congenital heart defect (CHD) that occurs due to deoxygenated blood bypassing the lungs and entering the systemic circulation or a mixture of oxygenated and unoxygenated blood entering the systemic circulation. It is caused by structural defects of the heart (i.e.: right-to-left, bidirectional shunting, malposition of the great arteries), or any condition which increases pulmonary vascular resistance. The result being the development of collateral circulation.

Signs and symptoms

Clubbing
The patient assuming a crouching position
Cyanosis - facial discolouration (particularly the lips) and digit discolouration (fingers & toes).
Crying
Crabbiness/irritability
Tachycardia
Tachypnea
A history of inadequate feeding.
Unusually large toe & fingernails.
Delayed development (both biological & psychological).

Diagnosis

Types

Tetralogy of Fallot (ToF)
Total anomalous pulmonary venous connection
Hypoplastic left heart syndrome (HLHS)
Transposition of the great arteries (d-TGA)
Truncus arteriosus (Persistent)
Tricuspid atresia
Interrupted aortic arch
Pulmonary atresia (PA)
Pulmonary stenosis (critical)
Eisenmenger syndrome (reversal of shunt due to pulmonary hypertension) .
Patent ductus arteriosus may cause cyanosis in late stage^[1]

According to a study in cyanotic congenital heart disease (CCHD) in Sohag University, Upper Egypt. 50 neonates were diagnosed as suffering from cyanotic congenital heart disease (CCHD), they concluded that cyanotic congenital heart disease (CCHD) frequency was significant (9.5%) with D-TGA being the commonest type. Majority of neonates with Cyanotic congenital heart disease (CCHD) showed survival with suitable management. ^[2]

Management

Morphine during Tet spells to decrease associated infundibular spasm.
Prophylactic: Propranolol/Inderall
Prostaglandin E (to keep the ductus arteriosus patent)
Prophylactic antibiotic to prevent endocarditis
Surgery: Glenn Shunt, Hemi-Fontan Procedure, Fontan Procedure. The purpose of these operations is to redirect the blood flow of the deoxygenated blood to the lungs by attaching the Superior Vena Cava directly to the Pulmonary Artery causing the blood that flows into the lungs to be oygenated before entering the chambers on the right side of the heart. Mathematical models are used to address the issue of pressure level alterations of circulation after the procedures. The pulmonary pressure resistance in the cavopulmonary connection is increased, and these models permit clear analyses of the pressure increase allowing doctors to avoid possible venous circulation congestion.

References

↑ Page Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.
↑ Abou-Taleb, A., Abdelhamid, M. A., & Bahkeet, M. A. (2016). Clinical profile of cyanotic congenital heart disease in neonatal intensive care unit at Sohag University Hospital, Upper Egypt. Egyptian Journal of Medical Human Genetics.

External links

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[1] Page Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.

[2] Abou-Taleb, A., Abdelhamid, M. A., & Bahkeet, M. A. (2016). Clinical profile of cyanotic congenital heart disease in neonatal intensive care unit at Sohag University Hospital, Upper Egypt. Egyptian Journal of Medical Human Genetics.