Transcript of DR. HANA OMER CONGENITAL HEART DEFECTS. The major development of the fetal heart occurs between the...
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- DR. HANA OMER CONGENITAL HEART DEFECTS
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- The major development of the fetal heart occurs between the
fourth and seventh weeks of gestation, and most congenital heart
defects arise during this time. resulting from an interaction
between a genetic predisposition toward development of a heart
defect and environmental influences. Approximately 13% of children
with congenital heart disease have an associated chromosomal
abnormality. maternal conditions and teratogenic influences,
including maternal diabetes, congenital rubella, maternal alcohol
ingestion, and treatment with anticonvulsant drugs.
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- Acyanotic and Cyanotic Disorders It is devided into cyanotic
and acyanotic disorders. Left-to-right shunts commonly are
categorized as acyanotic disorders and right-to left shunts with
obstruction as cyanotic disorders. Shunting of blood refers to the
diverting of blood flow from one system to the other from the
arterial to the venous system (i.e., left-to-right shunt) or from
the venous to the arterial system (i.e., right-to-left shunt).
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- CYANOTIC HEART DISEASE 1. Tetralogy of fallots. 2.
Transposition of great arteries (TGA). 3. Tricuspid atresia. 4.
Truncus arteriosus. 5. Eisenmengers syndrome.
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- Acyanotic Disorders With left to right shunt :- 1. Atrial
septal defect (ASD). 2. Ventricular septal defect (VSD). 3. Patent
ductus arteriosis. With no shunt :- 1. Coarctation of aorta. 2.
Congenital aortic stenosis. 3. Pulmonary stenosis, tricuspid
stenosis. 4. Dextrocatdia.
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- MITRAL STENOSIS
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- Almost all mitral stenosis is due to rheumatic heart disease.
Rheumatic mitral stenosis is much more common in women (about 1/3
case). Rare causes of mitral stenosis may be congenital, or because
calcification and fibrosis of the valve in elderly.
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- PATHOPHYSIOLOGY The commisures of mitral valve become adherent
and the chordae tendinae are short and deformed. The normal mitral
valve orifice is about 4-6 cm in diastole, it is reduced to about 1
cm in severe mitral stenosis. left atrial, pulmonary venous,
pulmonary capillary pressure. Also result in atrial fibrillation
pulmonary edema pulmonary hypertension. All cases may develop
pulmonary hypertension and right ventricular hypertrophy.
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- All patients with mitral stenosis are at risk of left atrial
thrombosis and systemic thromboembolism. Mitral stenosis is
frequently associated with mitral regurgitation or disease of the
aortic or tricuspid valve.
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- MITRAL STENOSIS
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- CLINICAL FEATURES
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- SYMPTOMS 1. DYSPNEA. 2. COUGH. 3. PALPITATION. 4. FEATURES OF
CHRONIC RIGHT HEART FAILURE.
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- ON EXAMINATION INSPECTION : left parasternal pulsation due to
right ventricular hypertrophy. PALPATION : 1. Apex beat not
displaced. 2. Tapping apex beat. 3. Left parasternal heave. 4.
Palpable P . AUSCULTATION : HEART SOUNDS : 1. Loud first heart
sound. 2. Loud P. 3. Opening snap.
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- MURMURS : 1. Mid-diastolic rumbling murmur. 2. Pre-systolic
accentuation of murmur.
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- COMPLICATION
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- 1. ATRIAL FIBRILLATION. 2. SYSTEMIC EMBOLIZATION. 3. PULMONARY
HYPERTENSION. 4. PULMONARY INFARCTION. 5. INFECTIVE ENDOCARDITIS.
6. TRICUSPID REGURGITATION. 7. RIGHT VENTRICULAR FAILURE.
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- INVESTIGATION
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- X-RAY CHEST : 1. Double shadow behind right heart :enlarged
left atrium. 2. Kerleys B lines : which are small 1-2 cm horizontal
lines present in the costophrenic angle appearing due to raised
pulmonary venous pressure. ECG. ECO.
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- Kerleys B lines
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- TREATMENT
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- MEDICAL TREATMENT MILD DYSPNEA : salt restriction, low doses of
diuretics. SINUS RHYTHM : beta blockers. ATRIAL FIBRILLATION : beta
blockers, calaium channel blocker Prphylactic antibiotics to
prevent infective endocarditis.
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- SURGICAL TREATMENT PERCUTANEOUS TRANSLUMINAL MITRAL
COMMISSUROTOMY (PTMC) : INDICATIONS: 1. Uncontrolled pulmonary
edema. 2. Symptoms of pulmonary congestion persist despite therapy.
3. Recurrent systemic emboli despite anticoagulation.
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- Thank you.