Revision 3: Congenital heart disease

Question 1

freq. of congenital heart diseases and most common types

Answer 1

they are common -> 6-8/1000 births

the most common types are VSD, then ASD

Question 2

Congenital heart defects

Answer 2

acyanotic: ASD, PFO, VSD, PDA (although a PDA can lead to Eisenmerger syndrome, which leads to cyanosis), co-arctation of aorta
cyanotic: tetralogy of Fallot, tricuspid atresia, transposition of great arteries, hypoplastic left heart

Question 3

Atrial septal defects

Answer 3

gap in intra-atrial wall allows blood through l -> r, ACYANOTIC

most common site is at the foramen ovale -> ostium secundum ASD

• a less common site is the inf. part of the septum -> ositum primum ASD

Question 4

patent foramen ovale

Answer 4

It is not a true ASD as the flaps are normally kept shut by the high left pressure - ACYANOTIC

however, a venour embolism may be allowed through if even a transient drop in the left-side pressure allows the flaps to open -> paradoxical embolism

Question 5

Ventricular septal defects

Answer 5

opening in intra ventricular septum, most common in membranous portion, allows blood l -> r, ACYANOTIC

Question 6

patent ductus arteriosus

Answer 6

In foetuses the DA allows blood to flow from the pulm. artery to the aorta

If this is open in neonates it allows flow the other way, as the pressure is greater in the aorta - (normally) ACYANOTIC

chronic l -> r shunting leads to vascular remodelling in the pulmonary circulation and an inc. in pulm. resistance

-> if pulm.>syst. resistance, leads to r->l shunt, CYANOSIS - Eisenmenger syndrome

Question 7

co-arctation of the aorta

Answer 7

ACYANOTIC

narrowing of the aortic lumen in the region of the ligamentum arteriosum (formally the DA) -> inc. after-load on l/ventricle -> l/ventricular hypertrophy

vessels carrying blood to head and u/limbs emerge proximally to the co-arctation, so these are not affected, but the rest of the body has a reduced blood supply

In severe cases, may present at birth with cardiac failure

In less severe cases it may even be detected as late as an adult

Question 8

tetralogy of fallot

Answer 8

CYANOTIC

defect placing outflow portion of i/vent. septum in an anterior and cephalad direction

4 abnormalities: Mainly pulmonary stenosis, r/vent. hypertrophy (as a result of the first), overriding aorta, VSD

high press. in r/side leads to r->l shunt

can present w/ cyan. in infacny but mild cases can present in adulthood

Question 9

tricuspid atresia

Answer 9

CYANOTIC

lack of development of tricuspid valve, no inlet to r/vent.

complete r->l shunt of all blood returning to r/atrium w/ ASD/PFO and VSD/PDA to allow the blood back to the right side in the ventricles

Question 10

Transition of great arteries

Answer 10

CYANOTIC

r/vent-> aorta, l/vent.-> pulmonary artery

not compatible w/life after birth, unless a shunt ie PDA a/o ASD allows communication

Question 11

hypoplastic left heart

Answer 11

CYANOTIC

l/vent. and aorta fail to develop correctly

PFO and ASD are present, blood -> systemic circulation via PDA

lethal w/o surgery