4 Common acyanotic lesions Ventricular septal defectsAtrial septal defectsAtrio-ventricular septal defectsPatent ductus arteriosusTruncus arteriosusPulmonary stenosisAortic stenosisMitral stenosis/incompetenceCoarctation of aortaTricuspid regurgitation
5 Common Cyanotic Lesions Decreased flow1. Tetralogy of Fallot2. Tricuspid Atresia3. Severe Pulmonic Stenosis4. Ebstein’s anamolyIncreased Flow5. Transposition of great vessles6. VSD with pulmonary atresia
6 Common Lesions producing cyanosis 7. Truncus Arteriosus8. Hypoplastic left heart9. Single ventricle10. TAPVR with infradiaphragmatic obstruction
7 Presenting complaints/signs Fast breathingOedemaHepatomegaly,spleenomegalyClubbingCyanosisFocal neurological lesionOther organ defectsChromosomal anomaliesFailure to thriveExercise intolerenceEasy fatigabilityChest indrawingSweating during feedingBluish spellsFever with rigorPalpitationConvulsion
8 Cyanosis: is it a cardiac cause or lung cause Hyperoxia testNeonates with cyanotic congenital heart disease usually do not have significantly raised arterial Pao2 during administration of 100% oxygen.
9 Ventricular Defect Small VSD Large VSD Asymptomatic A loud, harsh, or blowing holosystolic murmur.Large VSDdyspnea, feeding difficulties, poor growth, profuse perspiration, recurrent pulmonary infections, and cardiac failure in early infancy.80%Syndromes associated with this condition
10 VSD: ECG is normal but may show right ventricular hypertrophy, if present indicates defect is large and presence of pulmonary hypertension or pulmonry stenosis
11 Ventricular Septal Defect (VSD) Small VSDs, the chest radiograph is usually normalLarge VSD: The presence of right ventricular hypertrophy, olegeimic lung fields (pulmonary hypertension or an associated pulmonic stenosis), gross cardiomegaly with prominence of both ventricles, the left atrium.
12 Ventricular Septal defects 30–50% of small defects close spontaneously, most frequently during the 1st 2 yr of life.Small muscular VSDs are more likely to close (up to 80%) than membranous VSDs are (up to 35%).infants with large defects have repeated episodes of respiratory infection and heart failure despite optimal medical management.Surgical repair prior to development of an irreversible increase in pulmonary vasculalr resistance (usually prior to the patient's second birthday).
13 Atrial Septal Defects: secundum Most common form of ASD (fossa ovalis)In large defects, a considerable shunt of oxygenated blood flows from the left to the right atrium.Mostly asymptomaticThe 2nd heart sound is characteristically widely split and fixed.Secundum
14 Atrial Septal Defects:primum Situated in the lower portion of the atrial septum and overlies the mitral and tricuspid valves. In most instances, a cleft in the anterior leaflet of the mitral valve is also noted.Combination of a left-to-right shunt across the atrial defect and mitral insufficiencyC/F similar to that of an ostium secundum ASD
15 Atrial Septal Defect Enlargement of the right ventricle Enlargement of atriumLarge pulmonary arteryincreased pulmonary vascularity is.
16 The electrocardiogram in patients with a complete AV septal defect is distinctive. The principal abnormalities are (1) superior orientation of the mean frontal QRS axis with left axis deviation to the left upper or right upper quadrant, (2) counterclockwise inscription of the superiorly oriented QRS vector loop, (3) signs of biventricular hypertrophy or isolated right ventricular hypertrophy, (4) right ventricular conduction delay (RSR′ pattern in leads V3 R and V1 ), (5) normal or tall P waves, and (6) occasional prolongation of the P-R interval
17 Atrial Septal DefectsSecundum ASDs are well tolerated during childhood.Antibiotic prophylaxis for isolated secundum ASDs is not recommended.Surgery or transcatheter device closure is advised for all symptomatic patients and also for asymptomatic patients with a Qp:Qs ratio of at least 2:1.Ostium primum defects are approached surgically
18 Patent Ductus Arteriosus Small defect no symptoms.Large defect:Wide pulse pressureEnlarged heartThrill in L second ISContinuous murmurX-ray: prominent pulmonary artery with increased vascular markings.
19 Primary Pulmonary Hypertension Prominent pulmonary artery.Prominent right ventricleProminent vascularity in the hilar areasDecreased vascualr marking in the periphery.No treatmentPPrimary pulmonary hypertension is characterized by pulmonary vascular obstructive disease and right-sided heart failure. It occurs at any age, although in pediatric patients the diagnosis is initially made in the teenage years. Chest roentgenograms reveal a prominent pulmonary artery and right ventricle. The pulmonary vascularity in the hilar areas may be prominent, in contrast to the peripheral lung fields, in which pulmonary markings are decreased.
20 Mitral insufficiency: Rheumatic High volume loadInflammatory processEnlarged left ventriclesDilatation of the left atriumPulmonary congestionSymptoms of left sided failureSpontaneous improvementRepeated insultChronic mitral insufficiencyRaised Pulmonary APSymptoms of right heart failureEnlarged right ventricle and atrium
21 Mitral insufficiency: Rheumatic Signs of heart failureHeaving apical impulseApical systolic thrillAccentuated 2nd soundHolosystolic murmur radiating to axillaECG: bifid P waves and left ventricular hyertrophyX-ray: prominent left atrium and ventricle (straight left border)Prophylaxis against recurrence of rheumatic fever
22 Rheumatic valvular disease: Mitral stenosis Takes 10 years to developSymptoms proportionate to severityLeft ventricular failure right ventricular failureLoud first heart sound with opening snap.Diastolic murmurAbsent murmur if heart failure.Surgical intervention if symptomatic
23 Mitral Stenosis Loud 1st sound Diastolic murmur left atrial enlargementprominence of the pulmonary arteryenlarged right-sided heart chambers;ECG: prominent notched P wave.
29 Cardiac disease with increased vasculature Atrioventricular septal defectsCongestive cardiac failureTransposition of great arteries with VSDTotal anomalous pulmonary venous drainageTruncus arteriosusSingle ventricle without pulmonary stenosisHypoplastic left heart syndrome