Congenital Heart Disease With Left to Right Shunt
Description Diagnostic criteria General and supportive measures Medicine treatment Referral DESCRIPTION Structural abnormalities of the heart and great vessels that are usually associated with left to right shunting – most commonly: ventricular septal defect, atrial septal defect, patent ductus arteriosus and atrioventricular septal defect. DIAGNOSTIC CRITERIA Each condition has specific clinical
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
DESCRIPTION
Structural abnormalities of the heart and great vessels that are usually associated with left to right shunting – most commonly: ventricular septal defect, atrial septal defect, patent ductus arteriosus and atrioventricular septal defect.
DIAGNOSTIC CRITERIA
Each condition has specific clinical, radiological and ECG findings. Large left to right shunts present clinically with:
- Tachypnoea and indrawing.
- Sweating during feeds.
- Failure to thrive.
- Chest deformity: respiratory sulcus, praecordial bulge.
- Chest X-ray: usually cardiomegaly with plethoric lung fields.
- Cardiac impulse felt below the xiphisternum.
GENERAL AND SUPPORTIVE MEASURES
- Pay special attention to nutrition.
MEDICINE TREATMENT
- Furosemide, oral, 1 mg/kg/dose 8–12 hourly.
- Supplement with potassium chloride, oral, 25–50 mg/kg/dose 8–12 hourly.
If needed:
- Spironolactone oral, 1 mg/kg/dose 12 hourly, in which case, potassium supplementation should be stopped.
And if needed, in consultation with a paediatric cardiologist:
- ACE-inhibitor, e.g.
- Captopril, oral:
- Infants: 0.15–0.3 mg/kg/dose, 8–12 hourly (maximum 2 mg/kg/day).
- Children: 0.3–0.5 mg/kg/dose 8–12 hourly (maximum 6 mg/kg/day).
- Captopril, oral:
REFERRAL
- All children with suspected left to right shunts due to CHD should be referred to a paediatric cardiology centre for diagnostic evaluation and planning of further management.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 4: Cardiovascular System , 4.2 Congenital Heart Disease (CHD), 4.2.3 Congenital Heart Disease With Left to Right Shunt