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LECTURE - 2 Learning objectives. CONGENITAL HEART DISEASE 1. Introduction 2. Incidence 3. Pathogenesis 4. Types. Age of innocence ! ‏.

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Lecture 2 learning objectives

LECTURE - 2Learning objectives

CONGENITAL HEART DISEASE

1. Introduction

2. Incidence

3. Pathogenesis

4. Types


Age of innocence !

A little boy, after being shouted at by his mum was sitting sad alone in a corner. Dad asked: "What happened, son?" “Boy : Dad, I can't handle your wife any more ! I want my own wife ! "


40 year

after

Club


  • Abnormalities of heart/vessels at birth

  • Faulty embryogenesis during 3 – 8 wk

  • Major defects - septation, connections of great vessels/chambers, muscular

  • After surgery ht not normal; change - hypertrophy, remodelling pose problem

INTRODUCTION


INCIDENCE

  • Most common heart dis. in children

  • 1 % all live births, incidence higher in premature infants & stillbirths

  • 12 disorder account for 85% cases

  • Incidence increased due to better diagnostic methodologies – doppler echocardiography, MRI and others



PATHOGENESIS

  • Heart among 1st organ to develop, multiple cell lineage/ genes involved

  • Cause – genetic ; placental infection;maternal disease like diabetes; drug; chemical; irradiation, multifactorial

  • 10% identifiable, some genes /CH identified, trisomy 21 (Down synd)


CLINICAL FEATURE

  • R-L shunt; cyanosis, paradoxical embolism, polycythemia, clubbing

  • L-R shunt; ↑ pulmonary flow and hypertension, late cyanosis - tardive

  • Obstruction; abnormal narrowing of chambers, valves or blood vessels

Malformations


LEFT TO RIGHT

SHUNTS

  • ↑ pulmonary flow / hypertension

  • Late cyanosis(tardive), months/ yrs after birth, reversal of shunts

  • Example – ASD, VSD, AVSD, PDA – all contain the letter ‘D’ in titles

R

L


  • Abnormal opening atrial septum, communication left & right atria, 10%

  • 3 major type; secondum(90%), primum (51%), sinus venosustype: 5%

  • L to R shunt, higher pressure in left atrium

ASD


CLINICAL FEATURE


VENTRICULAR SEPTAL DEFECT

  • Incomplete VS formation, communication – LV / RV

  • Most common anomaly (40%), 30% isolated

  • 90% membranous part, rest in muscular septum

  • Large manifest at birth - signs of cardiac failure, small close spontaneously

VSD


R

L


Pediatric

Cardiologist


Umblical cord


PATENT DUCTUS ARTERIOSUS

  • Ductus open after birth, 90% isolated

  • Length/diameter vary widely, narrow PDA no effect on growth

  • Obstructive pulmonary disease, shunt reversal

  • Machinery murmur, closed surgically early

  • May be life saving in anomalies like aortic valve atresia

PDA


RIGHT TO LEFT SHUNTS

  • Early cyanosis in postnatal life

  • Tetralogy of Fallot, transposition of great arteries, triscupidatresia, patent truncusarteriosus

  • Each category begins with letter T

R

L


TA

  • Four (4)features :

    • Ventricular septal def

    • Pulmonary stenosis

    • Aorta overriding VSD

    • Right ventricular hypertrophy

  • Anterosuperior displacement of infundibulum septum in truncus

  • Some pts may survive into adult life even untreated

8.5 : 7.5

8 : 7


CLINICAL FEATURE

  • RV hypertrophy, heart boot shaped, VSD , aortic valve at sup. border of VSD

  • Severity of obstruction of RV flow determines direction of blood flow

  • Some children are cyanotic at birth

  • Complete surgical repair possible now


Patent truncus

arteriosus

TRANSPOSITION OF GREAT ARTERIES

  • Ventricular arterial discordance (partition – TA)

  • Incompatible with life unless shunt exists for mixing of blood, TGA with VSD or PDA

  • Right ventricular hypertrophy

  • No surgery, death in 1 month


TGA

with

VSD


OBSTRUCTIVE CONGENITAL ANOMALIES

  • Obstruction of blood flow at the level of heart valve or within a great vessel

  • Coarctation of the aorta , pulmonary stenosis/ atresia, aortic stenosis and atresia


COARCTATION OF AORTA

  • Common anomaly (5%), male effected twice, Turner synd

  • Two forms; infantile form - tubular hypoplasia of arch proximal to PDA, adultform – discrete ridge like infolding opposite ductusarteriosus


Types

Adult

Infantile


CLINICAL FEATURE

  • Clinical features depend on severity

  • Coarct & PDA; early manifestation, no survival without surgical intervention

  • Coarct without PDA; asymptomatic; hypertension upper limb, weak pulse in lower, collateral circulation, LVH




Thank you

THANK YOU winning


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