1. Congenital Heart Disease Dr. Raid Jastania

2. Congenital Heart Disease 8 per 1000 live birth Could be minor defect or major defect Cause – unknown –Genetic: chromosomal anomalies, trisomy 13, 18, 21 –Environmental: infections, rubella Types: –Left-to-Right shunt –Right-to-Left shunt –Obstructive defects

3. Congenital Heart Disease Systemic vs Pulmonary circulation Shunt of blood Cyanosis Increase/decrease pulmonary flow Pulmonary hypertension: reversible, irreversible, dyspnea, chest pain, syncope, hemoptosis, cyanosis, clubbing, erythrocytosis Presentation differ: fetal life, childhood, adulthood May have more than one defect

4. Left-to-Right Shunt

5. Most common ASD, VSD, PDA May be asymptomatic at birth Cyanosis is not early feature

6. Atrial Septal Defect 75% ostium secondum ASD 15% ostium primum ASD 10% sinus venosus ASD

8. Atrial Septal Defect –Asymptomatic early in life –Diagnosed usually in adulthood –In adult: atrial arrhythmia –Early : Left-Right shunt Middiastolic rumbling tricuspid murmur Midsystolic pulmonary ejection murmur –Pulmonary hypertension –Late: Right-Left Shunt Diastolic pulmonary incompetence murmur –Right atrial dilatation, right ventricular hypertrophy –Late: Cyanosis (Eisenmenger syndome) –CHF

10. Ventricular Septal Defect 70% in the membarneous region Most common congenital heart disease Many VSD close spontaneously Left to right shunt Right ventricular hypertrophy/dilatation Dilated pulmonary artery Pulmonary hypertension Late: CHF, cyanosis

12. Patent ductus arteriosus

13. Ductus arteriosus closes after birth by –Increase arterial oxygen –Drop in pulmonary vascular resistance –Decrease in prostaglandin E2 PDA leads to Left to right shunt Continuous Machinery murmur Left atrial and left ventricular hypertrophy Pulmonary hypertension – atherosclerosis and right ventricular hypertrophy Late: Cyanosis, CHF

15. Right-to-Left shunt

16. Tetralogy of Fallot Most common cyanotic congenital heat disease Consist of: 1.VSD 2.Over-riding Aorta 3.Pulmonary hypoplasia (RV outflow obstruction) 4.Right ventricular hypertrophy Boot shape heart Right to left shunt Pulmonary hypertension does not occur

18. Transposition of Great Arteries Aorta from the right ventricle Pulmonary artery from the left ventricle + PDA, ASD, VSD Cyanosis

20. Obstructive Defect

21. Coarctation of Aorta Narrowing of the aorta Preductal coarctation –Before ductus arteriosus –Right ventricualr hypertrophy –Selective cyanosis of lower extremities Postductal coarctation –Left ventricular hypertrophy –Hypertension of upper extremities –Weak pulse of legs, delayed pulse, claudication