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Congenital Heart Diseases: DR - Ankita Patel MPT (Cardio-Pulmonary)

The document summarizes several congenital heart diseases including cyanotic (with low oxygen saturation) and acyanotic (normal oxygen saturation). It describes key features of patent ductus arteriosus (PDA), coarctation of the aorta, atrial septal defect (ASD), ventricular septal defect (VSD), and Tetralogy of Fallot. For each condition, it discusses etiology, pathology, clinical features, investigations, complications, and treatment options.

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heena solanki
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124 views

Congenital Heart Diseases: DR - Ankita Patel MPT (Cardio-Pulmonary)

The document summarizes several congenital heart diseases including cyanotic (with low oxygen saturation) and acyanotic (normal oxygen saturation). It describes key features of patent ductus arteriosus (PDA), coarctation of the aorta, atrial septal defect (ASD), ventricular septal defect (VSD), and Tetralogy of Fallot. For each condition, it discusses etiology, pathology, clinical features, investigations, complications, and treatment options.

Uploaded by

heena solanki
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Congenital heart

diseases
Dr.Ankita Patel
MPT( Cardio-pulmonary)
Congenital heart disease

Cyanotic heart Acyanotic heart


disease disease

1) TOF 1) ASD
2) TPGV 2) VSD
3) PDA
4) COA
Acyanotic
congenital heart diseases
(1) PDA

 This is the commonest congenital heart


disease among all
 One in 4000 live birth
 15% of all CHD
 Females are more affected than male child
Aetiology
 It is the normal connecting pathway of fetal
life
 Pulmonary artery to aorta

 In the embryonic life blood passes fron


pulmonary artery to aorta, lung is bypass in
this circulation
 With birth baby start respiration and there is
expansion of the lung
↓
So blood enter to pulmonary circulation and DA
will close within few days
 Why PDA?

It is common after infusion of the


prostaglandin
Pathology
Pressure is higher in the aorta as compare to the
pulmonary artery
↓
Blood pass from aorta to PA
↓
So more blood goes to PA lung
↓
Dilatation of the PA and pulse also became prominent
↓
More blood goes to the LV so there is hypertrophy of
the LV
Clinical features

 Symptoms -------- size


 Physical sign:
1)continuous murmur- machinery
murmur-
best heard on the 2nd IC space over
the pulmonary area.
IX

 X-ray: may be normal


 Eco
 Cardiac catheterization
Complication

 1) cardiac failure
 2) bacterial endocarditis
Treatment

 Operation is the only treatment carried out in


the baby more than 2-3 years
 Technique: posterolateral approach throw
5thIC space. Lung is retracted.
 Vagus nerve and recurrent larangeal nerve
are retracted anteriorly.
 Ligation of the patent ductus is performed
with multiple nonabsorbable ligatures.
2) Coarctation of aorta
 Incidence: 10 -15 % of all congenital heart
diseases.
 Aetiology : this condition is the narrowing of
aorta immediately beyond the origin of the left
subclavian artery.
 The most popular theory is that coarctation is
an extension of the fibrotic process which
converts the patent ductus into ligamentum
arteriosum.
Pathology:

 In most of the cases constriction is about 2- 4


cm in length.
 Distal to the coarctation there is dilatation of
the aorta.
 Dilated intercostal artery gives collateral
pathway to the circulation.
↓
These produces notching of ribs
Types of coarctation
 Post ductal or adult type of coarctation.
 Pre ductal or infantile type of coarctation.-

coarctation may occur in aorta above the joining of


patent ductus arteriosus.
↓
Deoxygenated blood pass from the pulmonary into
aorta distal to the coarctation.
↓
So lower trunk and limbs become cyanosed , where as
head, neck and upper extremity become pink
Clinical features

 The main feature is that there will be hyper


tension above the obstruction and
hupotension below the obstruction.
 Hypertension is present as- headache,
throbbing and pulsation of arteries of head
and neck, chances of LV failure.
 Hypotension – weak femoral pulse
Complication

 LV failure
 Intracranial haemorrhage
 Intrathoracic haemorrhage
 Rupture of aorta
IX
 Chest radiogram- notching of ribs
 Echo cardiogram- LV hypertrophy
 Cardiac catheterization
Treatment

 Operative procedure
 Ideal age for operation-5 to 7 year.
 Operative procedure- coarctation of aorta is
incised and end to end anastomosis of aorta
is performed.
3) ASD- Atrial septal defect

 6 % of all congenital cardiac abnormality


 In this defect blood go from lt rt
↓
So rt side of heart lung received more blood
And left side of heart received less blood
Three main types

 1) secundum defect
 2) ostium primum
 3) anomalous drainage of pulmonary veins
Secundum defect

 Center of the septum


 Symptoms- fatigue

palpitation
exertional dyspnoea
soft systolic murmur at pulmonary area
Ostium primum

 4-5% of patient
 Usually associated with the incomplete
formation of mitral or tricuspid valve
Treatment

-Open heart surgery

-Prosthetic patch of dacron or pericardium


patch
4) VSD-Ventricular septal defect

 20-30% of cases
 Lt rt shunt
Pathology

 The defect may be single or multiple


 VSD is usually situated in the membranous
part or in the fibrous part of septum
 Size vary from 3mm to 3cm
 < 1 cm – small size VSD
 > 1 cm –large size VSD
 Over filling or rt ventricle
Clinical features

 Small size- no symptoms


 Large size- dyspnoea on exertion
 Loud pan systolic murmur in 3rd and 4th IC
space
 Thrill palpable
 Retardation of growth
IX
1) Chest x ray-
 Enlargement of both ventricle

 Enlargement of pulmonary artery

 Pulmonary congestion

2)Echo --rt ventricular hypertrophy

3) cardiac catheterization
 Extent of shunt
Treatment

 Operation is the treatment of the choice


performed in 2nd year of life
Canotic
congenital heart disease
Fallot’s tetralogy

 Incidence: 50 % of all cyanotic heart disease.

 4 features of it
 1) pulmonary stenosis
 2) RV hypertrophy
 3) VSD
 4) dexroposition of aorta
 In this condition becoz of outflow obstruction
of RV, deoxygenated blood is shunted to the
left side so cyanosis is there.

 Cerebral anoxia: becoz of the less o2


saturation ( 20-30%) patient may become
unconscious.

 Brain abscess
Clinical features

 Almost all the patients are symptomatic.


Dyspnoea on exertion is the common feature.
 Cyanosis
 After walking down few distance pt will squat
this will help in increase in the venous return
and also decrease in peripheral resistance.
 Clubbing
 Systolic murmur present at 3rd or 4th IC space
left sternal border.
 Second pulmonary sound is weak while
aortic sound is increased.
Special investigation

 Chest x-ray: boot shape heart


 decreased lung markings
 Electrocardiogram: RV hypertrophy
 Cardiac catheterization: shunt direction
Treatment
 Surgery is the only treatment to save the child.

LIFE SAVING PROCEDURES

Shunt procedures
 1) blalock’s shunt:- subclavian to pulmonary

anastomosis.
 2) pott’s shunt-: descending aorta and lt pulmonary
artery
 3) waterson shunt:- ascending aorta and rt pulmonary

artery.
 4) Glenn’s shunt:- SVC with rt pulmonary artery
Corrective procedures
 Median sternotomy
 High vertical ventriculotomy
 Dacron patch for correction of VSD
 Pulmonary infundibular or valvular widening
Prognosis

 Risk for operation is vary with age


 10% for smaller child
 2-5% in older child

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