Congenital Heart Disease

Dr. Raid Jastania

Congenital Heart Disease

• 8 per 1000 live birth• Could be minor defect or major defect• Cause – unknown

– Genetic: chromosomal anomalies, trisomy 13, 18, 21– Environmental: infections, rubella

• Types:– Left-to-Right shunt– Right-to-Left shunt– Obstructive defects

Left-to-Right Shunt

Left-to-Right Shunt

• Most common

• ASD, VSD, PDA

• May be asymptomatic at birth

• Cyanosis is not early feature

Atrial Septal Defect

• 75% ostium secondum ASD

• 15% ostium primum ASD

• 10% sinus venosus ASD

Atrial Septal Defect

• Diagnosed usually in adulthood

• Left to right shunt

• Right atrial dilatation, right ventricular hypertrophy

• Pulmonary hypertension

• Late: Cyanosis (Eisenmenger syndome)

• CHF

                                               

     

Ventricular Septal Defect

• 70% in the membarneous region• Most common congenital heart disease• Many VSD close spontaneously • Left to right shunt• Right ventricular hypertrophy/dilatation• Dilated pulmonary artery• Pulmonary hypertension• Late: CHF, cyanosis

                                               

     

Patent ductus arteriosus

Patent ductus arteriosus

• Ductus arteriosus closes after birth by– Increase arterial oxygen– Drop in pulmonary vascular resistance– Decrease in prostaglandin E2

• PDA leads to Left to right shunt• Left atrial and left ventricular hypertrophy• Pulmonary hypertension – atherosclerosis and right

ventricular hypertrophy• Machinery murmur• Late: Cyanosis, CHF

                                               

     

Right-to-Left shunt

Tetralogy of Fallot

• Most common cyanotic congenital heat disease• Consist of:

1. VSD

2. Over-riding Aorta

3. Pulmonary stenosis

4. Right ventricular hypertrophy

• Boot shape heart• Right to left shunt• Pulmonary hypertension does not occur

                                               

     

Transposition of Great Arteries

• Aorta from the right ventricle

• Pulmonary artery from the left ventricle

• + PDA, ASD, VSD

• Cyanosis

                                               

     

Obstructive Defect

Coarctation of Aorta

• Narrowing of the aorta• Preductal coarctation

– Before ductus arteriosus– Right ventricualr hypertrophy– Selective cyanosis of lower extremities

• Postductal coarctation– Left ventricular hypertrophy– Hypertension of upper extremities– Weak pulse of legs