Congenital Heart Disease Flashcards
Ventricular septal defect =
One or more openings in the inter-ventricular septum, allowing a blood shunt from the left ventricle to the right ventricle
Locations of the VSD =
- membranous
- trabecular=muscular
- infundibular=outlet=conal
- inlet septum=atrioventricular canal type
VSD symptoms:
The smaller the shunt , the less likely the symptoms and signs. Symptoms and signs : Exertional dyspnea Heart failure Pulmonary infection Cyanosis
Signs of VSD :
Essential :
Protosystolic/ holosystolic harsh murmur (centrifugally radiated over anterior chest)
+/- lower left parasternal thrill
Optional:
apical mid diastolic murmur( large volume shunt )
Early diastolic aortic regurgitation murmur
Central cyanosis & Clubbing appear after 10 years ( indicate Eisenmenger syndrome)
VSD on ECG:
- normal in small VSD
- LVH +/- LAH in moderate
- biventricular Hypertrophy -/+ left atrial hypertrophy in large VSD
- RVH in VSD complicated by Eisenmenger syndrome
Some facts about VSD :
- small muscular VSD in child probably will close spontaneously
- large VSD complicates early by heart failure
Management of VSD :
- treatment of HF
- prevention of endocarditis
- closure device for membranous VSD with left to right shunt
Surgical treatment of VSD:
- emergency surgery in case of HF in small child
- elective surgery when pulmonary to systemic output ratio Qp/Qs>1.6
Contraindication for surgery in VSD :
Pulmonary resistance / systemic vascular resistance >0.5
Complication of surgery in VSD :
Rezidual shunt
3rd degree AVblock
RBBB
Patent ductus arteriosus=
Absence of the physiologic obliteration of the ductus arteriosus, soon after birth. This ductus lays between the descending thoracic aorta and the proximal left pulmonary artery branch
Management of PDA :
- The arterial ductus closure in infants is tempted using INDOMETHACIN.
- Closure device
- prophylaxis of the infective endocraditis
Surgical treatment of PDA:
Indication -> any PDA as long as Qp/Qs> 1.5 and the pulmonary vascular resistance lowers during vasodilator administration
Contraindication for surgical treatment of PDA:
1) Eisenmenger syndrome
2) any cardiac anomaly whose survival is critically dependent on the patency of PDA
Complications of surgical treatment of PDA :
Left recurrent nerve damage
Phrenic nerve damage
Residual shunt
Late repermeabilisation
Congenital heart diseases whose survival depends critically on the permeability of the arterial ductus :
1) pulmonary atresia with intact interventricular septum
2) severe pulmonary stenosis
3) severe aortic coarctation
4) left heart hypoplastic syndrome
5) transposition of the great arteries with intact septae
Tetralogy of Fallot =
The combination of pulmonary stenosis , large membranous VSD , overriding aorta ( misplaced) and RVH
Symptoms of TeF:
-cyanosis at birth
-dyspnea upon exertion “hypoxic spell”
Triggered by feeding, crying, defecation , physical exercise.
**the child learns to alleviate the hypoxic spell by “squatting” position.
Signs of Tef:
Essential: Central cyanosis Clubbing Upper left parasternal systolic ejectional murmur -/+ systolic thrill Single second heart sound Optional: PDA murmur
ECG on TeF:
RVH , RAD, -/+ RAH
ChXR and Echocard.:
CXR= normaly sized cardiac silhouette, “coeur en sabot”, lower right cardiac border bulging , sparse pulmonary vascular markings Echo= large, nonrestrictive VSD, infundibular pulmonary stenosis , aortic root overriding the IVseptum, RVH
Management pf TeF:
For infants who cannot do the sqautting position , parents have to place the baby on his side and raise his knees to the chest then call 112
Hospital: O2, Ketamine , propanolol , morphine and sodium bicarbonate. Antibiotic prophylaxis against infective endocarditis
Surgical treatment of TeF :
1) palliative surgical shunt to increase pulmonary blood flow
2) definitive correction
Complications of surgical treatment of TeF :
Periooperative bleeding in adults Pulmonary regurgitation RBBB 3rd degree AVB Residual shunt at the VSD closure level
Pulmonary stenosis=
Reduction of the cross section area of any of the segments of the pulmonary infundibulum or of the pulmonary artery trunk or its branches.
Normal pulmonary valve opening area is > 2cm2 /m2
Classification of pulmonary stenosis:
1) valvular ps ( most common)
2) subvalvular ps
3) supravalvular ps
Sympt. And signs of PS:
Sympts:
*the larger the PS the less likely the symptoms
Exertional dyspnea , chest pain and cyanosis
Signs:
*newborn with severe PS may be cyanotic
* other babies have the normal skin tint
* lower left parasternal ejection click
* harsh upper parasternal systolic murmur
ECG and CXR of PS:
ECG:
RVH, RAH, may also be LVH
CXR:
RVH, RAH , post stenotic dilation of the pulmonary artery branches , diminished pulmonary vascular markings .
TTEcho. Of PS :
Valvular ps:
“En dome “ opening of the dysplastic valve
Post stenotic dilatation of the pA branches
RVH, peak transvalvular systolic pressure
Management of PS:
- in newborn with sever PS , the PDA must be kept open , until the urgent surgical correction is done
- endocarditis prophylaxis
- physical exercise is restricted in severe PS
Surgical treatment of PS :
Indications :
a) valvular PS with peak pressure gradient >80mmhg
b) non valvular PS
