Congenital Heart Disease

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Slide 1 :

Congenital Heart Disease Thoracic Conference Frank Nami, M.D.

Slide 2 :

The Heart

Slide 3 :

Congenial Heart Disease Obstructive Congenital Heart Lesions Congenital Heart Lesions that INCREASE Pulmonary Arterial Blood Flow Congenital Heart Lesions that DECREASE Pulmonary Arterial Blood Flow

Slide 4 :

Obstructive Congenital Heart Lesions Impede the forward flow of blood and increase ventricular afterloads. Pulmonary Stenosis Aortic Stenosis Coarctation of the Aorta

Slide 5 :

Pulmonary Stenosis No symptoms in mild or moderately severe lesions. Cyanosis and right-sided heart failure in patients with severe lesions. High pitched systolic ejection murmur maximal in second left interspace. Ejection click often present.

Slide 6 :

Pulmonary Stenosis

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Aortic Stenosis Valvular Aortic Stenosis Subaortic Stenosis Supravalvular Aortic Stenosis Asymmetric Septal Hypertrophy (Idiopathic Hypertrophic Subaortic Stenosis)

Slide 8 :

Valvular Aortic Stenosis Most common type, usually asymptomatic in children. May cause severe heart failure in infants. Prominent left ventricular impulse, narrow pulse pressure. Harsh systolic murmur and thrill along left sternal border, systolic ejection click.

Slide 9 :

Valvular Aortic Stenosis Predominantly in males Thickened, fibrotic, malformed aortic leaflets. Fused commissures Bicuspid aortic valve.

Slide 10 :

Valvular Aortic Stenosis

Slide 11 :

Coarctation of the Aorta Absent or weak femoral pulses. Systolic pressure higher in upper extremities than in lower extremities; diastolic pressures are similar. Harsh systolic murmur heard in the back.

Slide 12 :

Coarctation of the Aorta Males twice as frequently as females. 98% of all coarctations at segment of aorta adjacent to ductus arteriosus. Produced by both an external narrowing and an intraluminal membrane. Blood flow to the lower body maintained through collateral vessels.

Slide 13 :

Coarctation of the Aorta

Slide 14 :

Congenital Heart Lesions that INCREASE Pulmonary Arterial Blood Flow Atrial Septal Defect Complete Atrioventricular Canal Ventricular Septal Defect Patent Ductus Arteriosis Total Anomalous Pulmonary Venous Connection Truncus Arteriosus

Slide 15 :

Atrial Septal Defect Acyanotic; asymptomatic, or dyspnea on exertion. Right ventricular lift. Fixed, widely split second heart sound.

Slide 16 :

Atrial Septal Defect Average life expectancy reduced because of right ventricular failure, dysrhythmias, and pulmonary vascular disease. Surgical closure is recommended.

Slide 17 :

Atrial Septal Defect

Slide 18 :

Atrial Septal Defect

Slide 19 :

Atrial Septal Defect

Slide 20 :

Complete Atrioventricular Canal Heart failure common in infancy. Cardiomegaly, blowing pansystolic murmur, other variable murmurs. Deficiencies of both atrial and ventricular septal cushions and abnormalities of both mitral and tricuspid valves.

Slide 21 :

Complete Atrioventricular Canal Partial and complete AV canal defects frequently accompany Down’s syndrome. Early surgical correction. Reconstruction of the AV valves and closure of the septal defects by a single or double patch technique.

Slide 22 :

Complete Atrioventricular Canal

Slide 23 :

Complete Atrioventricular Canal

Slide 24 :

Ventricular Septal Defect Asymptomatic if defect is small. Heart failure with dyspnea, frequent respiratory infections, and poor growth if defect is large. Pansystolic murmur maximal at the left sternal border.

Slide 25 :

Ventricular Septal Defect Often one component of another more complex congenital heart lesion. Heart is enlarged and lung fields are overcirculated. Many of the defects will close spontaneously by age 7-8 years.

Slide 26 :

Ventricular Septal Defect

Slide 27 :

Ventricular Septal Defect

Slide 28 :

Patent Ductus Arteriosis Murmur usually systolic, sometimes continuous, “machinery” Poor feeding, respiratory distress, and frequent respiratory infections in infants with heart failure. Physical exam and echocardiography.

Slide 29 :

Patent Ductus Arteriosis Indomethacin, a prostaglandin E1 inhibitor may close a PDA. Surgical treatment after one week, by ligation, clipping, or division.

Slide 30 :

Patent Ductus Arteriosis

Slide 31 :

Patent Ductus Arteriosis

Slide 32 :

Total Anomalous Pulmonary Venous Connection Pulmonary veins do not make a direct connection with the left atrium. Blood reaches the left atrium only through an atrial septal defect or patent foramen ovale. Pulmonary congestion, tachypnea, cardiac failure, and variable cyanosis.

Slide 33 :

Total Anomalous Pulmonary Venous Connection Diagnosis by cardiac catherization or echocardiography. Operative repair in all cases.

Slide 34 :

Truncus Arteriosus Single large vessel overrides the ventricular septum and distributes all the blood ejected from the heart. Large VSD is present.

Slide 35 :

Truncus Arteriosus

Slide 36 :

Truncus Arteriosus Corrective operation with a valved conduit between right ventricle and pulmonary vessels. Conduit will need to be changed as child grows but likelihood to develop pulmonary vascular disease is greatly reduced.

Slide 37 :

Congenital Heart Lesions that DECREASE Pulmonary Arterial Blood Flow Tetralogy of Fallot Transposition of the Great Arteries Tricuspid Atresia Ebstein’s Anomaly

Slide 38 :

Tetralogy of Fallot Pulmonary stenosis VSD of the membranous portion Overriding aorta Right ventricular hypertrophy due to shunting of blood

Slide 39 :

Tetralogy of Fallot Addition of an atrial septal defect falls in the category of Pentalogy of Fallot. Hypoxic spells and squatting. Cyanosis and clubbing.

Slide 40 :

Tetralogy of Fallot

Slide 41 :

Transposition of the Great Arteries Aorta from right ventricle, pulmonary artery from left ventricle. Cyanosis from birth, hypoxic spells sometimes present. Heart failure often present. Cardiac enlargement and diminished pulmonary artery segment on x-ray.

Slide 42 :

Transposition of the Great Arteries Anatomic communication must exist between pulmonary and systemic circulation, VSD, ASD, or PDA.

Slide 43 :

Transposition of the Great Arteries

Slide 44 :

Transposition of the Great Arteries

Slide :

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