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Pulmonary Complications of Congenital Heart Disease PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Pulmonary Complications Of Congenital Heart Disease” by Dima Ezmigna, MD,FAAP.

This medical PowerPoint presentation is about congenital heart disease (CHD), a term used to describe a wide range of heart defects that are present at birth. These defects can affect the structure or function of the heart, and may result in a variety of pulmonary complications.

Some of the pulmonary complications associated with CHD include Pulmonary hypertension, Eisenmenger syndrome, Respiratory infections, Exercise intolerance, Chronic lung disease, Pulmonary edema and Sleep apnea.

Tags : Congenital Heart Disease, pulmonary complications, Pulmonary hypertension, Eisenmenger syndrome, Respiratory infections, Exercise intolerance, Chronic lung disease, Pulmonary edema, Sleep apnea, Neonatal-Perinatal Medicine, Neonatal-Perinatal Medicine PowerPoint presentation

Published on : Jun 07, 2023 | Views : 791 | Downloads : 0

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Pulmonary Complications Of Congenital Heart Disease Dima Ezmigna, MD,FAAP Assistant Professor Pediatric Pulmonology UF Health
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Outline Pulmonary Vascular Physiology And Cardiac Interaction Consequences Of LT-RT Cardiac Shunting Anatomic Compression Of Pediatric Airways Pulmonary Edema Atelectasis Coagulation Defects Surgical Trauma Pulmonary Infections Single Ventricle Physiology ???
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Outline Increased pulmonary blood flow Decreased pulmonary venous outflow Anatomical compression on the airways
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Pulmonary Blood Flow Bronchial blood flow : A very small portion of the output of LV ~2% Tracheobronchial tree with systemic arterial blood. Pulmonary blood flow : The entire output of the RV Supplies the lung with the mixed venous blood draining all the tissues of the body.
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Source: Chapter 1. Function and Structure of the Respiratory System, Pulmonary Physiology, 8e Citation: Levitzky MG. Pulmonary Physiology, 8e; 2013 Available at: https://accessmedicine.mhmedical.com/ViewLarge.aspx?figaid=57345341&gbosContainerID=0&gbosid=0 Accessed: February 23, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved Scanning electron micrograph of the surface and cross section of an alveolar septum. Capillaries (C) are seen sectioned in the foreground, with erythrocytes (EC) within them. A = alveolus; D = alveolar duct; PK = pore of Kohn; AR = alveolar entrance to duct; * = connective tissue fibers. The encircled asterisk is at a junction of 3 septa. (Reproduced with permission from Weibel, 1998.)
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Adaptation after birth! The highest oxygenated fetal blood is the umbilical vein with PO2 ~ 55±7 mmHg Blood returning to the placenta will have a PO2 of 15 to 25 mmHg. Significant Decreased in PVR after birth.
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Source: Chapter 4. Blood Flow to the Lung, Pulmonary Physiology, 8e Citation: Levitzky MG. Pulmonary Physiology, 8e; 2013 Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=575§ionid=42512982 Accessed: February 23, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved Pressures, expressed in mm Hg, in the systemic and pulmonary circulations.
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Pulmonary vascular resistance
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Pulmonary vascular resistance Pulmonary circulation is different from systemic circulation: Thinner walls Less vascular smooth muscles Distensible Compressible
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Pulmonary Vascular Resistance
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Pulmonary vascular resistance Extravascular effects on PVR: Gravity and Body position Lung volumes Alveolar and intrapleural pressure Intravascular pressure RV output
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Source: Chapter 4. Blood Flow to the Lung, Pulmonary Physiology, 8e Citation: Levitzky MG. Pulmonary Physiology, 8e; 2013 Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=575§ionid=42512982 Accessed: February 23, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved The effects of lung volume on pulmonary vascular resistance (PVR). PVR is lowest near the functional residual capacity (FRC) and increases at both high and low lung volumes because of the combined effects on the alveolar and extraalveolar vessels. To achieve low lung volumes, one must generate positive intrapleural pressures so that the extraalveolar vessels are compressed, as seen at left in the figure. RV = residual volume; TLC = total lung capacity. (Reproduced with permission from Graph after Murray, 1976, 1986.)
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Outline Increased pulmonary blood flow Decreased pulmonary venous outflow Anatomical compression on the airways Cardiac Vascular
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Left - Right Shunt Atrial Ventricular Arterial level
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Left –right shunt Increased pulmonary blood flow Increased extravascular fluid Pulmonary edema Tidal volume and lung compliance decreases and expiratory airway resistance increases Pulmonary function abnormalities resolve after surgical repair and normalization of Qp
