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8/12/2019 Congenital Heart Disease Non-cyanotic B
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Congenital Heart Disease
(Non-Cyanotic)IVANNA PUTERI .S (030.04.112)
JANE UTAMI SETIAWAN (030.04.113)JAROT WAHYU ARDHI (030.04.115)
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The Hearts Blood Flow
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Prevalence
0.5-0.8% of live births 2-3 in 1000 newborn infants
symptomatic with heart disease in the first
year of life Diagnosis during : 1 week of age in 40-
50%, 1 month of age in 50-60% of
patient Congenital heart disease remains the
leading cause of death in children with
congenital malformations.
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Etiology
Unknown Genetic factor
Maternal conditions and teratogenicagents
Congenital rubella syndrome
Maternal ingestion of drugs
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Classification of Non-CyanoticCongenital Heart Lessions
a. Increased volume loadatrial septal defect (ASD)
ventricular septal defect (VSD)AV septal defect (AV canal)
patent ductus arteriosus (PDA)
b. Increased pressure loadcoartation of the aorta (COA)
atrial stenosis (AS)
mitral stenosis (MS)
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Atrial Septal Defects
3 Type of ASD :1.Ostium Secundum ASD
2.Sinus Venosus ASD3.Ostium Primum ASD
In adult occurs commonly infemales
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Ostium Secundum Defect
Most common form ofASD
Occur at fossa ovalis Stucturally normal AV
valves
Single or multiple Openings 2 cm or
larger in diameter
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Sinus Venosus Atrial Septal
Defect Occur in the upper part ofthe atrial septum in closerelation to the entry of
the superior vena cava Sometimes the superiorvena cava straddles thedefect, some systemicvenosus blood enters the
left atrium The clinical manifestation
similar to secundum ASD
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Ostium Primum(Atrioventricular Septal Defect)
Occur in the lowerportion of the atrial
septum and over liesthe mitral andtricuspid valves
Markedly abnormal
AV valves
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Clinical manifestation
Asymtomatic until third decade In younger children : failure to thrive
In older children : varying degrees of exerciseintolerance Right ventricular diastolic volume increase Ejection time prolonged throughout all phases of
respiration Systolic ejection murmur is heard Easy fatigability Reccurent pneumonia
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Diagnose Anamnesa Physical examination
Chest rontgenogram ECG Echocardiogram
Treatment Surgical to do elective closure Palliation with pulmonary arterial banding
Prognose good if the closure is carried out Worse if heart failure and atrial fibrilation occur
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Ventricular Septal Defect
the most common of all congenitalcardiac defects
25% of all congenital heart disease,or about 2 in every 1000 live births
Most defect occur in membranoustypes
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Ventricular Septal Defect
Ventricular septal defect is an abnormal openingin the wall between the two ventricles
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Clinical manifestation
According to the size of thedefect and pulmonaryblood flow and pressure :
Small VSD left to right shunt, normal
pulmonary arterial pressure
Asymptomatic
Characteristic : loud, rash,blowing holosystolicmurmur, frequentlyaccompinied by a thrill
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Large VSDDyspnea
Feeding difficulties
Poor growth
Recurrent pulmonary
infection and cardiacheart failure in earlyinfancy
Holocystolic murmurgenerally harsh thansmall VSD
Profuse perspiration
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Diagnose Chest X ray Electrocardiogram
Complications
Infective endocarditis
Arrhytmia Heart failure
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Therapy
Small VSDProtection and care of endocarditis
Large VSDSurgerry
PrognoseSpontaneous closure 30-80% of cases within
the first and two years of life
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AV Septal Defect (AV Canal)
Ostium primum defect is in the lower portion ofatrial septum and overlies the mitral andtricuspid valve.
Contagious atrial & VSD with markedly abnormalAV valve. Common with down syndrom & may occur with
PS.
Asymptomatic. Exercise intolerance. Recurrent pneumonia.
