62
03/13/22 DR. M. S. PRASAD 1 Acyanotic Congenital Heart Acyanotic Congenital Heart Disease Disease Dr. M. S. Prasad Professor & HOD Dept. of Pediatrics SGT Medical College

Acyanotic chd

Embed Size (px)

Citation preview

04/15/23 DR. M. S. PRASAD 1

Acyanotic Congenital Heart DiseaseAcyanotic Congenital Heart Disease

Dr. M. S. PrasadProfessor & HODDept. of Pediatrics

SGT Medical College

04/15/23 DR. M. S. PRASAD 2

ObjectivesObjectives

• By the end of this class, the students will be able

– to define Congenital Heart Disease (CHD), and

– to describe common types of Acyanotic CHD.

04/15/23 DR. M. S. PRASAD 3

04/15/23 DR. M. S. PRASAD 4

Diagram of Normal HeartDiagram of Normal Heart

PAPAAortaAorta

RA

RV

LA

LV

PVPVIVC & SVC

04/15/23 DR. M. S. PRASAD 5

04/15/23 DR. M. S. PRASAD 6

04/15/23 DR. M. S. PRASAD 7

Cardiovascular DiseasesCardiovascular Diseases

• Congenital Heart Disease– Acyanotic CHD (L R shunt)– Cyanotic CHD (R L shunt).

• Acquired Heart Diseases:– Kawasaki Disease,– Myocarditis,– Rheumatic Heart Disease.

04/15/23 DR. M. S. PRASAD 8

Congenital Heart Disease (CHD)Congenital Heart Disease (CHD)

• Con = Together.

• Genitus = Born.

04/15/23 DR. M. S. PRASAD 9

Definition

• A structural or functional deficiency in heart or its appendages which originates during foetal life is known as ‘Congenital Heart Congenital Heart Disease’Disease’ (CHD).

• It may or may not manifest at birth.

• Congenital Bicuspid Aortic Valve is normal at birth but may take 2, 3, or more decades to stiffen, calcify and present as overt Aortic Stenosis.

04/15/23 DR. M. S. PRASAD 11

CLASSIFICATION

ACYANOTIC

CYANOTIC

Physical Examination, or Pulse Oximetry.

04/15/23 DR. M. S. PRASAD 12

04/15/23 DR. M. S. PRASAD 13

Acyanotic CHDAcyanotic CHD

• Shunt Lesions (Left Right),

• Obstructive Lesions,

• Regurgitant Lesions, and

• Mixed (combination)

04/15/23 DR. M. S. PRASAD 14

L L R Shunt Lesions R Shunt Lesions

• ASD (Atrial Septal Defect),

• AVSD (Atrio-ventricular Septal Defect),

• VSD (Ventricular Septal Defect),

• PDA (Patent Ductus Arteriosus).

04/15/23 DR. M. S. PRASAD 15

Obstructive LesionsObstructive Lesions

• AS (Aortic Stenosis),

• COA (Coarctation of Aorta)

• HLHS (Hypoplastic Left Heart Syndrome),

• PS (Pulmonary Stenosis),

• Mitral Stenosis,

• Tricuspid Stenosis

04/15/23 DR. M. S. PRASAD 16

Regurgitant LesionsRegurgitant Lesions

• AR (Aortic Regurgitation),

• MR (Mitral Regurgitation),

• MVP (Mitral Valve Prolapse),

• TR (Tricuspid Regurgitation),

• PI (Pulmonary Incompetence)

04/15/23 DR. M. S. PRASAD 17

Patent Foramen Ovale Patent Foramen Ovale (PFO)(PFO)

&&Atrial Septal DefectAtrial Septal Defect

(ASD)(ASD)

04/15/23 DR. M. S. PRASAD 18

PFOPFOPFOPFO

• An isolated patent foramen (PFO) is a common finding during infancy and it usually closes.

• It is not considered abnormal, even if it persists throughout life.

• It is usually of no hemodynamic significance and is not considered an ASD.

May play an important role if other structural heart defects are present.

04/15/23 DR. M. S. PRASAD 19

Atrial Septal Defect (ASD)Atrial Septal Defect (ASD)

• A defect in the wall between left and right atrium is known as Atrial Septal Defect (ASD).

• This is one of the Acyanotic CHD with L R shunt.

• More common in females than in males.

[M:F = 1:2].

04/15/23 DR. M. S. PRASAD 20

04/15/23 DR. M. S. PRASAD 21

Types of ASDTypes of ASD

• Ostium Secundum Defect(5-10% of CHD)

• Sinus Venosus ASD.(10% of ASD)

• Ostium primum ASD

04/15/23 DR. M. S. PRASAD 22

SVC

IVCTV

Ostium primum

Ostium secundum

Superior Sinus Venosus

Inferior Sinus Venosus

04/15/23 DR. M. S. PRASAD 23

• Ostium secundum ASD constitutes 5-10% of CHD.

• Ostium Secundum Defect is 3 times more common in girls than in boys.

• PAPVR may be present.

04/15/23 DR. M. S. PRASAD 24

Secundum ASDSecundum ASD

• Spontaneous closure up to 2-3 years may occur.

• Symptoms in childhood are rare.

