Congenital Heart Disease Flashcards
What are the different morphological features of the ventricles?
RV - Trabeculated endocardium, insertion of chordae to IVS, moderator band.
LV - Smooth endocardium, ellipsoid cavity
(CHD are becoming more common as people are surviving longer. 3000 per million)
Describe features of atrial septal defects
- Secundum ASD is the most common. Others include superior sinus venous defect, inferior sinus venous defect, coronary sinus defect and primum atrial septal defect (partial)
- In secundum ASD: Blood shunts from high pressure left side to the right side cause right heart volume loading. It may present with a pulmonary flow murmur and a fixed, split second heart sound.
A secundum ASD may lead to what?
- Right ventricular failure,
- Tricuspid regurgitation
- Atrial arrhythmias
- Pulmonary hypertension
- Eisenmenger syndrome (blood vessels become stiff and narrow)
Describe features of ventricular septal defects
- Can have multiple and if haemodynamically significant in early life it can cause pulmonary vascular disease.
- Left to right shunt which can cause left heart loading volume. Can present with a pansytolic murmur or no murmur.
A VSD can lead to?
LV failure,
aortic valve regurgitation,
RV outflow tract obstruction,
arrhythmias,
pulmonary hypertension,
Eisenmenger syndrome.
Describe features of Coarctation of the Aorta
- Tends to form after after the subclavian artery in a juxta-ductal position
- Can cause upper body hypertension, berry aneurysms, claudication and renal insufficiency.
- Associated with a bicuspid aortic valve and accelerated coronary artery disease
- Rib notching may be present on CXR due to retrograde flow
Explain the treatment of coarctation of the aorta
- Surgical repair via thoracotomy: Subclavian flap, end to end repair or jump graft
What are the four defects seen in tetralogy of fallot?
- Ventricular septal defect,
- Overriding aorta (aorta sits above the VSA),
- Right ventricular outflow tract obstruction,
- Right ventricular hypertrophy
What is the surgical treatment of TOF?
- BT shunt,
- Complete repair (offered at one year, fixes the VSD and overriding aorta)
What are some of the complication of a tetralogy of fallot?
- Pulmonary regurgitation which can result in right ventricular dilatation +/- dysfunction.
- Arrhythmias due to excess scarring tissue from previous surgeries. Particularly VT.
- Pulmonary arterial/branch PA stenosis
Describe features of transposition of the great arteries
- Cyanotic lesion where the two great arteries have swapped so aorta comes of RV and pulmonary artery comes off left ventricle.
- Identified in utero as it is incompatible with life. - - Can use prostaglandins to maintain the ductus arteriosus which allows for mixing of blood until a repair can be done.
Explain the foetal circulation
- Oxygenated blood is delivered by maternal placenta.
- Pulmonary circulation is minimal and at high resistance.
- Instead oxygenated blood is delivered via IVC to right atrium and then by-passes foetal lungs via foramen ovale into left ventricle.
- Any oxygenated blood pumped into pulmonary artery usually passes into the aorta via ductus arteriosus
What is the treatment for great transposition of the arteries?
Arterial switch which ensures the left ventricle is responsible for systemic circulation. Complications with coronary arteries can occur
Describe features of a univentricular heart
- Rare defect where there is only one functioning ventricle. Therefore it is reliant of the mixing of deoxygenated and oxygenated blood.
- Treatment is surgery, main aim will be to create two ventricles but if not then fontan circulation is created.
What is a fontan circulation?
The IVC and SVC are directly plumped into the pulmonary arteries bypassing the heart all together so the one ventricle is used solely for systemic circulation
