Relationship-Based Care for Newborns With Down Syndrome and Endocardial Cushion Defect

Down syndrome with endocardial cushion defect is a challenging diagnosis for parents as well as members of the health care team. Utilizing a framework of relationship-based care, nurses are in a position to positively affect parents' experience by providing education, advocacy, and support from initial diagnosis through discharge. The plan of care is multidisciplinary and focuses on critical developmental needs, such as bonding and feeding. Because Down syndrome is associated with multiple anomalies, anticipatory guidance is needed to assist parents with establishing a health maintenance plan for their child after discharge.

Congenital endocardial cushion defect detected during uncomplicated pregnancy: a case report

BACKGROUND

The first symptoms of previously undiagnosed congenital heart disease may become apparent during pregnancy. It is important to recognize structural heart lesions since they require additional monitoring during the prenatal, peripartum, and postpartum periods and are associated with increased maternal and fetal morbidity and mortality.

CASE

We report a case of a new diagnosis of an endocardial cushion defect in an otherwise healthy woman in her third trimester whose presenting complaint was dyspnea in the left lateral decubitus position.

CONCLUSION

We located only one other case report of a congenital heart lesion first diagnosed during pregnancy. While rare, since the signs and symptoms of congenital heart disease may also occur in normal pregnant women, it is important for the clinician to be aware that structural heart lesions are part of the differential diagnosis.

Complete atrioventricular canal

Complete atrioventricular canal (CAVC), also referred to as complete atrioventricular septal defect, is characterised by an ostium primum atrial septal defect, a common atrioventricular valve and a variable deficiency of the ventricular septum inflow. CAVC is an uncommon congenital heart disease, accounting for about 3% of cardiac malformations. Atrioventricular canal occurs in two out of every 10,000 live births. Both sexes are equally affected and a striking association with Down syndrome was found. Depending on the morphology of the superior leaflet of the common atrioventricular valve, 3 types of CAVC have been delineated (type A, B and C, according to Rastelli's classification). CAVC results in a significant interatrial and interventricular systemic-to-pulmonary shunt, thus inducing right ventricular pressure and volume overload and pulmonary hypertension. It becomes symptomatic in infancy due to congestive heart failure and failure to thrive. Diagnosis of CAVC might be suspected from electrocardiographic and chest X-ray findings. Echocardiography confirms it and gives anatomical details. Over time, pulmonary hypertension becomes irreversible, thus precluding the surgical therapy. This is the reason why cardiac catheterisation is not mandatory in infants (less than 6 months) but is indicated in older patients if irreversible pulmonary hypertension is suspected. Medical treatment (digitalis, diuretics, vasodilators) plays a role only as a bridge toward surgery, usually performed between the 3rd and 6th month of life.

Left-to-right shunt lesions

A left-to-right shunt lesions exists when blood from the left atrium, left ventricle, or aorta transits to the right atrium or its tributaries, the right ventricle, or the pulmonary artery. This article discusses: the incidence, types, embryology, clinical presentations, physical examinations, electrocardiographic features, chest radiographs, echocardiographic and cardiac catheterization issues, treatment, natural history of atrial septal defects, and outcomes of treatment of atrial septal defects, ventricular septal defects, patent ductus arteriosus, and endocardial cushion defects.

Transvenous dual chamber pacing via a unilateral left superior vena cava

A 74-year-old woman with a unilateral left superior vena cava required dual chamber permanent pacing after a radical cardiac operation for an incomplete from of endocardial cushion defect. An active fixation ventricular lead was used to prevent the instability induced by the strange course of the electrode. For atrial pacing, a ventricular passive fixation lead was used. A transvenous dual chamber pacemaker was successfully inserted via a unilateral left superior vena cava.

Cardiovascular disease in Down syndrome

This article focuses on the clinical evaluation of children with cardiovascular diseases associated with Down syndrome. Recent advances in diagnosis and management are discussed and the medical or surgical approach to the patient with severe cardiovascular malformations is presented.