Master the board step 3

Pediatrics
High-Yield Congenital Heart Defects
Acyanotic lesions
Heart Defect
Ventricular septal
defect
Atrial septal defect
Atrioventricular
canal
Pulmonary stenosis
Patent ductus
arteriosus
Aortic stenosis
Coarctation of the
aorta
Comments
Harsh holosystolic murmur over lower left sternal border ± thrill; loud pulmonic S2
Almost half of cases have spontaneous closure within the first 6 months.
Surgical repair if failure to thrive, pulmonary hypertension, or right-to-left shunt > 2:1
Loud S1, wide fixed splitting of S2, systolic ejection murmur along left upper sternal border.
Majority are asymptomatic, are of secundum types, and close by age 4.
Primary and sinus types require surgery.
Most common type: patent foramen ovale
A patent foramen ovale needs to be closed if a paradoxical embolus has gone through it.
Late complications: Mitral valve prolapse, dysrhythmias, and pulmonary hypertension
Combination of the primum type of atrial septal defect, ventricular septal defect, and
common atrioventricular valve
Presentation similar to ventricular septal defect
Perform surgery in infancy before pulmonary hypertension develops.
May be asymptomatic or may result in severe congestive heart failure.
Give prostaglandin E1 infusion at birth.
Attempt balloon valvuloplasty.
More common in girls (2:1), babies where maternal rubella infection was present, and
premature infants
Wide pulse pressure, bounding arterial pulses, and characteristic sound of “machinery”
(to-and-fro murmur)
Indomethacin-induced closure helpful in premature infants.
Term infants often require surgical closure.
Early systolic ejection click at apex of left sternal border
Valve replacement and anticoagulation may be required.
Of all cases, 98 percent occur at origin of left subclavian artery.
Blood pressure higher in arms than legs, bounding pulses in arms and decreased pulses in
legs
Ductus dependant: Give PGE1 infusion to maintain ductus patent (ensures lower extremity
blood flow)
Surgery repair after stabilization
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