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  1. Practical Nursing Considerations for Caring for the Adult Congenital Heart Patient Kristi Ryan, APN
  2. Objectives • Understand practical nursing considerations for caring for the adult patient with congenital heart disease • Common congenital heart complications that bring patients to the hospital • What makes these patients different?... Beyond the anatomy and physiology
  3. Normal Cardiac Anatomy
  4. Cardiac Pressures
  5. ACHD Defects • Classifications: Simple, Moderately complex, and Highly complex • ACHA (Adult Congenital Heart Association)
  6. Unrepaired: • Small ASD • Small VSD • Mild PS Repaired: • PDA • ASD • VSD Repaired/Unrepaired: • Isolated AoV • Isolated MV • PFO Simple CHD One visit to ACHD program then can be followed by general cardiologist or congenital cardiologist Any new issues should be re-evaluated by ACHD clinic
  7. Moderately complex CHD • ALCAPA • P/TAPVR • AV Canal • Sinus venosus ASD • Coarctation • Ebstein’s anomaly • RVOTO • PV regurgitation(> mod) • PV stenosis (> mod) • Subvalvar or supravalvar AS • Tetralogy of Fallot • VSD with valve problem or obstructions Follow up every 2 years or more with ACHD program
  8. Highly Complex CHD • Eisenmenger syndrome • All cyanotic patients • L-TGA • DORV • Mitral atresia • Pulmonary atresia • Shone’s complex • Single ventricle • D-TGA • Tricuspid atresia • Truncus • Heterotaxy • s/p BT shunt • s/p conduit • s/p double switch • Fontan • Mustard/Senning • Norwood • Rastelli At least annual visit at ACHD program
  9. Common Adult Lesions CHD diagnosed in adulthood • Atrial Septal Defect (ASD) • Coarctation of Aorta • Congenitally Corrected Transposition (L-TGA) • Patent foramen ovale
  10. Re-operation/Intervention • Aortic regurgitation • Aortic stenosis • Aortic root enlargement • Coarctation of aorta • Pulmonary regurgitation/stenosis • RV to PA conduit failure • Fontan revision • Mustartd/Senning baffle obstruction • Arrhythmia interventions: – ICD/pacemakers – Ablations – Cardioversions
  11. Atrial Septal Defects (ASD)
  12. ASD • ~1/3 diagnosed as an adult • Multiple types of ASDs: – PFO, secundum, primum, sinus venosus • Symptoms and presentation depends – Size of hole – Location – Any other defects, comorbidities – Age • Closure: cath lab vs. surgery • Eisenmenger Syndrome- long term complication if unrepaired
  13. Eisenmenger Syndrome
  14. Tetralogy of Fallot (TOF) Four abnormalities: • Ventricular septal defect (VSD) • RV outflow tract obstruction (Subpulmonary stenosis) • Right ventricular hypertrophy • Overriding aorta
  15. TOF: Initial Palliation • Need to establish pulmonary blood flow • Classic BT Shunt ligated the subclavian artery
  16. TOF: Surgical Repair Valve Sparing Repair RV to PA Conduit
  17. Adult RV to PA Replacement Transcatheter valve replacement – Melody Transcatheter Pulmonary Valve – Edwards Sapien XT Pulmonary Valve Surgical replacement – Redo sternotomy
  18. Coarctation of Aorta Narrowing of aorta • Diagnosed any time in life • 4 extremity BP helpful in diagnosis and monitoring • Commonly associated with bicuspid aortic valve
  19. Repair of coarctation Surgical Intervention Catheter intervention
  20. Where will you see them? • Emergency room • Operating room and post op (CVICU) • Cardiology and medical admissions • Labor & delivery • Psychology admissions
  21. Reason for hospitalization Shikhar Agarwal et al. J Am Heart Assoc 2016;5:e002330 Complex ACHD Simple ACHD (ASD/PFO excluded) Simple ASD/PFO • CHF • Respiratory disorders • Arrhythmias • Valve disease • Coronary artery disease • Arrhythmias • CVA- 26% • Arrhythmia
  22. Tips for admitting ACHD • Identify patient as ACHD patient – Were they born with the defect? – Do they have a scar in the middle of chest or a thoracotomy? – Did they see a cardiologist as a child? • Consult the ACHD team! • Only ~10% of ACHD patients in the US are currently getting the ACHD care that is recommended
  23. Why are they different? • Increased incidence of comorbidities: obesity, hypertension, smoking, kidney disease • Psychological impact of- depression and anxiety more common • Social considerations • Quality of life
  24. Summary • ACHD patients are special • There are some nursing considerations that must be considered- the key is ASSESSMENT and consultation! • Nearly all congenital heart patients need life long follow up with an ACHD specialist. Many have been lost to follow up. They may show up in your office, ED or department. • There are lots of resources available to you. Never hesitate to call our office.
  25. “…I think those of us who have had life-threatening illness have been blessed with a knowledge of how precious life is.” -Dylan Henricks “To be able to survive in spite of poor odds, there has to be a strong will and a passion for life.” -Tara Shane “As a child, I was very ashamed of all my scars and never wanted anyone to see them. As I’ve gotten older, I’ve realized that without those scars I wouldn’t be alive today and able to do the great things I’ve done.” -Kayla Pepmeyer
  26. Kristi Ryan, APN Adult Congenital Heart Childrens Hospital of Illinois OSF St. Francis 309-624-3893

Notas del editor

  1. TOF – Pulmonary valve insufficiency; RV-PA conduit stenosis, regurgitation TGA s/p arterial switch – may have aortic valve insufficiency TGA s/p senning – systemic ventricular dysfunction, baffle leak, arrhythmia
  2. Melody valve needs 22 fr venous introducer Coarctation stents must be done in peds cath lab – size of stents, bi-plane cameras
  3. Describe defect, diagnosed as infant, teen or adult. How diagnosed…
  4. Coarc repair and reintervention