Day 12 Pediatric Cardiology

Patient 1: Fetal echo 27 weeks

Single umbilical artery; should be two artery, one vein
Could be associated with congenital abnormalities like congenital heart disease.
Flow of vsd both arterial and venous flow, So two colors on echo are seen going back and forth through the VSD
Muscular seplal defect has a greater chance of recovery and closing than other septal defects.
Usually closes on own depending on size.
Ductus spenousis can tells us about umbilical and heart, stenosis, acts as sphincter...if born without it, the heart will get flooded and we can see flow abnormalities.
Doplar it on echo to see flow of blood.
Look for aorta and ductal arch 
Patients other child had muscular VSD which closed after birth
Ductal arch stenosis than right ventricle becomes sick and needs early delivery.
VSD shunting bi-directional flow, common finding, usually closes spontaneously sometimes before birth.
Patent ductus foramen ovale right to left shunt.
If murmer after birth means vsd not closed, the louder the murmer, the smaller the vsd
(Note to self from doc, this is the middle east so don't want to upset ppl...like taking patients out of order).

Patient 2: Normal exam, 30 weeks
No pericardial effusion
Birth defect-twins 
One girl blind
Microopthalmia
Dolichicephaly
Looking for heart defect also.

Patient 3: In neonatal ward: Anus inperforated
Fistula into vagina, not very healthy
Vater:  vertebral problemes, fistula, renal problems, anal atresia, cardiac problems

Patient 4: BPD: broncho pulmonary displasia, 
Premature and on oxygen more 28 days has BPD
Has PDA
Pulmonary problems
Not because right ventricle but because pulmonary pressure so high.
Right ventricle hypertrophic
Abdomen so big pushing heart
PR gradient can get diastolic pressure 20mmhg high 
Give home NO or give Viagra for pulmonary hypertension
Viagra cheaper than NO
Very edematous child
Big PDA- left to right shunt? Gradient of 4 previously
All right to left shunt, worse now.
Maybe ductus closed, can't see it on echo.left to right when it was open.now right to left.
Right ventricle not as big as it should be. 
IVC and hepatic veins small
No retrograde into hepatic vein
Right to left BC pfo flow not open to lungs and systemic flow BC pressure in diastole 
130 days old, has bad lungs premature birth no surfactant and alveoli not mature
Right ventrical was not contractiong so put on NO (nitric oxide) 

Patient 5: Blood sat 60! BPD patient, 3 months old
300 per min high frequency ventilation pushes and pulls oscillation
Bpd, just closed huge ductus
Swollen child due to PDA not being closed on time.
3 months old, PDA closed 2 days ago.
Intracranial bleeding in brain itself on both hemispheres
Possible treatment of premature lungs;
Beta agonist if needed, Viagra, NO. O2.
Right to left at pfo