Tiffaney is worried about her newborn son. Ever since she brought Caleb home fro

Question

Tiffaney is worried about her newborn son. Ever since she brought Caleb home from the hospital it has been so hard to get him to eat and he seems to be breathing hard all the time. She stopped breastfeeding and tried every formula on the market, but nothing has improved his feeding. So at his one month checkup her stomach is in knots as they place Caleb on the scale. “9 pounds 7oz” says the nurse. Tiffaney realizes Caleb has only gained one pound since he was born and she burst into tears.
In the exam room Dr. Baker checks Caleb for taking extra time feeling and listening to his chest. During the exam Tiffaney explains her struggle with trying to get her son to eat and how he cries almost the entire day. After the exam Dr. Baker says “When I listen to Caleb’s heart I hear an extra sound called a murmur. I want to use an echocardiogram and an ECG to get a good picture of all the parts of his heart.”
After a full day of tests Tiffaney meets with Dr. Baker in his office. “After a careful review of all the information I have discovered that Caleb has a hole in the heart muscle wall between his right and left ventricles. We call it a ventricular septal defect. That is probably why he has been so irritable and hard to feed. The hole is not very big but he will still need to have surgery to repair it” says Dr. Baker. Although the thought of her tiny son having surgery is terrifying Tiffaney is relieved to know why things have been so tough at home.

1. What do you think happens to Caleb’s ejection fraction into the pulmonary artery as a result of his ventricular septal defect (VSD)? Explain your answer.

Explanation / Answer

The ventricles are the lower chambers of the heart. They have strong , thick muscles so that they can contract stongly enough to push blood out of the heart.

The pulmonary artery arises from the right ventricle and takes the deoxygenated blood to the lungs for oxygenation.

The aorta, which is the largest artery comes out of the left ventricle and takes oxygenated blood out of the heart for distribution to all body parts.

A ventricular septal defect [VSD] means that the oxygenated and deoxygenated blood will mix when the ventricles contract . Since, the left ventricle is the main pumping chamber of the heart, so ejection fraction is usually measured in the left ventricle[ LV ]. An LV ejection fraction of 55% is considered to be normal.

Echocardiography is normally used to measure ejection fraction. It is a non-invasive and safe technique . It provides estimates of end - diastolic [EDV] and end -systolic [ESV] and also stroke volumes [SV] .

On calculations, SV = EDV -- ESV.

Normally, ejection faction is less than 60% .

Caleb is most probably suffering from Pulmonary arterial hypertention [PAH] . He has decreased right ventricular ejection fraction. This is associated with increased right ventricle wall stress and might result in congestive heart failure.

Caleb's right ventricle ejection factor [RVEF] is lower than normal so enough blood cannot be pumped into the pulmonary artery to be taken for oxygenation to the lungs.

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