CK CHD

ACYANOTIC CARDIAC MALFORMATIONS

CK CHD

VENTRICULAR SEPTAL DEFECT ATRIAL SEPTAL DEFECT PATENT DUCTUS ARTERIOSUS COARCTATION OF AORTA VALVULAR LESIONS

CK CHD

VENTRICULAR SEPTAL DEFECT

MOST COMMON DEFECT (25%) ACYANOTIC LEFT TO RIGHT SHUNT EARLY ONSET CONGESTIVE

CARDIAC FAILURE

CK CHD

PATHOPHYSIOLOGY– MAJORITY MEMBRANOUS TYPE

– MUSCULAR TYPE ARE MULTIPLE

– SMALL TO LARGE DEFECTS

– PULMONARY HYPERTENSION: AT BIRTH PERSISTENT/ DUE TO LARGE VOLUME

HAEMODYNAMICS– LEFT TO RIGHT SHUNT

– DEPENDS ON SIZE OF DEFECT

– DEGREE OF PULMONARY HYPERTENSION

CK CHD

CLINICAL MANIFESTATIONS

ASYMPTOMATIC FAILURE TO THRIVE FEEDING DIFFICULTY DYSPNOEA RECURRENT LOWER RESPIRATORY

INFECTION EARLY CONGESTIVE CARDIAC

FAILURE

CK CHD

CLINICAL SIGNS

PRAECORDIAL PROMINENCE MAY HAVE LARGE VOLUME PULSE APICAL IMPULSE:

– HEAVING (LVH)

– SHIFTED DOWN AND OUT

PARASTERNAL HEAVE (RVH) SYSTOLIC THRILL LOWER LEFT

STERNAL BORDER LOUD SECOND SOUND SYSTOLIC MURMER AT LLSB

CK CHD

CLINICAL SIGNS(CONT) MURMER:

– HARSH AND LOUD IN SMALL DEFECTS– DOES NOT EXTEND TO 2ND SOUND– PANSYSTOLIC AND MAY MASK THE

SECOND SOUND– SHORTENED WITH PULMONARY

HYPERTENSION SHORT APICAL MID DIASTOLIC

MURMER: FLOWMURMER

CK CHD

INVESTIGATIONS

CHEST XRAY(CARDIOMEGALY) ECG(BIVENTRICULAR

HYPERTROPHY) CARDIAC CATHETERISATION

CK CHD

TREATMENT

DEFINITIVE– SURGERY

SUPPORTIVE– ANTIFAILURE– TREAT THE INFECTIONS– NUTRITION– PROPHYLAXIS FOR INFECTIVE

ENDOCARDITIS TREAT THE COMPLICATIONS

CK CHD

ASD

OSTIUM SECUNDUM TYPE HAEMODYNAMICS

– LARGE LEFT TO RIGHT SHUNT– PULMONARY BLOOD FLOW 2TO 4

TIMES SYSTEMIC FLOW– COMPLIANCE OF RIGHT VENTRICLE

DECIDING FACTOR OF DEGREE OF SHUNT

CK CHD

CLINICAL MANIFESTATIONS ASYMPTOMATIC EXERSISE INTOLERANCE SIGNS OF RIGHT/BIVENTRICULAR

HYPERTROPHY THRILL IS VERY RARE LOUD FIRST HEART SOUND SECOND HEART SOUND WIDELY SPLIT

AND FIXED SYSTOLIC MURMER

CK CHD

CLINICAL MANIFESTATIONS (CONT)

MURMER– DUE TO THE FLOW ACROSS THE

PULMONARY VALVE INTO THE PULMONARY ARTERY

– OVER MID OR UPPER LEFT STERNAL BORDER

– EJECTION SYSTOLIC– MEDIUM PITCHED

CK CHD

INVESTIGATIONS

CHEST XRAY-- LARGE RIGHT VENTRICLE AND ATRIUM

LARGE PULMONARY ARTERY PULMONARY PLETHORA ECG -- NORMAL/ RIGHT AXIS

DEVIATION & RVH EHCO CATHETERISATION

CK CHD

PROGRESS & COMPLICATIONS

SYMPTOMS APPEAR IN 3RD TO 4TH DECADE

PULMONARY HYPERTENSION ATRIAL ARRHYTHMIAS CCF -- RARE TRICUSPID/ MITRAL

REGURGITATION -- RARE INFECTIVE ENDOCARDITIS -- RARE

CK CHD

TREATMENT

ELECTIVE SURGERY TREAT COMPLICATIONS

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PATENT DUCTUS ARTERIOSUS

MOST COMMON ACYANOTIC CHD FUNCTIONAL CLOSURE AT BIRTH MOST COMMON CHD WITH MATERNAL

RUBELLA FEMALE : MALE 2 : 1 BIFURCATION OF PA TO DISTAL TO LEFT

SUBCLAVION PROBLEM IN PRETERM INFANTS HIGH ALTITUDE

CK CHD

HAEMODYNAMICS

BLOOD FLOW FROM AORTA TO PA IN SYSTOLE AND DIASTOLE

EXTENT OF SHUNT DEPENDS ON RATIO OF SYSTEMIC TO PULMONARY VASCULAR RESISTANCE

UPTO 70% OF LV OUTPUT CAN BE SHUNTED

RA AND RV PRESSURES DEPEND ON THE MAGNITUDE OF SHUNT

CK CHD

CLINICAL MANIFESTATIONS ASYMPTOMATIC PHYSICAL GROWTH RETARDATION RECURRENT LOWER RESPIRATORY

INFECTION CONGESTIVE CARDIAC FAILURE WIDE PULSE PRESSURE PROMINENT PRAECORDIUM HEAVING APICAL IMPULSE SYSTOLIC OR CONTINUOUS THRILL IN

SECOND LEFT SPACE

CK CHD

THRILL IS MAY RADIATE TO LEFT CLAVICLE, LEFT STERNAL BORDER, APEX

CONTINUOS MACHINARY MURMER IN SECOND LEFT SPACE, RADIATES TO LEFT CLAVICLE OR DOWN THE STERNUM. STARTS AFTER FIRST SOUND, ENDS VARIABLY IN DIASTOLE

DIASTOLIC COMPONENT SOFT WITH PULM HYPERTENSION

MITRAL DIASTOLIC FLOW MURMER

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COURSE AND TREAT MENT MAY CLOSE IN INFANCY ASYMPTOMATIC CONGESTIVE FAILURE INFECTIVE ENDOCARDITIS EMBOLIC MANIFESTATION

SURGERY