Congenital Heart Defects

Question 1

What are congenital heart defects?

Answer 1

conditions present from birth, presenting as structural abnormalities

Question 2

What are the 2 categories of congenital cardiac defects?

Answer 2

• cyanotic
  
  • right to left
• acyanotic
  
  • left to right

Question 3

What syndromes can be associated with congenital cardiac defects?

Answer 3

• Down syndrome
• Turner syndrome
• Ehlers-Danlos syndrome
• Marfan syndrome
• DiGeroge syndrome
• Williams syndrome
• Noonan syndrome
• Holt-Oram syndrome
• Alagille syndrome

Question 4

What is a ventricular septal defect?

Answer 4

• congenital heart defect
  
  • VSD
• abnormal opening in the septum
  
  • between ventricles
  • blood flow between ventricles
  • mix of oxygenated and deoxygenated

Question 5

What features of a ventricular septal defect affect the severity?

Answer 5

• size of the defect
  
  • larger allows for greater blood flow
• location of defect
  
  • can involve other structures
    
    • other than the septum
• presence of multiple defects
  
  • compound effect
• level of construction
  
  • pressure in vessels

Question 6

How can ventricular septal defect be managed?

Answer 6

• dependent on size, location and symptoms
• small defects
  
  • may close spontaneously
  • monitoring and observation
• large defects
  
  • surgical intervention
    
    • transcatheter
    • open heart surgery
• medications
  
  • management of symptoms
    
    • breathing difficulties
    • fluid build up
• lifestyle modifications
  
  • avoid strenuous physical activity
  • reduce strain on heart

Question 7

What is infective endocarditis?

Answer 7

• infection of the endocardium, including the heart valves, through micro-organisms in the bloodstream
  
  • microbes adhere to damaged areas

Question 8

What is the incidence of infective endocarditis in dentistry?

Answer 8

2-5%

Question 9

What patients are at an increased risk of developing infective endocarditis?

Answer 9

• prosthetic heart valves
• previous experience of IE
• congenital heart disease
• mitral valve prolapse
• history of cardiac surgery

Question 10

What patients are most at risk of infective endocarditis and there fore require non-routine management?

Answer 10

• prosthetic heart valve patients
• previous endocarditis
• cyanotic congenital heart disease
• complex congenital heart disease
• surgically corrected congenital heart disease
  
  • with residual defects
• cardiac transplant patients

Question 11

Which patients with cardiac conditions are not at risk of infective endocarditis?

Answer 11

• simple congenital heart defects
  
  • successfully repaired
• minor valve abnormalities
• hypertension
• coronary artery disease
• pacemakers without valvular involvement

Question 12

What guidelines are available surrounding infective endocarditis and what are the recommendations for dental treatment?

Answer 12

• NICE guidelines
• patients not at increased risk
  
  • not prescribed antibiotic prophylaxis
• patients at increased risk
  
  • considered for antibiotic prophylaxis
  • assessment of patient
  • consultation with cardiologist
  • patient aware of risks
  • prevention advice

Question 13

What are the clinical features of infective endocarditis?

Answer 13

• fever and sweating
• fetigue
• heart murmur
• joint and muscle pain
• weight loss

Question 14

Provide examples of acyanotic congenital heart defects

Answer 14

• ventricular septal defects
• patent ductus arterioles
• pulmonary stenosis
• atrial septal defect
• coarctation fo aorta
• aortic stenosis

Question 14

Why might a patient with congenital heart defects be on an enhanced prevention plan and what would this involve?

Answer 14

• to reduce the risk of caries and infection
  
  • minimises need for invasive treatment
• personalised toothbrushing advice
• regular appointments to monitor OH
• fissure sealants
• fluoride varnish
• delivery of high fluoride toothpaste

Question 15

Provide examples of cyanotic congenital heart defects

Answer 15

• tetralogy of fallot
• transposition of great arteries

Question 16

What is tetralogy of fallot and how is it managed?

Answer 16

• consists of 4 cardiac features
  
  • ventricular septal defect
  • pulmonary stenosi s
  • over-riding aorta
  • right ventricular hypertrophy
• definitive surgical treatment

Question 17

What are possible dental implications of congenital heart defects?

Answer 17

• increased risk of enamel hypoplasia
• hypodontia associated with conditions
  
  • Down syndrome
• increased bleeding tendency
  
  • warfarin
  • aspirin
• care with adrenaline in local anaesthetic
• higher risk with general anaesthetic
• increased risk of infective endocarditis
  
  • results from oral bacteraemia

Question 18

What procedures are considered invasive when considering patients at risk of infective endocarditis?

Answer 18

• placement of matrix bands
• placement of sub gingival dam clamps
• sub gingival restorations including fixes pros
• endodontic treatment before apical stop
• preformed-metal crowns
• full periodontal examinations
• sub-gingival PMPR
• incision and drainage of abscess
• dental extractions
• surgery involving raising a flap
• placement of dental implants
• uncovering subimplant structures

Question 19

What procedures are considered non-invasive when considering patients at risk of infective endocarditis?

Answer 19

• infiltrations or block local anaesthetic
• BPE screening
• supra-gingival PMPR
• supra-gingical restorations
• supra-gingival orthodontic bands/separators
• removal of sutires
• radiographs
• placement/adjustment of ortho/RPDs