Congenital heart Diseases Ahmad Osailan. Fetal Circulation Embryonic lungs and digestive tract are...

Congenital heart Diseases

Ahmad Osailan

Fetal Circulation

• Embryonic lungs and digestive tract are nonfunctional

• Respiratory functions and nutrition provided by placenta

Placental blood supplyBlood flow to the placenta:• Through pair of umbilical arteries which arise

from the internal iliac arteries and enter umbilical cord.

Blood returns from placenta:• In a single umbilical vein which drains into

ductus venosusDuctus Venosus:• Empties into inferior vena cava

• The right V produces higher pressure than Left ventricle and blood travels into ductus arteriosus instead of pulmonary circuit.

Before Birth

• Fetal Lungs are collapsed • O2 provided by placenta circulation

• AT Birth • Neoborn breath air • Lung expand • Pulmonary circulation provide O2

Fetal pulmonary circulation bypass

1. Foramen Ovale:• Interatrial opening• Covered by valve like flab• Directs blood from right to left atrium

2. Ductus Arteriosus:• Short vessel• Connects between pulmonary and aortic

trunks

Cardiovascular changes at birth

• Pulmonary vessels expand • Ductus arteriousus constricts – HOW? Rise of O2

• Foramen ovale colse – HOW? Left atrium rise in pressure

• Conginital cardiovascular proplems develop if proper circulatory changes do not occur.

Congenital heart defects

• Congenital heart defects are abnormalities in the heart's structure that are present at birth.

• Approximately 8 out of every 1,000 newborns have congenital heart defects, ranging from mild to severe

Etiology

• 1.Genetic factor (internalfactor)• 2. Environmental factor (external factor):

High altitude• 3. Other related factors: Viral infections of

pregnancy , Mothers who are diabetic, alcoholics or drug addictive.

Types of Congenital cardiovascular defects

CHD

Acyanotic

L to R shuntsASDVSDPDA

Obstructive lesionPulmonic stenosis

Aortic stenosis

Cyanotic

R to L Shunts Tetralogy of fallot

Complete TGA

Acyanotic (non cyanotic Defects)

ASD (atrial septal defect) Patent Foramen Ovale and Ductus Arteriosus:Blood recirculates through pulmonary circuit

due to higher left pressure.Left ventricle work Pulmonary pressure Pulmonary hypertension -> cardiac

enlargement pulmonary edema

Acyanotic (non cyanotic Defects)

VSD (ventricular septal defects)Opening in interventricular septum 0.12% of BirthsSame as ASD and PDA

Cyanotic Defects

Tetralogy of fallot:• Cyanosis, especially in the adult, is the result of a small number of cardiac

malformations well determined…. One…is much more frequent than the others…. This malformation consists of a true anatomopathologic type represented by the following tetralogy: (1) Stenosis of the pulmonary artery; (2) Interventricular communication; (3) Deviation of the origin of the aorta to the right; and (4) Hypertrophy, almost always concentric in type, of the right ventricle. Failure of obliteration of the foramen ovale may occasionally be added in a wholly accessory manner.”– Fallot, Ètienne-Louis-Arthur. Contribution to the pathologic anatomy of

morbus caeruleus (cardiac cyanosis). Marseilles Med. 1888; 25:418-20.

Aorta originates from interventricular septum

Cyanotic Defects

Transposition of great vessels

Physical Therapy for CHD

• Physical therapists can also provide suggestions for exercises and other activities that may be done at home to help improve your child's muscle strength and coordination, as well as help him/her achieve developmental milestones, such as sitting, crawling, pulling up to stand, and walking. Physical therapy may be carried out in sessions at the hospital, as well as by parents at home

Exercise • In the past, children with congenital heart disease were discouraged from

exercising because it was felt that their health was too fragile to withstand the effects of vigorous physical activity. However, this is now thought to be inaccurate and exercise is believed to improve health, boost a child’s self-esteem and help prevent problems developing in later life.

• There is no reason why most children with congenital heart disease cannot take part in normal physical activities, such as PE lessons, as long as:

• their defect has been fully repaired with surgery • they do not have symptoms associated with congenital heart disease, such as

shortness of breath during physical activity • their blood pressure is within the normal range • they do not have any complications of congenital heart disease, such as abnormal

heartbeat • Even if your child doesn't satisfy these recommendations, they can still benefit

from a more limited programme of physical activity, such as walking or, in some cases, swimming.

• Your child’s heart specialist can give you more detailed advice about the level of physical activity that is suitable for your child.