1. Congenital Heart Disease
MSN. khetam awamreh

2. 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 .

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

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

6. ** 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

7. VSD

8. ** 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

9. ASD

10. A trial Sepal Defect

11. ** 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

12. AVC

13. **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

14. 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

15. PDA

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

18. **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

19. Pulmonary stenosis

20. **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

21. Aortic stenosis

22. ** 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

23. Coarctation of the Aorta

25. Cyanotic Heart Defect

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

27. **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

28. Transposition of the great Arteries

29. ** 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

30. Total Anomalous pulmonary venous return

31. ** 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

32. Truncus Arteriosus

33. ** 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

35. Echocardiogram

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

37. **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

38. Tricuspid Atresia

39. **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.

40. Tetrology of Fallot

41. 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

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

44. Cardiac catheter