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Congenital Heart Disease
Congenital Heart Disease
Part I
By
Katrice L. Herndon, M.D.
Acyanotic Congenital Heart Disease
• Answer:
Systolic murmur is caused by increased flow across the
pulmonary valve, NOT THE ASD.
• Answer:
NO
Ventricular Septal Defect
• VSD – is an abnormal opening in the
ventricular septum, which allows free
communication between the Rt & Lt
ventricles. Accounts for 25% of CHD.
Ventricular Septal Defect
• 4 Types
• Perimembranous (or membranous) – Most
common.
• Answer:
Down’s Syndrome (Trisomy 21), Seen in
20-25% of cases.
Atrioventricular Septal Defect
Complete Form Incomplete Form
• Low primum ASD • Any one of the
continuous with a posterior components may be
VSD. present.
• Answer:
Rubella
Patent Ductus Arteriosus
Hemodynamics
• As a result of higher aortic pressure, blood shunts
L to R through the ductus from Aorta to PA.
• Aortic Stenosis
• Answer:
Noonan’s Syndrome, secondary to valve
dysplasia.
Pulmonary Stenosis
Hemodynamics
• RV pressure hypertrophy RV failure.
• RV pressures maybe > systemic pressure.
• Post-stenotic dilation of main PA.
• W/intact septum & severe stenosis R-L
shunt through PFO cyanosis.
• Cyanosis is indicative of Critical PS.
Pulmonary Stenosis
Clinical Signs & Symptoms
• Depends on the severity of obstruction.
• Asymptomatic w/ mild PS < 30mmHg.
• Mod-severe: 30-60mmHg, > 60mmHg
• Prominent jugular a-wave, RV lift
• Split 2nd hrt sound w/ a delay
• Ejection click, followed by systolic murmur.
• Heart failure & cyanosis seen in severe cases.
Pulmonary Stenosis
Treatment
• Mild PS no intervention required, close follow-up.
• Answer:
Williams Syndrome
Aortic Stenosis
Hemodynamics
• Pressure hypertrophy of the LV and LA
with obstruction to flow from the LV.
• Mild AS 0-25mmHG
• Moderate AS 25-50mmHg
• Severe AS 50-75mmHg
• Critical AS > 75mmHg
Aortic Stenosis
Clinical Signs & Symptoms
• Mild AS may present with exercise intolerance,
easy fatigabiltity, but usually asymptomatic.
• Answer:
Bicuspid aortic valve, seen in > 70% of
cases.
Coarctation of the Aorta
• Question:
What genetic syndrome is coarctation seen
in?
• Answer:
Turner’s Syndrome
Coarctation of the Aorta
Hemodynamics
• Obstruction of left ventricular outflow
pressure hypertrophy of the LV.
Coarctation of the Aorta
Clinical Signs & Symptoms
• Classic signs of coarctation are diminution or
absence of femoral pulses.