dr.

karwanbk

_ Acyanotic heart diseases

1_ Left to Right shunt
VSD (Ventricular septal defect)
ASD (Atrial septal defect)
PDA (Patent ductus arteriosus)
1_ Stenotic Type more severe

Pulmonary artery stenosis

Aortic artery stenosis
Coarctation of Aorta
ISD
# Clinical features
-Most Commonly Diagnosed incidentally (Heart Murmur on Stethoscopes

# Investigations
-CXR, ECG, Echo (Definitive Diagnosis

# Notes
-PDA is present in any Normal baby within first 2.3 Days, only in pre-mature
baby it
may extend up to 1 month to close.

-Any full-term baby with PDA not closed after 7th Consider as PDA.

USD is
* about 25% of non-cyanotic heart Disease, Small K3mm, Large >6rm
Small Usually close Spontaneously while large need surgical intervention.

Acyanotic
* CHD Usually asymptomatic Until 2month when Pulmonary Vascular Resistance

Decrease, may produce dyspnea on Exertion

Aorta
PDA

Pulmonary artery
_ Cyanotic heart diseases 5T

Right to left shunt

TOF (Tetralogy of Fallot)
TGA (Transposition of Great arteries)
TAPVR (Total anomaly of pulmonary venous return)
Truncus arteriosus
Tricuspid atresia
* In Right to left shunt , Bloodfrom Right side of the heart goes to left side of the Heart

✗
Deoxygenated Blood goes to the Body , So cyanosis appear

• when will cyanosis appear ?

-
When there is 5
grams of Deoxygenated Blood per of Blood
Ioocc
-
In Anemia we will have cyanosis much easier than polycythemia
Normal Neonate is polycythemia

• what is Pulmonary Vascular Resistance ?

-
Pulmonary Vascular Resistance in Pulmonary Aorta Decrease Blood flow
to the lungs which are Immature lungs DUR Decrease after 2 month of Age
,
Tetralogy of Fallot (TOF)
-
Most Common Congenital Heart Disease
U

Cyanosis appear within first 24h

-

Pulmonary Overriding Aorta

in first
24h
Should start managing
-

stenosis
Imaging studies 2
RVH
mmmm

Boot shaped Heart

3
CXR •
- _

Ventricular Septal defect

-
ECG → RT axis Deviation, RUH
-
Echo - ☆ Diagnostic

Treatment
mm

1- Prostaglandin G- i in order to PDA not close ,

2-
Placing stent by catheterization in the DDA
c Within first 2 weeks to keep PDA Open ,

3-
Surgery i within 2 months
only Done in Isreal ,
Italy ,

Complicating
-
Endocarditis _ • Give penicillins as
prophylaxis
" " " "
* Tof patients will have Tent attack or Hyper cyanotic spell which Cause

Cyanosis , Hyper pnea ,

Restlessness, Agitated and Irritable
In Severe cases lead to Unconscious, Convulsion , Death
may

* Treatment _ • - 02 , knee chest position

'

= Morphine
-
Sodium Bicarbonate

* Tof is fatal if not treated , can lead to thrombus formation

and cerebral edema
eventually stroke or
Total anomalous of pulmonary venous return
-
Aorta Gives Blood to the Body , But the Blood Circulate Only Between
Body and left side of the heart , Blood in Right side is oxygenated
and circulate only Between Right side of the Heart and lungs .

-
Almost the same as TGA , except that in TAA the abnormality is between
Aorta and Pulmonary Aorta , while here the abnormality is between
Pulmonary vein and SVC .

Snowman sign - • TAPUR

-
Treatment - • ① PDA stent Cto keep it open ) in 2 months
TGARTAPUR ② Surgical intervention

Truncus arteriosus and Tricuspid atresia

-
Very Rare , Mostly Dies within first 24h of life .
* CHD would be difficult to treat if the defect outside the heart .

-
USD , ASD, PDA _ • Managed by catheterization

-
Stenosis , TAA - * Managed by PDA stent then surgery .

Total anomaly of
Pulmonary Venous
Return

* causes of CHD - •
The main cause is Unknown , we only have Risk factors .

* Risk factors for CHD ?

-
Pre term -

-
Genetic Disease

- of parents
Consanguinity
-
young age of mother < Zoyrs
-
Old
age of mother > USyrs

-
Drug Used during pregnancy .

-
Radiation therapy during pregnancy .

-
All TORCH infection can cause CHD .

* Complications of Congenital Heart Diseases .

1 Cardiac complications 2 Extra Cardiac Complications

- Heart failure ( Most common ) -

Polycythemia ( Most common, [ phlebotomy ]
-
Blood clot formation _
failure to thrive
- Endocarditis _
Stroke , Brain Abscess , Intracranial hemorrhage
-
Cardiomyopathy _
Clubbing of fingers
-
RUH, LUA, SVT, UT _
Poor School Performance

-
Recurrent admission to hospital , chest Infection '

- Death .

* Auscultation for Murmur

-
USD _ • Pan Systolic Murmur More clear
in left sternal border

-
ASD - • Systolic Murmur Or Apical area

-
PDA - * Systolic ejection click
More clear in Right sternal Border .