34. Congenital heart disease with left to right shunt.

Question 1

Congenital heart diseases with left to right shunt

Answer 1

PDA

VSD

ASD

Question 2

VSD

Answer 2

• acyanotic, left to right
• small: Often asymptomatic, but with loud murmur
• moderate to large: Pulmonary overcirculation and HF
• asymptomatic at birth (pulm. vasc. resitance still high)
• SOUND: Pansystolic murmur p.m. lower left sternal border
• IMAGING: ECG and chest x-ray, echo
• TREATMENT:
  
  • 1/3 close spontaneously
  • diuretics, digoxin to reduce afterload
  • surgery or catheterization

Question 3

ASD:

Answer 3

• CLINIC:
  
  • infants are rarely symptomatic
  • systolic ejection murmur
  • fixed split S2
• IMAGING:
  
  • ECG and x-ray show increased blood flow
• TREATMENT:
  
  • medical maagement is rarely indicated
    
    • if shunt after 3 years closure
  • catheter closure device or surgical closure

Question 4

PDA

Answer 4

• ductus allows blood to flow from the pulmonary artery to the aorta
• CLINIC:
  
  • depends on the amount of pulm. blood flow
  • magnitute depends on the size of the PDA
  • small = asymptomatic
  • moderate/large = heart failure symptoms
  • continuous machine-like murmur
• TREATMENT:
  
  • spontaneous closure after a few wks. uncommon
  • moderate & large shunts may be managed with diuretics
  • coil embolization
  • PDA-closure device