1. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Alterations of Cardiovascular Function in Children Chapter 24

2. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Congenital Heart Defects  Major cause of death in the first year of life other than prematurity  Prenatal, environmental, and genetic risk factors  Maternal rubella, type 1 diabetes, alcoholism, PKU, and hypercalcemia  Drugs  Chromosome aberrations

3. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Congenital Heart Disease  Heart defects  Hemodynamic alterations  Right-to-left shunt, left-to-right shunt  Status of tissue oxygenation  Cyanotic defects  Acyanotic defects

4. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Obstructive Defects  Coarctation of the aorta  Narrowing of the lumen of the aorta that impedes blood flow  Coarctation of the aorta is almost always in a juxtaductal position, but it can occur anywhere between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen

5. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Coarctation of the Aorta

6. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Obstructive Defects  Aortic stenosis  Narrowing of the aortic outflow tract  Caused by malformation or fusion of the cusps  Causes an increased workload on the left ventricle

7. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Aortic Stenosis

8. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Obstructive Defects  Valvular aortic stenosis  Malformed or fused cusps  Progressive obstruction with episodes of ischemia  Strenuous activity limited  Subvalvular aortic stenosis  Stricture caused by a fibrous ring below a valve  Konno procedure used to correct

9. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Obstructive Defects  Pulmonic stenosis  Narrowing of the pulmonary outflow tract  Abnormal thickening of the valve leaflets  Narrowing of the valve  Pulmonary semilunar valve atresia

10. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Pulmonic Stenosis

11. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Defects Increasing Pulmonary Blood Flow  Patent ductus arteriosus (PDA)  Failure of the ductus arteriosus to close  PDA allows blood to shunt from the pulmonary artery to the aorta

12. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Patent Ductus Arteriosus (PDA)

13. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Defects Increasing Pulmonary Blood Flow  Atrial septal defect  Abnormal opening between the atria  Three major types Ostium primum defect Ostium primum defect Ostium secundum defect Ostium secundum defect Sinus venosus defect Sinus venosus defect

14. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Defects Increasing Pulmonary Blood Flow  Ventricular septal defect (VSD)  Abnormal communication between the ventricles  Most common type of congenital heart lesion  Types Perimembranous VSD Perimembranous VSD Muscular VSD Muscular VSD  Eisenmenger syndrome

15. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Defects Increasing Pulmonary Blood Flow  Atrioventricular canal defect (AVC)  Results from nonfusion of the endocardial cushions  Demonstrates abnormalities in the atrial and ventricular septa and atrioventricular valves  Complete, partial, and transitional AVCs

16. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Atrioventricular Canal Defect

17. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Defects Decreasing Pulmonary Blood Flow  Tetralogy of Fallot  Syndrome represented by four defects Ventricular septal defect (VSD) Ventricular septal defect (VSD) Overriding aorta Overriding aorta Pulmonary valve stenosis Pulmonary valve stenosis Right ventricle hypertrophy Right ventricle hypertrophy

18. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Tetralogy of Fallot

19. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Defects Decreasing Pulmonary Blood Flow  Tricuspid atresia  Imperforate tricuspid valve  Lack of communication between the right atrium and right ventricle  Additional defects Septal defect Septal defect Hypoplastic or absent right ventricle Hypoplastic or absent right ventricle Enlarged mitral valve and left ventricle Enlarged mitral valve and left ventricle Pulmonic stenosis Pulmonic stenosis

20. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Tricuspid Atresia

21. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Mixed Defects  Transposition of the great arteries  Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle

22. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Mixed Defects  Transposition of the great arteries  Results in two separate, parallel circuits Unoxygenated blood circulates continuously through the systemic circulation Unoxygenated blood circulates continuously through the systemic circulation Oxygenated blood circulates continuously through the pulmonary circulation Oxygenated blood circulates continuously through the pulmonary circulation  Extrauterine survival requires communication between the two circuits

23. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Transposition of the Great Arteries

24. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Mixed Defects  Total anomalous pulmonary venous connection (TAPVC)  Pulmonary veins connect to the right side of the heart, directly or indirectly through one or more systemic veins that drain into the right atrium  Classified by point of attachment Supracardiac Supracardiac Cardiac Cardiac Infracardiac Infracardiac

25. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Total Anomalous Pulmonary Venous Connection (TAPVC)

26. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Mixed Defects  Truncus arteriosus  Failure of the embryonic artery and the truncus arteriosus to divide into the pulmonary artery and the aorta  The trunk straddles an always present VSD  Types I, II, and III

27. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Truncus Arteriosus

28. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Obstructive Defects  Hypoplastic left heart syndrome  Abnormal development of the left-sided cardiac structures Obstruction to blood flow from the left ventricular outflow tract Obstruction to blood flow from the left ventricular outflow tract  Under development of the left ventricle, aorta and aortic arch, and mitral atresia or stenosis

29. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Hypoplastic Left Heart Syndrome

30. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Congestive Heart Failure  Heart is not able to maintain cardiac output at level that meets demands of body  Result from poor ventricular function

31. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Acquired Cardiovascular Disorders  Kawasaki disease  Also known as mucocutaneous lymph node syndrome  Acute, self-limiting systemic vasculitis that may result in cardiac sequelae

32. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Kawasaki Disease  Stages  Acute: capillaries, venules, arterioles, and the heart become inflamed  Subacute: inflammation of larger vessels; coronary aneurysms appear  Convalescent: medium-sized arteries begin granulation process; small vessel inflammation decreases

33. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Kawasaki Disease  Stages  Post convalescent: scarring of vessels, thickening of tunica intima, calcification, coronary artery stenosis

34. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Kawasaki Disease  Diagnosis (5 of 6 major findings)  Fever for 5 or more days (unresponsive to antibiotics)  Bilateral conjunctivitis without exudation  Erythema of oral mucosa (strawberry tongue)

35. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Kawasaki Disease  Diagnosis (5 of 6 major findings)  Changes in the extremities, such as peripheral edema and erythema with desquamation of palms and soles  Polymorphous rash  Cervical lymphadenopathy

36. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Acquired Cardiovascular Disorders  Systemic hypertension  Hypertension in children differs from adult hypertension Often have an underlying disease Often have an underlying disease  Renal disease or coarctation of the aorta A cause of the hypertension in children is almost always found A cause of the hypertension in children is almost always found Children with hypertension are commonly asymptomatic Children with hypertension are commonly asymptomatic

37. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published. Acquired Cardiovascular Disorders  Childhood obesity  Multivariable and multidimensional  Risk factors Obesity, insulin resistance, diabetes, cardiovascular disease Obesity, insulin resistance, diabetes, cardiovascular disease Childhood nutrition, level of physical activity, and engagement of sedentary activities (TV, computer use, etc.) Childhood nutrition, level of physical activity, and engagement of sedentary activities (TV, computer use, etc.)  Association with parental obesity