Congenital Heart Disease

(Non-Cyanotic)
IVANNA PUTERI .S (030.04.112)
JANE UTAMI SETIAWAN (030.04.113)
JAROT WAHYU ARDHI (030.04.115)
The Hearts Blood Flow
Prevalence
0.5-0.8% of live births
2-3 in 1000 newborn infants
symptomatic with heart disease in the first
year of life
Diagnosis during : 1 week of age in 40-
50%, 1 month of age in 50-60% of
patient
Congenital heart disease remains the
leading cause of death in children with
congenital malformations.
Etiology
Unknown
Genetic factor
Maternal conditions and teratogenic
agents
Congenital rubella syndrome
Maternal ingestion of drugs

Classification of Non-Cyanotic
Congenital Heart Lessions
a. Increased volume load
atrial septal defect (ASD)
ventricular septal defect (VSD)
AV septal defect (AV canal)
patent ductus arteriosus (PDA)
b. Increased pressure load
coartation of the aorta (COA)
atrial stenosis (AS)
mitral stenosis (MS)
Atrial Septal Defects
3 Type of ASD :
1.Ostium Secundum ASD
2.Sinus Venosus ASD
3.Ostium Primum ASD

In adult occurs commonly in
females


Ostium Secundum Defect
Most common form of
ASD
Occur at fossa ovalis
Stucturally normal AV
valves
Single or multiple
Openings 2 cm or
larger in diameter

Sinus Venosus Atrial Septal
Defect
Occur in the upper part of
the atrial septum in close
relation to the entry of
the superior vena cava
Sometimes the superior
vena cava straddles the
defect, some systemic
venosus blood enters the
left atrium
The clinical manifestation
similar to secundum ASD
Ostium Primum
(Atrioventricular Septal Defect)
Occur in the lower
portion of the atrial
septum and over lies
the mitral and
tricuspid valves
Markedly abnormal
AV valves

Clinical manifestation
Asymtomatic until third decade
In younger children : failure to thrive
In older children : varying degrees of exercise
intolerance
Right ventricular diastolic volume increase
Ejection time prolonged throughout all phases of
respiration
Systolic ejection murmur is heard
Easy fatigability
Reccurent pneumonia

Diagnose
Anamnesa
Physical examination
Chest rontgenogram
ECG
Echocardiogram

Treatment
Surgical to do elective closure
Palliation with pulmonary arterial banding

Prognose
good if the closure is carried out
Worse if heart failure and atrial fibrilation occur


Ventricular Septal Defect
the most common of all congenital
cardiac defects
25% of all congenital heart disease,
or about 2 in every 1000 live births
Most defect occur in membranous
types


Ventricular Septal Defect
Ventricular septal defect is an abnormal opening
in the wall between the two ventricles
Clinical manifestation
According to the size of the
defect and pulmonary
blood flow and pressure :
Small VSD
left to right shunt, normal
pulmonary arterial pressure
Asymptomatic
Characteristic : loud, rash,
blowing holosystolic
murmur, frequently
accompinied by a thrill
Large VSD
Dyspnea
Feeding difficulties
Poor growth
Recurrent pulmonary
infection and cardiac
heart failure in early
infancy
Holocystolic murmur
generally harsh than
small VSD
Profuse perspiration


Diagnose
Chest X ray
Electrocardiogram

Complications
Infective endocarditis
Arrhytmia
Heart failure


Therapy
Small VSD
Protection and care of endocarditis
Large VSD
Surgerry

Prognose
Spontaneous closure 30-80% of cases within
the first and two years of life


AV Septal Defect (AV Canal)
Ostium primum defect is in the lower portion of
atrial septum and overlies the mitral and
tricuspid valve.
Contagious atrial & VSD with markedly abnormal
AV valve.
Common with down syndrom & may occur with
PS.
Asymptomatic.
Exercise intolerance.
Recurrent pneumonia.
Diagnose :
1. Chest radiograph
2. EEG
3. Echocardiogram
4. Cardiac Catheterization &
Angiocardiography
5. Selective Right Ventriculography

