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Congenital Heart
Disease
MSN. khetam awamreh
Outline
* Classification of Congenital
Heart Disease.
1. Acyanotic Heart Disease
a. Increase pulmonary blood
flow
b. Obstruction of blood flow
2. Cynatoic Heart disease
a. Decrease pulmonary blood
flow
b. Mixed blood flow .
A Cyanotic Heart Defect
Move blood from arterial …to…venous system
A Cyanotic
Increased in pulmonary
blood flow
1. ASD
2. VSD
3. AVC
4. PDA
Obstruction of blood flow form
ventricle
1. Pulmonary stenosis
2. Aortic stenosis
3.Coarctation of the Aorta
* Defect with increased pulmonary
blood flow
1. VSD (ventricular septal
defect )
2. ASD (Atrial septal defect )
3. AVC (Atrioventricular canal
defect )
4. PDA ( patent ductus
artriosus)
** 1.VSD (ventricular septal defect )
**1. VSD …30% of CHD
85% spontaneous closed
*Assessment . (4 to 8 week of age )
fatigue…murmur 3 ICS depend on
P.E …thrill may be palpable..
Echo .ECG, MRI , (RT ventricle
hypertrophy )
Treatment …
cardiac catheterization .. Surgery
VSD
** 2.ASD (blood flow from left to right atrium)
Tow type ..
1. Ostium primum ASD1 ( lower end of the
septum )
2. Ostium secundum ASD2( center of the
septum )
**Assessment ...systolic murmur 3 ICS
enlarged RT side of the heart ..increased in
pulmonary circulation…Echo.
**Management …cath repaired, or open heart
surgery (1 to 3 y/d )…especially in girls
**Complication ..arrhythmias …emboli
ASD
A trial Sepal Defect
** 3.AVC ( Arterioventricular Canal Defect)
…Low a trial septal defect continuous
with high ventricular defect and
distortion of the mitral and tricuspid
valve
**Assessment …Echo …surgical is
important some time need new valve
**Treatment …after surgery give
antibiotic and anticoagulant
Closed observation to the jaundice
AVC
**4.PDA ( Patent Ductus Arteriosus)
• it’s failed to closed at birth ,blood will
shunt from the aorta to the pulmonary
artery.
• Complete closure occurs…3 month
• More common in girls than boys
**Assessment ….direct after birth..P.E
cardiac catheterization
**Treatment…in infant give IV or OR
indomethacin(3time \12hr or 24hr)
to lower the PGE & lead to closed the
ductus closer
Cont…PDA
Side effect…
1. Reduce glomerular filtration rate.
2. Impaired plat aggregation
3. Demention GI & CNS blood flow
** Treatment…
Cath at age of (6m to 1y) or surgical
intervention by Thoraoctomy
If not treatment …
1. CHF
2. Infected Endocardities
PDA
**Obstruction of blood flow form
ventricle
1.Pulmonary stenosis
2.Aortic stenosis
3.Coarctation of the Aorta
**1.pulmonary stenosis 10%
• Narrowing in pulmonary valve
• Assessment like RT side heart
failure
* Systolic murmur…thrill
• ECG …Echo (RT side
hypertrophy )
• Treatment
Balloon angioplasty
Pulmonary stenosis
**2. Aortic stenosis
* 7% of total cases of CHD
• Increased pressure in the LF side of
the heart (LV hypertrophy)
• Assessment… murmur ,thrill ,faint
pulses, high BP,high HR.
• Treatment..
- Beta-blocker or ca channel blocker to
decreased hypertrophy
- Bolloon valvoplasty
Aortic stenosis
** 3.Coarctation of the Aorta 6%
in boys more than in girls
** assessment
high BP in upper body part in the arm
20mmhg more than leg, headache,
vertigo, epistaxis.
Assessment murmur, LV. hypertrophy
ECG,Cho
• Treatment
Digoxin & diuretic before surgery
Surgical at the age of 2y/d end of the
aorta anastomosed
Coarctation of the Aorta
Cyanotic Heart Defect
Cyanotic
Decreased pulmonary
blood flow
Mixed blood flow
mixed blood flow
1. Transposition of the great Arteries
2. Total pulmonary venous return
3. Truncus Arteriosus
4. Hypo plastic left Heart Syndrome
**1.Transposition of the great
Arteries 5%
In boys more than girls
*assessment …cyanotic from birth,
murmur may or not ,Echo,ECG
cath.
*Treatment.
PGE to keep PDA opining
Surgical at 1week to 3months
Transposition of the great Arteries
** 2. Total Pulmonary venous
return 2%
Pulmonary vein return to the right
atrium or the superior vena cava
instead of the left atrium
An absent spleen is associated with this
disorder
* Treatment
Give PGE,cath, and surgical treatment
Total Anomalous pulmonary venous
return
** 3.Truncus Arteriosus 1%
One major artery or (trunk) arises from
the LF & RT ventricle in place of a
separate Aorta & Pulmonary Artery
with VSD.
• Assessment … Cyanosis, murmur
• Treatment … surgical at school age
Truncus Arteriosus
** 4.Hypo plastic left Heart
Syndrome
*assessment of HLHS
Infants may appear healthy at birth, but signs of
HLHS soon become apparent after the ductus
arteriosus closes. These signs include the
following:
Cyanosis (a blue skin, lips, fingernails and other
areas of the body as a result of the lack of oxygenrich blood to the body)
1. Heart murmur
2. Enlargement of the heart (as seen in an
echocardiogram)
3. Noticeably troubled breathing
4. Apparent weakness
5. Inability to feed normally
6. Cold extremities
Echocardiogram
**Defect with Decreased pulmonary
blood flow
1. Tricuspid Artesia
2. Tetrology of Fallot
**1. Tricuspid Artesia
Tricuspid valve closed no blood from
RA to RV
* if still foramen ovale and PDA still
open will maintain good O2 blood so
you have to give PGE IV.
• If not open … sever cyanosis
,tachycardia ,dyspnea
* Treatment
Surgically
Tricuspid Atresia
**2. Tetrology of Fallot 10%
1. Pulmonary stenosis
2. VSD *usually large*
3. dextra position (overriding of
the Aorta )
4. Hypertrophy of the right
ventricle.
Tetrology of Fallot
TOF
Assessment ..
1. Incresed activity .increased cyanosis
2. Polycythemia
3. Dyspnea, murmur
4. Growth retardation
5. Clubing finger
6. syncop
7. Hypoxic episodes with crying
8. knee/chest position
TOF
Treatment …
1.Give O2 therapy, give morphine
sulfate ,Propranol,
knee-chest position
3.Surgical …1 to 2 y/d
Cardiac catheter