It 3 - Penyakit Jantung Bawaan - Ria
-
Upload
kemalaandini -
Category
Documents
-
view
223 -
download
0
description
Transcript of It 3 - Penyakit Jantung Bawaan - Ria
-
Structures of the heart
-
Normal Heart
-
Atrial Septal defect( ASD )Insidence : + 10 % : ratio = 1,5 to 2 : 1Anatomy : Defect on foramen ovale : Secundum ASD Defect at SVC and RA junction: sinus venosus ASD Defect at ostium primum : primum ASD
-
ANATOMY
-
ASD
-
Atrial Septal DefectDiagram of ASD
-
Clinical FeaturesSymptomsMost infants : asymptomatic ..undetectedThe first present at age 6 to 8 weeks with a soft murmur and possibly a fixed and somewhat widely split S2Infant with large ASD may present with poor growth, recurrent lower respiratory tract infection and heart failure
-
LALVRVRAPAAOSystemicLungsQp > QsAtrial septal defect
-
RARVLALVRARVLALVAtrial septal Defect
-
Atrial Septal DefectAuscultation :1st HS N or loudwidely split and fixed 2nd HS Ejection Sistolic Murmur
-
Atrial Septal DefectDiagnosis Differential
Primary Atrial Septal DefectECG : LADPartial Anomalous Pulmonary Vein DrainagePulmonary StenosisInnocent Murmur
-
Atrial Septal defect
ManagementSurgery : Preschool ageRecent treatment: transcatheter closure using ASO (Amplatzer septal occluder)
-
ASDSmall ShuntLarge ShuntObservationEvaluationAt age 5-8 yrsCathFR1.5ConservativeInfantsChildren/AdultsHeart Failure (-)Heart Failure (+)Age >1yrsW >10kgTranscatheter closure (Secundum ASD) /Surgical Closure(other tipe of ASD)ConservativeAnti failureFailSuccessPH (-)PH (+)PVD (-)PVD (+)HyperoxiaReac-tiveNonreactiveSurgicalClosure
-
Transchateter closure of ASD
-
Atrial septal defect
-
Ventricular septal defectInsidence 20 % of all CHD No sex influencedAnatomy Subarterial defect : below pulmonary andaortic valve Perimembranous defect: below aortic valve at pars membranous septum Muscular defect
-
VSD
-
SystemicLungsQp > QsVentricular Septal defect
-
LA
LV
RV
RA
PA
AO
-
RARVRALALARVLVLVVentricular septal defect
-
Ventricular Septal DefectClinical findingsDay 1st after birth: murmur (-)After 2-6 weeks : murmur (+)Murmur : pansystolic grade 3/6 or higher at LSB 3 Small muscular defect: early systolic murmurSignificant defect: Mid diastolic murmur at apex
-
Small VSD Large VSD Ventricular Septal DefectMurmur: pansystolic grade 3/6 or higher at LSB 3
-
Ventricular Septal DefectCardiomegalyApex down wardProminence pulmonary artery segmentIncreased pulmonary vascular marking
-
Ventricular septal DefectDiagnosis Differential
PDA with PHTetralogy Fallot non cyanoticInoscent murmur
-
Ventricular septal defectManagement:
Definitive : VSD closure Surgery Transcatheter closure
- DSVHeart failure (+)Heart failure (-)Anti failureFailSuccessPABEvaluate in 6 mthsSurgical closure/Transcatheter closureAortic valve prolapsInfundibular stenosisPHSmallerSpontaneousclosureCathPVD(-)PVD(+)CathCathReactiveNon-reactiveConservativeFR>1.5FR
-
Patent Ductus Arteriosus Anatomy
Fetus: ductus arteriosus connects PA and aorta
If ductus does not closs Patent Ductus arteriosus
-
PDA
-
RARVLALVRALARVLVPatent Ductus Arteriosus
-
LALVRVRAPAAOSystemicLungsQp > QsPatent Ductus Arteriosus
-
PDA is more common in : Premature infants BW < 1750 g : 45% BW < 1200 g : 80% Genetic abnormalities Infants whose mother had German measles (Rubella)PDA in preterm haemodynamic instability co-morbidity & mortality EARLY DIAGNOSIS
-
Patent Ductus ArteriosusClinical findings
Small defect: Symptom (-) Growth and development normalModerate and large defect:Decreased exercise tolerantWeigh gained not goodFrequent URTI
-
DIAGNOSIS
-
Patent Ductus ArteriosusAuscultation : continuosus murmur at upper LSB 2
-
Chest X-RayLarge PDA:Prominence of the left atrium,left ventricle, ascending aorta,Pulmonary vascular marking
-
ECGSmall PDA : normalModerate PDA : LVHLarge PDA : BVHPDA with PVOD : RVH
-
Patent Ductus ArteriosusDiagnosis DifferentialAP-windowArterio-venous fistulae
Management premature: ibuprofenPDA closure : surgery transcatheter closure
-
MANAGEMENT
Medical treatment : prostaglandin synthesis inhibitorPreterm neonates : usefullAterm neonates : useless
Transcatheter closure : mostly choice treatment
Surgical closure :Infant < 5 kg with large PDAPreterm neonates : medical treatment unsuccessful or contraindicated
-
PDA IN PRETERM NEONATESSpecial problem : haemodynamic instability
Treatment should be started as soon as PDA suspected Once a significant shunt is present increased pulmonary blood flow damage to premature lungs
PDA can be closed with prostaglandin synthesis inhibitors
-
TRANSCATHETER CLOSURE *Transcatheter occlusion is effective with a high rate of complete occlusion
*Complication rare
-
Tetralogy FallotIncidence5-8% from all CHD
AnatomyCause: Left-anterior deviation of infundibular septum
Sindroma consist of 4 items: VSD pulmonary stenosis aortic over-riding RVH
-
Tetralogy Fallot
-
Central cyanosis
-
Central cyanosis
-
PathophysiologyCyanosis is a bluish discoloration of the skin and mucous membranes resulting from an increased concentration of reduced hemoglobinClinical cyanosis occurs when the amount of reduced hemoglobin in the cutaneous vein may result 5 g/100mlThe critical level of reduced hemoglobin in the cutaneous vein may result from either desaturation of arterial blood or increased extraction of oxygen by peripheral tissue
-
Cardiac causes of cyanosisInadequate pulmonary blood flow (severe cyanosis)Tricuspid atresiaPulmonary atresiaTetralogy of Fallot
Independent pulmonary and systemic circulation (severe cyanosis)Tranpose great artery
Mixing (moderate cyanosis)Truncus arteriosus
-
Diagnosis
Clinically : cyanosis Single 2nd HS, ejection systolic murmur
X Ray : Boot ShapedECG: RAD, RVH
-
Tetralogy FallotSingle 2nd HS, ejection systolic murmur
-
CXR : Boot-shapedConcave pulmonary segmentApex upturnedDecreased pulmonary blood flow
-
Tetralogy FallotECG : RAD, RVHEchocardiography : to confirm diagnosis
-
Tetralogy FallotDiagnosis Differential Pulmonary Atresia Double outlet right ventricle and pulmonary stenosis Transposisi of great arteri and pulmonary stenosis
Management Paliative treatment: Blalock-Taussig shunt Definitive: total correction
-
Tetralogy of Fallot< 1 yr> 1 yrspell (+)spell (-)propranololfailedsucceedBTStotal correction cathsmall PAgood sized PA clinically ECG CXR echoage 1 yrcathBTS/PDA Stentevaluation