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Acyanotic Congenital Heart Disease

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Presentation on theme: "Acyanotic Congenital Heart Disease"— Presentation transcript:

1 Acyanotic Congenital Heart Disease
Dr David Coleman Consultant Paediatric Cardiologist Our Lady’s Children’s Hospital, Crumlin Dublin

2 Common Shunt Lesions ♥ Ventricular septal defect (VSD)
♥ Atrial septal defect (ASD) ♥ Patent ductus arteriosus (PDA) * All 3 lesions can lead to Eisenmenger’s Syndrome if a large lesion is not detected and treated early enough

3 Common Stenotic Lesions
♥ Pulmonary stenosis (PS) ♥ Aortic stenosis (AS) ♥ Coarctation of the aorta (CoA)

4 VSD’s ♥ Commonest form of CHD ♥ Commonest types:
membranous (perimembranous) ~75% muscular ♥ Can be single or multiple


6 VSD’s ♥ Symptoms relate to the degree of shunt (VSD size, pulmonary vascular resistance) if small: no symptoms if large (high pulmonary blood flow, CHF): tachypnoea dyspnoea slow feeding failure to thrive sweating

7 VSD’s ♥ Exam (smaller VSD): pink normal pulses normal S1 and S2
± systolic thrill harsh pansystolic murmur LLSE ♥ ECG: normal (smaller VSD) or LVH ± RVH (larger VSD)

8 VSD’s ♥ Larger defect: MDM @ apex (mitral flow murmur)
narrowly split S2 and loud P2 ± S3 CXR: cardiomegaly increased pulmonary vascularity

9 VSD’s ♥ Treatment options: Nil (spontaneous closure) Surgical closure
Device closure

10 ASD’s ♥ Three types: secundum primum sinus venosus
♥ Commonest: secundum ♥ Primum: a form of atrioventricular septal (canal) defect



13 Secundum ASD ♥ Usually no symptoms in childhood ♥ Exam: pink
normal pulses wide ± ‘fixed’ split S2 soft ULSE ♥ ECG: incomplete RBBB (95%) ♥ CXR: often normal sometimes pulmonary plethora

14 Secundum ASD ♥ Haemodynamic significance of ASD is assessed to decide if closure appropriate ♥ Usually closed age 3-5 years (earlier if symptomatic) or when diagnosed if later ♥ Two options for closure: surgery - suture or patch interventional catheter - device

15 Amplatzer ASD Occluder

16 PDA ♥ CHF symptoms if large ductus in very young infant, otherwise often asymptomatic ♥ Exam: pink full volume pulses harsh systolic (1st few weeks) or continuous ‘machinery’ murmur loudest under left clavicle ♥ ECG: normal (small PDA) LVH ± RVH (large PDA)


18 PDA ♥ Options for closure: ♥ CXR: ± cardiomegaly, pulm plethora
surgery - ligation interventional catheter - coil(s) or device

19 Pulmonary Stenosis ♥ Usually asymptomatic ♥ Exam: pink normal pulses
± systolic ejection click ESM ULSE if severe, S2 widely split (not fixed)


21 Pulmonary Stenosis ♥ ECG: RAD, RVH ♥ CXR: normal
± prominent MPA (post-stenotic dilatation) ♥ Treatment of valvar PS (moderate/severe): balloon valvuloplasty preferred uncommonly surgical valvotomy

22 Aortic Stenosis ♥ Often asymptomatic;
otherwise SOB, syncope or chest pain on exertion ♥ Exam: pink small volume pulse, small pulse pressure ± LV lift ± systolic thrill (suprasternal, URSE) ± systolic ejection click harsh ESM URSE & radiating to carotids if severe, narrow split S2 (even reversed)


24 Aortic Stenosis ♥ ECG: normal (mild AS) LVH ± strain (more severe AS)
♥ CXR: often normal ± dilated ascending aorta ♥ Treatment of valvar AS (moderate/severe): balloon valvuloplasty surgical valvotomy

25 Coarctation of the Aorta
♥ CHF in neonate if severe CoA; often asymptomatic in older child ♥ Exam: pink reduced or absent femoral pulses soft systolic murmur mid LSE and/or mid left back ♥ ECG: RVH in 1st few months of life, LVH if older


27 Coarctation of the Aorta
♥ CXR: cardiomegaly evidence of CHF rib notching (older child) ♥ Treatment: surgery for ‘native’ CoA balloon angioplasty for re-CoA

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