Congenital Heart Lesions

1. Congenital Heart Lesions Dominic Blurton MD PCA Pediatric Cardiology

2. Outline Normal anatomy 1.L -> R shunt 2.Left side obstruction 3.Cyanotic heart lesions Right side obstruction and R -> L shunt Transposition 4.Mixing Lesions Surgical therapy

3. Ductus Arteriosus Aorta Pulmonary Artery Left Atrium Patent Foramen Ovale Right Atrium LeftVentricle Right Ventricle

4. Key Points Blood flows to the path of least resistance Pulmonary resistance < systemic resistance All newborns have connections PDA PFO

5. Physiological classification of defects • 1.L -> R shunt • 2.Left side obstruction • 3.Cyanotic heart lesions • Right side obstruction and R -> L shunt • Transposition • 4.Mixing Lesions

6. Outline Normal anatomy L -> R shunt Left side obstruction Cyanotic heart lesions Right side obstruction and R -> L shunt Transposition Mixing Lesions Surgical therapy

7. Left to right shunting Right and left side connected Increased (too much) pulmonary blood flow Respiratory distress/ CHF

8. Left to right shunt lesions Ventricular septal defect (VSD) Atrial septal defect (ASD) AV canal Patent ductus arteriosus (PDA)

14. Outline Normal anatomy L -> R shunt Left side obstruction Cyanotic heart lesions Right side obstruction and R -> L shunt Transposition Mixing Lesions Surgical therapy

15. Left side obstruction Not enough blood to the body Hypo-perfusion, acidosis, shock

16. Left side obstructive lesions Mitral valve obstruction Aortic valve obstruction Coarctation of the aorta Everything obstructed Hypoplastic left heart syndrome

22. Outline Normal anatomy L -> R shunt Left side obstruction Cyanotic heart lesions Right side obstruction & R -> L shunt Transposition Mixing Lesions Surgical therapy

23. Cyanotic lesions Connection - right and left sides AND right side obstruction Decreased pulmonary blood flow OR Separated systems

24. Cyanotic lesions Right side obstructions Tricuspid obstruction Pulmonary obstruction Tetralogy of Fallot Separate systems Transposition of the great vessels

34. Outline Normal anatomy L -> R shunt Left side obstruction Cyanotic heart lesions Right side obstruction & R -> L shunt Transposition Mixing Lesions Surgical therapy

35. Mixing lesions Very large intra or extracardiac connection Key points- What goes into the lungs comes out of the lungs = red What goes into the body comes out of the body = blue May have right side obstruction

36. Mixing Lesions Single ventricle Double inlet left ventricle (DILV) Double outlet right ventricle (DORV) Primitive ventricle Hypoplastic right or left ventricle Total anomalous pulmonary venous return (TAPVR) Truncus arteriosus

39. Outline Normal anatomy L -> R shunt Left side obstruction Cyanotic heart lesions Right side obstruction & R -> L shunt Transposition Mixing Lesions Surgical therapy

40. Surgical therapy Repair vs. palliation Palliating a single ventricle - Example: HLHS Stage I: Norwood and BT shunt Stage II: Glenn shunt Stage III: Fontan

41. Hypoplastic Left Heart Syndrome

42. Stage I: Norwood + BT shunt

43. Stage II: Glenn shunt

44. Stage III: Fontan

45. Norwood RMBTS

46. Norwood RMBTS

47. Norwood RMBTS

48. Norwood Sano

49. Norwood Sano

50. RMBTS