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Left-Right Shunt (atrial) Usually less severe Atrial level shunts often result in enlargement of the right ventricle (RV volume overload) It is rare that RV and pulmonary artery pressures are significantly elevated RVSP  RV hypertrophy decreased diastolic complicate  limitation of shunt
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Left-Right Shunt Newborns with ASDs may initially have right-to-left shunting. As (PVR) gradually declines postnatally, right ventricular compliance slowly increases and is accompanied by increasing atrial left-to-right shunting.
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Left-Right Shunt ( ventricular) Membranous and muscular defects Atrioventricular (AV) canal defects Conoventricular defects.
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Consequences of lT-RT shunts at the ventricular level : Increased (Qp) Pulmonary hypertension – Unrestrictive VSDs Metabolic and neurohumoral effects –This may result in the initiation of compensatory reflex mechanisms to maintain organ perfusion, which have deleterious long-term effects.
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Shunt-flow limitation The amount of left-to-right shunting in this disorder is determined by the degree of obstruction of the right ventricular outflow tract. Other examples : valvar or supravalvar pulmonic stenosis, hypoplasia of the pulmonary arteries TOF
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PPHN-affecting LT-RT Shunt This reduces the extent of left-to-right shunting and limits the development of left ventricular volume overload and signs and symptoms of heart failure.
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Shunt-flow enhancement Obstruction to left ventricular outflow, such as subvalvar and valvar aortic stenosis or obstructive lesions of the aortic arch, favor left-to-right shunting.
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Outline Increased pulmonary blood flow Pulmonary hypertension Pulmonary edema Decreased pulmonary venous outflow Anatomical compression on the airways
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Pulmonary hypertension
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Pulmonary hypertension Failure of the pulmonary microvasculature to undergo remodeling of the pulmonary arteriolar wall that normally occurs in early infancy Alveolar hypoxia or other local effects that favor pulmonary vasoconstriction may exacerbate this process.
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Pulmonary hypertension Increased concentration of plasma endothelin and impaired endothelium-dependent pulmonary vascular relaxation in patients with increased pulmonary blood flow due to left-to-right shunts.
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Pulmonary Edema Decreases lung compliance Restrictive defects predominate. Total lung capacity Diffusion capacity of carbon monoxide (DLCO) are abnormally decreased in patients with acute or chronic pulmonary edema Source: Chapter 4. Blood Flow to the Lung, Pulmonary Physiology, 8e Citation: Levitzky MG. Pulmonary Physiology, 8e; 2013 Available 12982 Accessed: February 23, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved
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Pulmonary Edema Oxygen and ventilator support (1) reduction of pulmonary venous return (preload reduction) (2) reduction of systemic vascular resistance (afterload reduction), and, in some cases (3) inotropic support.
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Outline Increased pulmonary blood flow Decreased pulmonary venous outflow Anatomical compression on the airways
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Post capillary disease/Pulmonary hypertension
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Outline Increased pulmonary blood flow Decreased pulmonary venous outflow Anatomical compression on the airways
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Anatomical Compression: Cardiac Left bronchial compression: Combined enlargement of the pulmonary arteries and left atrium Massive cardiomegaly widening of the angle of tracheal bifurcation: Left atrial enlargement LLL compression and bronchiectasis Tracheobronchomalacia
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Anatomical Compression: Vascular Compression of the airway by a pulsatile artery and subsequent malacia of that airway. Symptoms of airway compression may be mild Difficulty in extubating Ex: Abnormalities of the aortic arch, pulmonary artery slings, anomalous innominate artery, dilated pulmonary artery.
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Double aortic arch with tracheal compression
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Pulmonary artery sling compression of ther trachea and esophagus
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Atelectasis Small airway size Reduced number of interalveolar pores of kohn Reduced number of bronchiole-alveolar channels of lambert. Reduced lung compliance Ventilation/perfusion mismatching that result in hypoxemia. Extrinsic compression from vascular malformation, restrictive defects from pulmonary edema, or from underlying respiratory tract infection.
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Surgical trauma to the respiratory system
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Pulmonary infections
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Thank you !