R Rukma Juslim

CONGENITAL HEART DISEASE

EPIDEMIOLOGY

1. 8 in 1000 live births.

2. Cyanotic & Acyanotic
3. Most CHDs should be detected by a good
neonatal examination.
4. Before Surgical correction: < 20% survived
5. After Surgical correction : 85% survived
Differentiation of CHD

NEONATE
Cyanotic :
TGA
Tricuspid Atresia
Obstructed TAPVD
Severe Ebstein’s anomaly with ASD
Hypoplastic Left Heart
 Acyanotic :
Congenital Aortic Stenosis
Coarctation + VSD/PDA

INFANT & OLDER CHILD

Cyanotic :
TGA
Tetralogy of Fallot
Acyanotic
VSD
ASD
PDA
Congenital Aortic Stenosis
Coarctation
Pulmonary Stenosis
Partial APVD + ASD
DIAGNOSTIC

 Physical Examination
 Radiology
 Electrocardigraphy
 Echocardiography
 Catherization
 MRI
MANAGEMENT

 CONSERVATIF

 SURGERY
 OCCLUDER
 OPEN HEART
ATRIAL SEPTAL DEFECT

TYPE :
Patent Foramen Ovale (PFO)
Primum
Secundum (most common)

Physical findings :
Widely or Fixed split second heart sound, &
Soft systolic murmur at Left ICSII
Epidemiology

 Asymptomatic through infancy and

childhood, though the timing of clinical
presentation depends on the degree of left-
to-right shunt.
 Symptoms become more common with
advancing age. By the age of 40 years, 90% of
untreated patients have symptoms of
exertional dyspnea, fatigue, palpitation,
sustained arrhythmia, or even evidence of
heart failure.
CLASSIFICATION

 Ostium primum: The second most common

type of ASD accounts for 15-20% of all ASDs.
Primum ASD is a form of atrioventricular
septal defect and is commonly associated
with mitral valve abnormalities.
 Ostium secundum: The most common type of
ASD accounting for 75% of all ASD cases,
representing approximately 7% of all
congenital cardiac defects and 30-40% of all
congenital heart disease in patients older
than 40 years.
 Sinus venosus: The least common of the
three, sinus venosus (SV) ASD is seen in 5-
10% of all ASDs. The defect is located along
the superior aspect of the atrial septum.
Anomalous connection of the right-sided
pulmonary veins is common and should be
expected.
VENTRICULAR SEPTAL DEFECT

Type:
1. Membranous (Infracristal) (most common)
2. Muscular
3. Inlet or Atrioventricular
4. Infundibular (Supracrystal /subaortic)

Physical findings:
Holosystolic murmur/pansystolic murmur
 General examination findings remain normal,
with no signs of respiratory distress or growth
failure
 Infants with larger defects, especially those
associated with significant left ventricular
outflow obstruction (eg, doubly committed
subarterial defect with interrupted aortic
arch), may present as early as the first week
of life with profound congestive heart failure
and cardiogenic shock.
PATENT DUCTUS ARTERIOSUS

PDA is More common in children at high

altitudes & females.
PDA is the most common CHD after maternal
rubella.

Physical findings :
Continuous machinery murmur in ICS II
 If a PDA is large, an infant also may have
symptoms of volume overload and increased
blood flow to the lungs. If a PDA is small, it
may not be diagnosed until later in childhood.
COARCTATION OF THE AORTA

Type :
Infantile
Adult type
Pseudocoarctation

Physical findings :
Continuous murmur
 Coarctation (ko-ahrk-TAY-shun) of the aorta
— or aortic coarctation — is a narrowing of
the aorta, the large blood vessel that
branches off your heart and delivers oxygen-
rich blood to your body. When this occurs,
your heart must pump harder to force blood
through the narrow part of your aorta.
CLASSIFICATION

 preductal, where the narrowing is proximal

to the ductus arteriosus or ligamentum
arteriosum.
 postductal, where the narrowing is distal to
the ductus arteriosus or ligamentum
arteriosum.
TETRALOGY OF FALLOT

1. Right Ventricular Outflow Tract Obstruction

(Double –outlet RV with PS)
2. Nonrestrictive VSD
3. Aortic override of the Ventricular septum
4. Right Ventricular Hypertrophy
 The child suddenly becomes blue, has difficulty
breathing, and may become extremely irritable
or even faint.

Up to 20-70% of children with tetralogy of Fallot

experience these spells.

The spells often happen during feeding, crying,

straining, or on awakening in the morning.

Spells can last from a few minutes to a few hours

EISENMENGER SYNDROME

 Inoperable Cyanotic CHD

 Bidirectional shunting
 Pulmonary Vs Systemic Vasculary Resistance

Physical findings :
Cyanosis & digital clubbing
Holosystolic murmur of TR &
Diastolic decrescendo murmur of PR