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PRINCIPLE OF CONGENITAL HEART DISEASES

PRINCIPLE OF CONGENITAL HEART DISEASES. SASMITO. CONGENITAL HEART DISEASE INCIDENCE : 4-8 / 1000 LIVE BIRTH ETYOLOGIC FACTORS : ENVIROMENT GENETIC /CHROMOSSOMAL ABNORMALITY CLINICALLY TYPE : ACYANOTIC CHD CYANOTIC CHD. THE TYPE OF CHD

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PRINCIPLE OF CONGENITAL HEART DISEASES

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  1. PRINCIPLE OF CONGENITAL HEART DISEASES SASMITO

  2. CONGENITAL HEART DISEASE INCIDENCE : 4-8 / 1000 LIVE BIRTH ETYOLOGIC FACTORS : ENVIROMENT GENETIC /CHROMOSSOMAL ABNORMALITY CLINICALLY TYPE : ACYANOTIC CHD CYANOTIC CHD

  3. THE TYPE OF CHD • BASED ON FLOW OF THE SHUNT • DEFECT WITH LEFT TO RIGHT SHUNT • 2. DEFECT WITH RIGHT TO LEFT SHUNT • 3. DEFECT WITH MIXING SHUNT • BASED ON ANATOMY • DEFECT AT THE VENTRICLE LEVEL • 2. DEFECT AT THE ATRIAL LEVEL • 3. DEFECT AT THE ARTERIAL LEVEL • 4. DEFECT AT THE VALVE • BASED ON CLINICAL APPEARANCE • CYANOTIC HEART DEFECT • 2. ACYANOTIC HEART DEFECT

  4. CYANOTIC CHD • COMMON CYANOTIC HEART DEFECT ( TOF,TRUNCUS • TAPVD, PA-VSD,TA) • 2. CRITICALLY CYANOTIC HEART DEFECT ( TGA,PA-IVS) • 3. COMPLEX CYANOTIC HEART DEFECT

  5. ANAMNESTIC PHYSICAL EXAMINATION RADIOLOGY ECG ECHO CAT/ ANG 1.Cough 1.Inspection Chest X ray RVH Anatomical 2. dyspnea 2. Pulse Thrill - Cardiomegaly - Normal LVH defect 3. Edema 3. Auscultation : murmur Plethora RAH Myocard 4. Ascites 4. Down Syndrome etc LAH contraction 5. Cyanotic 5. cataract LV func 6. Squatting Cyan . spell 7. Cataract 8. Deafness DIAGNOSTIC APPROACH dysrithmic

  6. PDA Diastolic : Ins. Pulm Ins. Aorta 1 2 3 Systolic : VSD Systolic ASD I, ASD II, Pulm sten, Aorta sten, Co-Arc 4 5 Diastolic Mitral stenotic Diastolic Tricuspid stenotic Systolic Mitral ins Systolic Tricuspid ins

  7. Bayangan jantung CTR = Ka +Ki Th Posterior Anterior Mengukur rasio Kardio Thorax (CTR) a a = cekungan pulmonal Kontur Jantung dengan hipertrofi ventrikel kanan

  8. Blood pressure Oxygen saturation

  9. CLINICAL SYMPTOM : Ussually asimptomative Physical Exam : S 2 wide fixed split, ESM 2-3/6 LSB 2 ECG : RAD ( 90-180°), RVH volume type CXR : PA prominent, RAE,RVE, plethorik Echo : anatomical and type of ASD

  10. Natural hystory : 14-55 % closed spontaneously in 4 years old ASD found in months old : - < 3mm 100% closed in 1 year old - 3-8 mm 80% closed in 1,5 years old th - > 8 mm rare closely spontaneously Management: No activity limitation Not need prophylaxis SBE unless associated MVP Heart failure infant anti congestive is recomended ASD closure by ASDOS or surgical after 4 years old

  11. VSD ( Ventricular septal defect) • 15-20 % CHD • Type : peri membran , muscular, sub arterial ( 30 %) • Size : small, moderate, large • Clinical symptom : • Small defect asymptomative • Moderate-large defect : failure to thrive, repeated Pulm inf • decreased exercise tolerance • Large defect cause heart failure in infant • PH : cyanotic , decreased exercise tolerance

  12. Physical Examination • Bulging and hyperactivity precordial in large defect • PSM 3- 4/6 in LSB 3 • ECG : small defect : normal • moderate defect : LAH, LVH • large defect : BVH • PH : RVH • CXR : Cardiomegaly, PVM plethoric • PH: normal heart size , PVM : pruning • Echo : anatomy, defect size, number and type of defect

  13. Natural history: • Spontaneous closure : 30-40 % before 6 months • Heart failure in infant after 6 months • PH in large defect after 6-12 months • PS infundibular • Endocarditis infective • VSD associated by AI in 4 years of age

  14. Management : • Medicamentosa in heart failure patient • No limitation activity unless PH • Oral hygiene and SBE prophylaxis. • Defect closure: • - non surgical • - surgical : as soon as possible if not respond with anti • congestive • > 1 year if respond to anti congestive • > 4 years if not closure spontaneously

  15. PDA( ductus arteriosus persistent) • 5-10% CHD • M :FM : 1 : 3 • Very common in premature baby • Clinical symptom: • Small defect asymptomative • Large defect : repeated lung infection, H failure • Physical examination: • tachycardia, dyspnea on effort • cyanotic differential in PH • hyperactive precordial • . Continuous machinery murmur inL infra clavicle • Bounding pulse

  16. ECG : small sz normal, moderate/large : LVH/BVH • CXR : small size normal • moderate/large : cardiomegaly, plethoric, PA prominent • ECHO : anatomy, type, defect size • Natural history : • Spontaneous closure in premature baby with small defect • heart failure in large defect, pneumonia • PH • endocarditis • Management: • Indomethacin in premature baby • SBE prophylaxis • ADO • Ligation : in 6 months - 2 years, as soon as posible in H.fail

  17. OBSTRUCTIVE OF THE GREAT LEVEL

  18. CYANOTIC CHD

  19. MIXING TYPE

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