1. Congenital heart Diseases
Ahmad Osailan

2. Fetal Circulation
Embryonic lungs and digestive tract are nonfunctional
Respiratory functions and nutrition provided by placenta

4. Placental blood supply
Blood 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 venosus
Ductus Venosus:
Empties into inferior vena cava

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

6. Before Birth AT Birth Fetal Lungs are collapsed
O2 provided by placenta circulation
AT Birth
Neoborn breath air
Lung expand
Pulmonary circulation provide O2

7. Fetal pulmonary circulation bypass
Foramen Ovale:
Interatrial opening
Covered by valve like flab
Directs blood from right to left atrium
Ductus Arteriosus:
Short vessel
Connects between pulmonary and aortic trunks

8. 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.

9. 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

10. 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.

11. Types of Congenital cardiovascular defects
CHD
Acyanotic
L to R shunts
ASD
VSD
PDA
Obstructive lesion
Pulmonic stenosis
Aortic stenosis
Cyanotic
R to L Shunts
Tetralogy of fallot
Complete TGA

12. 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

13. Acyanotic (non cyanotic Defects)
VSD (ventricular septal defects)
Opening in interventricular septum
0.12% of Births
Same as ASD and PDA

17. 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:
Aorta originates from interventricular septum

19. Cyanotic Defects
Transposition of great vessels

20. 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

21. 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.