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

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Presentation on theme: "Acyanotic Congenital Heart Disease Dr David Coleman Consultant Paediatric Cardiologist Our Lady’s Children’s Hospital, Crumlin Dublin."— 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

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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: 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

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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 (1 st few weeks) or continuous ‘machinery’ murmur loudest under left clavicle ♥ ECG:normal (small PDA) LVH ± RVH (large PDA)

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18 PDA ♥ CXR:± cardiomegaly, pulm plethora ♥ Options for closure: 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)

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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)

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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 1 st few months of life, LVH if older

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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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