Frequency of congenital heart

diseases in Tuschinskaya

Children’s hospital from the year 2000 to

2009

Classification of congenital cardiac defects

Left to right shunts

Right to left shunts

Obstructive lesions

Mixing

•Ventricular septal defect•Atrial septal defect•Atrioventricular septal defect•Patent ductus arteriosus

•Tetralogy of Fallot•Transposition of great arteries•Tricuspid atresia

•Aortic stenosis•Pulmonary stenosis•Coarctation of aorta

•Truncus arteriosus•Total anomalous pulmonary venous return•Hypoplastic left heart syndrome

The worldwide incidences of different types of congenital heart diseases

VSD=Ventricular Septal DefectASD=Atrial Septal DefectAVSD=Atrioventricular Septal DefectTOF=Tetralogy of FallotCOA=Coarctation of AortaPS=Pulmonary StenosisPDA=Patent Ductus ArteriosusAS=Aortic Stenosis

TGA=Transposition of Great ArteriesTAPVR=Total anomalus Pulmonary Venous ReturnHLV=Hypoplastic Left Heart

Aim of the study

To find out the frequency and types of congenital heart diseases in newborns in Tuschinskaya Children’s Hospital from the year 2000 to 2009

Study Design There are total 2582 newborns admitted

in Tuschinskaya Children’s Hospital from the year 2000 to 2009

The number of newborns with congenital Heart diseases => 113

Frequency of congenital heart diseases in newborns in Tuchinskaya Childrean’s

Hospital from 2000 to 2009

Difference in frequency of congenital heart diseases between boys and girls

Different types of Congenital Heart Diseases within 10 years in

Tuschinskaya Children’s Hospital All newborns with congenital heart diseases =

113 patients (a) Septal Defects in all years =

108 patients(95.6%) Atrial septal defects ( open foramen ovale) = 85

patients(75.2%) Atrial septal defects

=11 patients(22.1%) All atrial septal defects

=91 patients(80.5%) Ventricular septal defects

=25 patients(13.2%) Atrioventricular septal defects =15

patients(9.7%)

(b)Non-spetal defects in all years= 23 patients(20.3%)Patent ductus arteriosus = 13

patients(11.5%)Tetralogy of Fallot = 1

patients(0.88%)Aortic stenosis = 1

patients(0.88%)Hypoplastic left ventricle = 1

patients(0.88%)Septal aneurysms = 3

patients(2.6%)Cardiac Rhabdomyoma = 1

patients(0.88%)Truncus arteriosus = 1

patients(0.88%)Syndromes =3

patients(2.6%)

 

Types of congenital heart diseases in newborns

in Tuchinskaya Children’s hospital from the year 2000 to 2009

In ASD, small defects = <5mm (diameter) Medium defects = 5-8mm (diameter) Large defects = >8mm ( diameter) Small to moderate sized ostium

secundum septal defects =>spontaneous closure or reduction in size =>no medical intervention is needed.

Such patients should be followed until age 3-4 years then =>consider either device use or surgical closure.

No specific medications

There are only 3 patients with congenital heart diseases who presented Heart Failure (3.5%)

They are _1.2 newborns with Open ductus arteriosus and2.A newborn with Truncus arteriosusIf patients with congenital heart diseases develop

heart failure, oxygen, diuretics (frusemide, spironolactone, ACE inhibitors,

thiazides) and digoxin can be givenDigoxin dose=> 0.05mg/kg for 3 days After 3rd day, if the pulse is normal full dose/5 is

givenIf Bradycardia (+), 1/6-1/7 from full dose is givenIf Tachycardia (+), ¼ from full dose is given

Clinical pictures of congenital heart diseases Left to right shunts => Frequent chest infections => Tendency to develop congestive heart failure(Tricuspid or mitral delayed diastolic

murmur) => No cyanosis Right to left shunts => Cyanosis => polycythemia, clubbing Ejection systolic murmur (1) Cyanosis with normal or decreased pulmonary pressure=> moderate to severe

cyanosis (2) Cyanosis with increased pulmonary pressure => mild cyanosis=>irreversible

pulmonary hypertension Obstructive lesions => Heaving cardiac impulse <= concentric

hypertrophy of the ventricles (Without Cardiomegaly) =>No Frequent chest infections , no cyanosis Ejection systolic murmur

