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Congenital Heart Disease

Congenital Heart Disease. Dr. Raid Jastania. Congenital Heart Disease. 8 per 1000 live birth Could be minor defect or major defect Cause – unknown Genetic: chromosomal anomalies, trisomy 13, 18, 21 Environmental: infections, rubella Types: Left-to-Right shunt Right-to-Left shunt

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Congenital Heart Disease

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  1. Congenital Heart Disease Dr. Raid Jastania

  2. Congenital Heart Disease • 8 per 1000 live birth • Could be minor defect or major defect • Cause – unknown • Genetic: chromosomal anomalies, trisomy 13, 18, 21 • Environmental: infections, rubella • Types: • Left-to-Right shunt • Right-to-Left shunt • Obstructive defects

  3. Congenital Heart Disease • Systemic vs Pulmonary circulation • Shunt of blood • Cyanosis • Increase/decrease pulmonary flow • Pulmonary hypertension: reversible, irreversible, dyspnea, chest pain, syncope, hemoptosis, cyanosis, clubbing, erythrocytosis • Presentation differ: fetal life, childhood, adulthood • May have more than one defect

  4. Left-to-Right Shunt

  5. Left-to-Right Shunt • Most common • ASD, VSD, PDA • May be asymptomatic at birth • Cyanosis is not early feature

  6. Atrial Septal Defect • 75% ostium secondum ASD • 15% ostium primum ASD • 10% sinus venosus ASD

  7. Atrial Septal Defect • Asymptomatic early in life • Diagnosed usually in adulthood • In adult: atrial arrhythmia • Early : Left-Right shunt • Middiastolic rumbling tricuspid murmur • Midsystolic pulmonary ejection murmur • Pulmonary hypertension • Late: Right-Left Shunt • Diastolic pulmonary incompetence murmur • Right atrial dilatation, right ventricular hypertrophy • Late: Cyanosis (Eisenmenger syndome) • CHF

  8. Ventricular Septal Defect • 70% in the membarneous region • Most common congenital heart disease • Many VSD close spontaneously • Left to right shunt • Right ventricular hypertrophy/dilatation • Dilated pulmonary artery • Pulmonary hypertension • Late: CHF, cyanosis

  9. Patent ductus arteriosus

  10. Patent ductus arteriosus • Ductus arteriosus closes after birth by • Increase arterial oxygen • Drop in pulmonary vascular resistance • Decrease in prostaglandin E2 • PDA leads to Left to right shunt • Continuous Machinery murmur • Left atrial and left ventricular hypertrophy • Pulmonary hypertension – atherosclerosis and right ventricular hypertrophy • Late: Cyanosis, CHF

  11. Right-to-Left shunt

  12. Tetralogy of Fallot • Most common cyanotic congenital heat disease • Consist of: • VSD • Over-riding Aorta • Pulmonary hypoplasia (RV outflow obstruction) • Right ventricular hypertrophy • Boot shape heart • Right to left shunt • Pulmonary hypertension does not occur

  13. Transposition of Great Arteries • Aorta from the right ventricle • Pulmonary artery from the left ventricle • + PDA, ASD, VSD • Cyanosis

  14. Obstructive Defect

  15. Coarctation of Aorta • Narrowing of the aorta • Preductal coarctation • Before ductus arteriosus • Right ventricualr hypertrophy • Selective cyanosis of lower extremities • Postductal coarctation • Left ventricular hypertrophy • Hypertension of upper extremities • Weak pulse of legs, delayed pulse, claudication

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