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Diagnose :1. Chest radiograph
2. EEG
3. Echocardiogram4. Cardiac Catheterization &
Angiocardiography
5. Selective Right Ventriculography
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Theraphy :Surgically
Prognose :
Depent on : 1. Magnitude of L-R Shunt
2. Pulmonary vasc.Resistance
3. Severity of AV valve
insuficiency
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Patent Ductus Arteriosus (PDA)
The ductus arteriosus is a blood vesselthat is present in all babies before they
are born While in the womb, the lungs of the fetus
cannot provide oxygen to the fetus's blood
the fetus receives its oxygen from itsmother, through the umbilical cord
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connects the pulmonary artery to the
aorta, allowing blood to bypass the lungs Normally the ductus arteriosus closes on
its own within a few days of birth as the
lungs begin to strengthen and provide thebody with the oxygen it requires
Ligamentum Arteriosus
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Clinical Manifestations
Congestive heart failure rapid breathing
tiring more easily This condition also varies depending on
how wide the Ductus Arteriosus opened
A small opening may not produce any symptomsA larger opening may produce a heart murmur
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Diagnose Chest X ray Electrocardiogram
Treatment
Surgical or catheter closureThe surgery in small PDA is done to prevent late complicationsThe surgery in large PDA is done to treat heart failure or prevent
the development of pulmonary vascular disease
Prognose
Small PDA may live a normal spant with few or nocardiac symptoms Large PDA may cause congestive heart failure
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Mitral Stenosis (MS)
Symptom appear within the 1st2 year oflife.
Underdeveloped. Cyanosis & pallor. Heart enlargement (RV & LA, Dilatation &
Hiperthropy)
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Diagnose: 1. ECG RVH
2. Rontgen3. Echocardiogram
4. Cardiac Catheterization
5. Angicardigraphy
Theraphy :1. Surgical
2. Transcatheter BaloonValvuloplasty
Prognose :Poor
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Coarctation Of The Aorta
98 % occur just bellow the origin of the leftsubclavian artery at the origin of the ductusarteriosus ( juxtaductal coarctation )
C.A may be a feature of Turner Syndrome (XO) The term Shone Syndrome refers to multiple
levels of left heart obstructive disease, including
mitral stenosis, bicuspid aortic valve with orwithout aortic stenosis, tubular hypoplasia of theaortic isthmus, and coarctation of the aorta
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Clinical Manifestation
Weakness or pain ( or both ) in the legs afterexercise, but in many instances, even patientswith severe coarctation is asymptomatic
The classic sign of C.A is a disparity inpulsation and blood pressure in the arms andlegs
The femoral, popliteal, posterior tibial, anddorsalis pedis pulses are weak ( or absent inup to 40% of patients ), in contrast to thebounding pulses of the arms and carotidvessels
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This differential in blood pressure iscommon in patients with coarctation whoare older than 1 year
The pathognomonic murmur of C.A isheard in the left axilla and the left back orthe left infrascapular area
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DIAGNOSIS
EchocardiogramNeonates and young infants display
rightor biventricular hypertrophy
Echocardiography (two-dimensional)
Color Doppler
Pulsed and continuous wave Doppler
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Prognosis and Complications
Severe neurologic damage or even deathmay rarely occur from associated
cerebrovascular disease The common serious complications are :
1. Premature coronary artery disease
2. Heart failure3. Hypertensive encephalopathy
4. Intracranial hemorrhage
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Treatment
Infusion of prostaglandin E1Anticongestive
The procedure of choice for isolatedjuxtaductal coarctation of aorta iscontroversial
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Postcoarctectomy Syndrome* Acute hypertension
* Abdominal pain
* Anorexia, Nausea, Vomiting
* Leukocytosis* Intestinal hemorrhage
* Bowel necrosis
* Small bowel obstruction Relief is usually obtained with antihypertensivedrugs and intestinal decompression
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