Investigations for Congenital Heart Diseases

1. Chest X Ray => Size and shape of the Heart

=> Pulmonary complications

2. Electrocardiogram => state of atriums and ventricles

=> Pulmonary Hypertension +/_

=> Rhythm abnormalities +/_

3. Echocardiogram => Type and size of the lesions

=> Associated lesions +/_

4. Cardiac catheterization => Detailed abnormal anatomy

5. Angiography => Detailed abnormal anatomy

Treatment Options For Congenital Heart Diseases

Treatments depend on =>Type , Size , Severity of lesions

=>Associated lesions +/_

=>Complications (Pulmonary hypertension,

Heart failure, Arrhythmias) +/_ Medical Treatments =>Nutrition

=>Treatment of associated anemia or infections

=>prevention of Infective Endocarditis

=>Treatment of complications Surgical Treatments=> Options depend on Type, size , severity ,

(+/_) of complications, Age of the Patient Palliative or Corrective Surgery

Cardiac Catheterization=> Minimal

Invasive Treatment

A case of newborn with Atrioventricular septal defect with patent ductus arteriosus in the Intensive care Unit of Tuschinskaya

Children’s Hospital(03.03.2010 to 21.03.2010)

10 days old boy- birth weight 2540g , body length 49cm was admitted in neonatal intensive care unit of Tuschinskaya Children’s Hospital from 03.03.2010 to 21.03.2010 (18 days)

Diagnosis => Congenital heart Disease( Atrioventricular septal defect and pulmonary hypertension ) with Heart Failure (Grade II) and also associated with Dawn’s syndrome and polydactaly.

Mother is 34 years old and had medical and gynecological problems such as chronic cholecystitis, arterial hypertension, adnexitis, uterine erosion.

Clinical Features General condition of the child after birth is poor(serious) Systolic murmur was heard on the 1st day of life Meconium aspiration syndrome (+) and initially treated by suction with endotracheal intubation

Investigations

Investigations include Blood analysis, Chest X ray, Electrocardiogram(ECG), and Echocardiogram

Chest X ray( 21.03.2010) ,

right sided pneumonia with

atelectasis , Congenital Heart

disease and Cardiomegaly

was diagnosed

Electrocardiogram (ECG) Sinus tachycardia and acute P wave

demonstrating the right atrial hypertrophy

Left axis deviation in V5 and V6 demonstrating the right ventricular hypertrophy

Echocardiogram In Echocardiogram(05.03.2010),

Atrioventricular septal defect is diagnosed and Atrial septal defect is more significant.

In the Echocardiogram(16.03.2010) blood flow through the ASD is noted.

Pulmonary artery _ 12mm Patent Ductus arteriosus_3mm

the aorta arising from the left

ventricle and the pulmonary

trunk from the right ventricle

with aorto-pulmonary

communication which is

demonstrating feature of

atrioventricular septal defect.

Ineffective functioning of the valves during systole.

Management in Intensive Care Unit (ICU)

Monitoring The patient was monitered by_ 2 Hourly Blood pressure, Hourly Pulse Rate,Respiratory

Rate,Temperature, and SaO2 Hematocrit, Hemoglobin(Hb), pH,

PCO2, PO2 are also monitored

Treatment Nutrition -Frisopre 40ml 7 times=280 ml/day

Infusion Therapy-Fluid Volume => 121 ml/kg/day (2.5kg)

20% Glucose - 15ml 10% Aminoven infant - 5ml 4% KCL - 5ml 10% Ca-gluconate - 4ml Genapin(200units) - 4ml Rate=> 1,5 ml per hour

Antibiotic Treatment IV Maksicef(MgSO4) 150mg (1,5ml) .. 2 times/ day IV Angesin 40mg (0.8ml) + 5% glucose (4.2ml ) .. 3

times/ day IV Diflucan 26mg (13 ml) .. 1 time per day Treatment for heart failure

IV Digoxin 0,001% … 0.5 ml .. 2 times per day

Conclusion From the year 2000 to 2009, the medium frequency of

congenital heart diseases in newborns in each year is 4% .

It is found that septal defects(95.6%) are more common than non-septal defects(20.3%) and there are newborns with both septal and non-septal defects(15.9%).

Among the defects, atrial septal defects are the commonest form (80.5%) and ventricular septal defects are the second commonest ( 13.2%).

2.8% of newborns with congenital heart diseases are associated with Syndromes.

Patients are treated medically to relieve symptoms and to be ready for proper surgical treatment.