Mod13 CHD Flashcards
Congenital Heart Disease (CHD)
defect in embryogenesis of the heart that may be severe enough to alter cardiac function
Anatomical defect usually results from:
altered embryonic development of normal structure
failure of such a structure to progress beyond early stage of embryonic or fetal development
Exposure of these during critical period are RFs for CDH
anticoagulant Warfarin
Anticonvulsive trimethadione
chronic alcohol abuse
infection with rubella
Congenital defects allow survival into adult life if:
lesion is mild
multiple lesions counterbalance each other
compensatory mechs take place
lesions have had intervetions (surgery/catherterization)
Cyanotic CDH
defect that allows blood low in O2 to be shunted from R-L side of heart, bypassing lungs for re-oxygenation; results in baby’s skin having blue tint
Common Cyanotic Lesions
tetralogy of Fallot
transposition of the great arteries
Ebstein’s anomaly (intermittent cyanosis)
Eisenmenger’s syndrome
Common Acyanotic lesions
atrial septal defect (ASD) ventricular septal defect (VSD) Atrioventricular septal defect Patent Ductus arteriosus congential aortic stenosis pulmonic stenosis coarctation of aorta (dissection)
Atrial Septal Defect (ASD)
opening in the interatrial septum that remains after birth; causing predominantly L-R shunting
3 main types of ASD
Ostium Secundum (70%) Ostium Primum (20%) Sinus Venosus (10%)
Ostium Secundum (type of ASD)
occurs where there is inadequate dev of septum primum and/or septum secundum
Ostium Primum (type of ASD)
occurs when the septum primum in unable to fuse with endocardial cushions
Sinus Venosus (type of ASD)
occurs when sinus venosus is not completely absorbed in RA; usually found along with anomalous drainage of pulmonary veins
Patent Foramen Ovale (PFO)
when fusion of atrial septa fails; extremely common type of ASD (25%); 40% of patients with ischemic stroke also have PFO
Signs and Symptoms of ASD
heart murmur exertional dyspnea fatigue atrial arrhythmias lower respiratory tract infections ***may spontaneously close in first 5 years of life
Diagnosis of ASD
Colour doppler interrogation with Echo or TEE; can see saline bubbles crossing interatrial septum
Treatment of ASD
Surgical treatment with pericardial or Dacron patch; transcatheter closure
Ventricular Septal Defect (VSD)
common opening in interventricular septal wall (divides LV and RV) which results in L-R shunting of blood
5 types of ventricular septal defects
Perimembranous (most common)
Trabecular (2nd most common)
Inlet: associated with atrioventricular septal defects
Outlet: associated with aortic regurgitation
Malalignment- tetralogy of Fallot
Formation of VSD
deficiency of growth/failure of alignment or fusion of the ventricular muscle septum
signs/symptoms of VSD
large VSD show early signs of HF, tachypnea, poor feeding, frequent respiratory tract infections and cyanotic
Diagnosis of VSD
harsh holosytolic murmur; colour doppler interrogation with TEE or TTE
Treatment of VSD
surgical treatment with pericardial or Dacron patch or transcatheter closure
Atrioventricular septal defect
spectrum of defects that occur in the embryonic endocardial cushions which can affect the atrial and ventricular septa and parts of atrioventricular valves
3 types of atrioventricular septal defects
partial, complete and incomplete
partial atrioventricular septal defect
ostium primum ASD and cleft mitral valve
Complete atrioventricular septal defect
ostium primum, inlet type VSD, common AV valve
Incomplete atrioventricular septal defect
two AV valve orifices, LV and RA shunt, trileaflet cleft mitral valve
Signs and Symptoms of Atrioventricular septal defect
associated with HF, cyanosis, and Eisenmenger’s syndrome
Treatment of Atrioventricular septal defect
closure of ASD or VSD
Repair of AV valve
Patent Ductus Arteriosus (PDA)
persistence of fetal connection of the aorta to the pulmonary artery which is supposed to begin to close within few hours after birth; common in infants whose mothers contacted rubella, who are premature and who are born at high altitudes; will see blood shunting from aorta into pulmonary vascular beds
Formation of Patent ductus arteriosus
normally, due to sudden increase in O2 tension and decrease in protaglandins at birth the ductus will close; when it fails it results in abnormal L-R shunting of blood btw systemic and pulmonary vascular beds
Role of Ductus arteriosus
diverts blood flow away from high resistance pulmonary circuit and into descending aorta
Amount of O2 blood shunted from aorta into pulmonary artery determined by:
cross-sectional area and length of ductus
relative resistance of pulmonary and systemic vasculatures
signs and symptoms of patent ductus arteriosus (PDAs)
HF, Tachycardia, poor feeding, slow growth; may be cyanotic in presence of pulmonary vascular disease
will feel fatigue, dyspnea, respiratory tract infections and palpitations
Diagnosis of PDA
continous murmur; doppler colour interrogation with echo
Treatment of PDA
ligration division or placement of clip on ductus
transcatheter closure with an occlude, coil or plug
Congenital Aortic Stenosis
narrowing of aortic valve orifice from abnormal development of valve
Signs and symptoms of Congenital aortic stenosis
dependant on severity; HF can cause tachycardia/pnea, and poor feeding
as it worsens: exertional dyspnea, angina, syncope, soft A2, systolic ejection murmur
Diagnosis of congenital aortic stenosis
harsh crescendo-decresendo systolic ejection murmur; but echo is always the best tool
Treatment of congenital aortic stenosis
valvuloplasty
valve replacement
Congenital pulmonic stenosis
obstruction of blood flow from RV to main pulmonary artery during systole; at level of valve, surpravalvular or subvalvular
Diagnosis of congenital pulmonic stenosis
pulmonic ejection click; echo is most useful tool to determine severity, morphology of valve and extent of compensatory mechs
Treatment of congenital pulmonic stenosis
valvuloplasty
valve replacement
***same as aortic stenosis
Coarctation of Aorta
constricted segment in aortic lumen; associated with Turner’s Syndrome; majority of patients also have Bicuspid Aortic valve (50-80%)
Three types of Coarctations (based on location of narrowing in relation to ductus arteriosus)
Preductal: proximal of ductus
Postductal: distal to ductus
Juxtaductal: adjacent to ductus
Preductal Coarctation formation:
occurs when there is decrease in blood flow through left side of heart during fetal development (causing underdeveloped aorta); will see cyanosis if they have preexisitng PDA
Postductal coarctation formation:
caused my muscular tissue extending into aorta during fetal development which later constricts
Diagnosis of Coarctation
diagnosed by difference in 15-20mmHg or greater in systolic BP in right arm vs right leg; echo is still best tool
treatment of aortic coarctation
bypass tube graft
dacron graft/patch repair
surgical resection
