Download Narrowing of aorta

Practical Nursing
Considerations for Caring
for the Adult Congenital
Heart Patient
Kristi Ryan, APN
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
Normal Cardiac Anatomy
Cardiac Pressures
ACHD Defects
• Classifications: Simple,
Moderately complex,
and Highly complex
• ACHA (Adult Congenital
Heart Association)
ACHAHeart.org
Simple CHD
Unrepaired:
• Small ASD
• Small VSD
• Mild PS
Repaired:
• PDA
• ASD
• VSD
Repaired/Unrepaired:
• Isolated AoV
• Isolated MV
• PFO
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
ACHAHeart.org
Moderately complex CHD
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ALCAPA
P/TAPVR
AV Canal
Sinus venosus ASD
Coarctation
Ebstein’s anomaly
RVOTO
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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
ACHAHeart.org
Highly Complex CHD
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Eisenmenger syndrome
All cyanotic patients
L-TGA
DORV
Mitral atresia
Pulmonary atresia
Shone’s complex
Single ventricle
D-TGA
Tricuspid atresia
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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
ACHAHeart.org
Common Adult Lesions
CHD diagnosed in adulthood
• Atrial Septal Defect (ASD)
• Coarctation of Aorta
• Congenitally Corrected Transposition (L-TGA)
• Patent foramen ovale
Re-operation/Intervention
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Aortic regurgitation
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Aortic stenosis
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Aortic root enlargement
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Coarctation of aorta
Pulmonary
regurgitation/stenosis
• RV to PA conduit failure
Fontan revision
Mustartd/Senning baffle
obstruction
Arrhythmia
interventions:
– ICD/pacemakers
– Ablations
– Cardioversions
Atrial Septal Defects (ASD)
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
Eisenmenger Syndrome
Tetralogy of Fallot (TOF)
Four abnormalities:
• Ventricular septal
defect (VSD)
• RV outflow tract
obstruction
(Subpulmonary
stenosis)
• Right ventricular
hypertrophy
• Overriding aorta
TOF: Initial Palliation
• Need to establish
pulmonary blood
flow
• Classic BT Shunt
ligated the
subclavian artery
TOF: Surgical Repair
Valve Sparing Repair
RV to PA Conduit
Adult RV to PA Replacement
Transcatheter valve replacement
– Melody Transcatheter Pulmonary Valve
– Edwards Sapien XT Pulmonary Valve
Surgical replacement
– Redo sternotomy
Coarctation of Aorta
• Diagnosed any time
in life
• 4 extremity BP helpful
in diagnosis and
monitoring
• Commonly associated
with bicuspid aortic
valve
Narrowing of aorta
Repair of coarctation
Surgical Intervention
Catheter intervention
Where will you see them?
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Emergency room
Operating room and post op (CVICU)
Cardiology and medical admissions
Labor & delivery
Psychology admissions
Reason for hospitalization
Complex ACHD
• CHF
• Respiratory
disorders
• Arrhythmias
Simple ACHD
(ASD/PFO excluded)
• Valve disease
• Coronary artery
disease
• Arrhythmias
Shikhar Agarwal et al. J Am Heart Assoc 2016;5:e002330
Simple ASD/PFO
• CVA- 26%
• Arrhythmia
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
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
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.
“…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
Kristi Ryan, APN
Adult Congenital Heart
Childrens Hospital of Illinois
OSF St. Francis
[email protected]
309-624-3893