Theraphy : Surgically

Prognose :
Depent on : 1. Magnitude of L-R Shunt
2. Pulmonary vasc.
Resistance
3. Severity of AV valve
insuficiency

Patent Ductus Arteriosus (PDA)
The ductus arteriosus is a blood vessel
that is present in all babies before they
are born
While in the womb, the lungs of the fetus
cannot provide oxygen to the fetus's blood
the fetus receives its oxygen from its
mother, through the umbilical cord

connects the pulmonary artery to the
aorta, allowing blood to bypass the lungs
Normally the ductus arteriosus closes on
its own within a few days of birth as the
lungs begin to strengthen and provide the
body with the oxygen it requires

Ligamentum Arteriosus
Clinical Manifestations
Congestive heart failure
rapid breathing
tiring more easily
This condition also varies depending on
how wide the Ductus Arteriosus opened
A small opening may not produce any symptoms
A larger opening may produce a heart murmur
Diagnose
Chest X ray
Electrocardiogram

Treatment
Surgical or catheter closure
The surgery in small PDA is done to prevent late complications
The surgery in large PDA is done to treat heart failure or prevent
the development of pulmonary vascular disease
Prognose
Small PDA may live a normal spant with few or no
cardiac symptoms
Large PDA may cause congestive heart failure
Mitral Stenosis (MS)
Symptom appear within the 1
st
2 year of
life.
Underdeveloped.
Cyanosis & pallor.
Heart enlargement (RV & LA, Dilatation &
Hiperthropy)
Diagnose : 1. ECG RVH
2. Rontgen
3. Echocardiogram
4. Cardiac Catheterization
5. Angicardigraphy

Theraphy : 1. Surgical
2. Transcatheter Baloon
Valvuloplasty

Prognose : Poor



Coarctation Of The Aorta
98 % occur just bellow the origin of the left
subclavian artery at the origin of the ductus
arteriosus ( juxtaductal coarctation )
C.A may be a feature of Turner Syndrome (XO)
The term Shone Syndrome refers to multiple
levels of left heart obstructive disease, including
mitral stenosis, bicuspid aortic valve with or
without aortic stenosis, tubular hypoplasia of the
aortic isthmus, and coarctation of the aorta
Clinical Manifestation
Weakness or pain ( or both ) in the legs after
exercise, but in many instances, even patients
with severe coarctation is asymptomatic
The classic sign of C.A is a disparity in
pulsation and blood pressure in the arms and
legs
The femoral, popliteal, posterior tibial, and
dorsalis pedis pulses are weak ( or absent in
up to 40% of patients ), in contrast to the
bounding pulses of the arms and carotid
vessels
This differential in blood pressure is
common in patients with coarctation who
are older than 1 year
The pathognomonic murmur of C.A is
heard in the left axilla and the left back or
the left infrascapular area

DIAGNOSIS
Echocardiogram
Neonates and young infants display
right
or biventricular hypertrophy
Echocardiography (two-dimensional)
Color Doppler
Pulsed and continuous wave Doppler
Prognosis and Complications
Severe neurologic damage or even death
may rarely occur from associated
cerebrovascular disease
The common serious complications are :
1. Premature coronary artery disease
2. Heart failure
3. Hypertensive encephalopathy
4. Intracranial hemorrhage
Treatment
Infusion of prostaglandin E1
Anticongestive
The procedure of choice for isolated
juxtaductal coarctation of aorta is
controversial
Postcoarctectomy Syndrome
* Acute hypertension
* Abdominal pain
* Anorexia, Nausea, Vomiting
* Leukocytosis
* Intestinal hemorrhage
* Bowel necrosis
* Small bowel obstruction
Relief is usually obtained with antihypertensive
drugs and intestinal decompression