Congenital Heart Disease MSN. khetam awamreh

Outline * Classification of Congenital Heart Disease. 1. Acyanotic Heart Disease a. Increase pulmonary blood flow b. Obstruction of blood flow 2. Cynatoic Heart disease a. Decrease pulmonary blood flow b. Mixed blood flow .

A Cyanotic Heart Defect Move blood from arterial …to…venous system

* Defect with increased pulmonary blood flow VSD (ventricular septal defect ) ASD (Atrial septal defect ) AVC (Atrioventricular canal defect ) PDA ( patent ductus artriosus)

** 1.VSD (ventricular septal defect ) **1. VSD …30% of CHD 85% spontaneous closed *Assessment . (4 to 8 week of age ) fatigue…murmur 3 ICS depend on P.E …thrill may be palpable.. Echo .ECG, MRI , (RT ventricle hypertrophy ) Treatment … cardiac catheterization .. Surgery

VSD

** 2.ASD (blood flow from left to right atrium) Tow type .. Ostium primum ASD1 ( lower end of the septum ) Ostium secundum ASD2( center of the septum ) **Assessment ...systolic murmur 3 ICS enlarged RT side of the heart ..increased in pulmonary circulation…Echo. **Management …cath repaired, or open heart surgery (1 to 3 y/d )…especially in girls **Complication ..arrhythmias …emboli

ASD

A trial Sepal Defect

** 3.AVC ( Arterioventricular Canal Defect) …Low a trial septal defect continuous with high ventricular defect and distortion of the mitral and tricuspid valve **Assessment …Echo …surgical is important some time need new valve **Treatment …after surgery give antibiotic and anticoagulant Closed observation to the jaundice

AVC

**4.PDA ( Patent Ductus Arteriosus) it’s failed to closed at birth ,blood will shunt from the aorta to the pulmonary artery. Complete closure occurs…3 month More common in girls than boys **Assessment ….direct after birth..P.E cardiac catheterization **Treatment…in infant give IV or OR indomethacin(3time \12hr or 24hr) to lower the PGE & lead to closed the ductus closer

Cont…PDA ** Treatment… Side effect… 1. Reduce glomerular filtration rate. 2. Impaired plat aggregation 3. Demention GI & CNS blood flow ** Treatment… Cath at age of (6m to 1y) or surgical intervention by Thoraoctomy If not treatment … CHF Infected Endocardities

PDA

**Obstruction of blood flow form ventricle 1.Pulmonary stenosis 2.Aortic stenosis 3.Coarctation of the Aorta

**1.pulmonary stenosis 10% Narrowing in pulmonary valve Assessment like RT side heart failure * Systolic murmur…thrill ECG …Echo (RT side hypertrophy ) Treatment Balloon angioplasty

Pulmonary stenosis

**2. Aortic stenosis * 7% of total cases of CHD Increased pressure in the LF side of the heart (LV hypertrophy) Assessment… murmur ,thrill ,faint pulses, high BP,high HR. Treatment.. Beta-blocker or ca channel blocker to decreased hypertrophy Bolloon valvoplasty

Aortic stenosis

** 3.Coarctation of the Aorta 6% in boys more than in girls ** assessment high BP in upper body part in the arm 20mmhg more than leg, headache, vertigo, epistaxis. Assessment murmur, LV. hypertrophy ECG,Cho Treatment Digoxin & diuretic before surgery Surgical at the age of 2y/d end of the aorta anastomosed

Coarctation of the Aorta

Cyanotic Heart Defect

mixed blood flow Transposition of the great Arteries 2. Total pulmonary venous return 3. Truncus Arteriosus 4. Hypo plastic left Heart Syndrome

**1.Transposition of the great Arteries 5% In boys more than girls *assessment …cyanotic from birth, murmur may or not ,Echo,ECG cath. *Treatment. PGE to keep PDA opining Surgical at 1week to 3months

Transposition of the great Arteries

** 2. Total Pulmonary venous return 2% Pulmonary vein return to the right atrium or the superior vena cava instead of the left atrium An absent spleen is associated with this disorder * Treatment Give PGE,cath, and surgical treatment

Total Anomalous pulmonary venous return

** 3.Truncus Arteriosus 1% One major artery or (trunk) arises from the LF & RT ventricle in place of a separate Aorta & Pulmonary Artery with VSD. Assessment … Cyanosis, murmur Treatment … surgical at school age

Truncus Arteriosus

** 4.Hypo plastic left Heart Syndrome *assessment of HLHS Infants may appear healthy at birth, but signs of HLHS soon become apparent after the ductus arteriosus closes. These signs include the following: Cyanosis (a blue skin, lips, fingernails and other areas of the body as a result of the lack of oxygen-rich blood to the body) 1. Heart murmur 2. Enlargement of the heart (as seen in an echocardiogram) 3. Noticeably troubled breathing 4. Apparent weakness 5. Inability to feed normally 6. Cold extremities

Echocardiogram

**Defect with Decreased pulmonary blood flow Tricuspid Artesia 2. Tetrology of Fallot

**1. Tricuspid Artesia Tricuspid valve closed no blood from RA to RV * if still foramen ovale and PDA still open will maintain good O2 blood so you have to give PGE IV. If not open … sever cyanosis ,tachycardia ,dyspnea * Treatment Surgically

Tricuspid Atresia

**2. Tetrology of Fallot 10% 1. Pulmonary stenosis 2. VSD *usually large* 3. dextra position (overriding of the Aorta ) 4. Hypertrophy of the right ventricle.

Tetrology of Fallot

TOF Assessment .. 1. Incresed activity .increased cyanosis 2. Polycythemia 3. Dyspnea, murmur 4. Growth retardation 5. Clubing finger 6. syncop 7. Hypoxic episodes with crying 8. knee/chest position

TOF Treatment … 1.Give O2 therapy, give morphine sulfate ,Propranol, knee-chest position 3.Surgical …1 to 2 y/d

Cardiac catheter