• Life expectancy virtually normal if closure undertaken in childhood.

04/15/23 DR. M. S. PRASAD 25

Sinus VenosusSinus Venosus

• Spontaneous closure does not occur.

• Natural history same as secundum ASD.

04/15/23 DR. M. S. PRASAD 26

ASD

• History: Usually asymptomatic.• Physical Examination:

– Thin built.– There is absence of sinus arrhythmia.– Wide & fixed splitting of 2nd Heart Sound.– Ejection Systolic Murmur.

• ECG• CXR• Echocardiogram

04/15/23 DR. M. S. PRASAD 27

ASDASD• ECG:

– Features of RBBB– rsR/ pattern V1

– Mild RVH– RAD

• CXR:– Cardiomegaly– Prominent Pulmonary Conus.– Increased Pulmonary Vascular Markings.

• Echocardiography– Diagnostic,– shows exact location.

04/15/23 DR. M. S. PRASAD 28

Atrio-ventricular Septal DefectAtrio-ventricular Septal Defect

04/15/23 DR. M. S. PRASAD 29

Atrio-Ventricular Septal DefectAtrio-Ventricular Septal Defect

• Partial (ostium primum) AVSD– Atrial Shunting,– Mitral Valve is always defective,– LV RA shunting may occur.

• Complete AVSD– Strong association with Down’s Syndrome,– Atrial and Ventricular shunting,– AV regurgitation.

04/15/23 DR. M. S. PRASAD 30

Clinical FeaturesClinical Features

• FTT

• Clinical signs of CHF,

• Signs of the most prominent lesion (ASD, Regurgitation, others)

04/15/23 DR. M. S. PRASAD 31

ManagementManagement

• Management of CHF,

• Corrective surgery.

04/15/23 DR. M. S. PRASAD 32

04/15/23 DR. M. S. PRASAD 33

Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD)

VSD is the most common cardiac malformation and accounts for 32% of CHD

04/15/23 DR. M. S. PRASAD 34

04/15/23 DR. M. S. PRASAD 35

Types of VSDTypes of VSD

• Membranous.

• Muscular.

• Swiss Cheese Septum.

• Membranous.

• Muscular.

• Swiss Cheese Septum.

04/15/23 DR. M. S. PRASAD 36

VSD: PathopyhsiologyVSD: Pathopyhsiology

• LV pressure higher than RV.

• Blood passes through the defect to RV.

• RV load is increased.

• PA receives more volume than expected.

• This extremely large pulmonary blood flow results into Pulmonary Hypertension.

04/15/23 DR. M. S. PRASAD 37

Clinical ManifestationsClinical Manifestations

04/15/23 DR. M. S. PRASAD 38

Small VSDSmall VSD

• Asymptomatic.

• Cardiac lesion is usually found during routine physical examination.

• A loud, harsh, or blowing systolic murmur best heard over the lower left sternal border.

04/15/23 DR. M. S. PRASAD 39

Large VSDLarge VSD• Patients with large defects typically

develop CHF.

• Excessive pulmonary blood flow and Pulmonary Hypertension

• Dyspnoea or effort intolerance.

• Poor Growth.

04/15/23 DR. M. S. PRASAD 40

Large VSD Large VSD (continued)

• Profuse Perspiration (Sweating).

• Recurrent RTI.

• Feeding difficulty,

• Systolic Murmur: less harsh, more blowing

• Loud P2

04/15/23 DR. M. S. PRASAD 41

VSD: VSD: DiagnosisDiagnosis• Most common Acyanotic CHD.• CXR:

– Small VSD: Normal.– Large VSD:

• Cardiomegaly.• Increased Pulmonary Vascular Markings.

• ECG:– Small VSD: Normal.– Large VSD: Biventricular Hypertrophy.

• Echocardiogram• Cardiac Catheterization.

04/15/23 DR. M. S. PRASAD 42

Natural HistoryNatural History

• 65% of VSD present at birth close spontaneously.

• Remaining cases:– FTT,– Feeding difficulty,– Signs of VSD and CHF.

04/15/23 DR. M. S. PRASAD 43

ManagementManagement

• Manage CHF,

• Surgical closure.

04/15/23 DR. M. S. PRASAD 44

Patent Ductus ArteriosusPatent Ductus Arteriosus(PDA)(PDA)

04/15/23 DR. M. S. PRASAD 45

Patent Ductus Arteriosus Patent Ductus Arteriosus (PDA)(PDA)

Patent Ductus Arteriosus Patent Ductus Arteriosus (PDA)(PDA)

PAAorta

RA

RV

LA

LV

PVIVC & SVC

04/15/23 DR. M. S. PRASAD 46

04/15/23 DR. M. S. PRASAD 47

04/15/23 DR. M. S. PRASAD 48

PDAPDA• More in females [2:1]

• Maternal Rubella in early pregnancy.

• Common in premature infants.

• 10% of PDA is associated with other CHD.

04/15/23 DR. M. S. PRASAD 49

PDA: Clinical ManifestationsPDA: Clinical Manifestations

• Wide Pulse Pressure.• Bounding Peripheral Pulses.• Cardiac Enlargement.• Thrill.

LSB & below left clavicle.

• Machinery Murmur.• CHF

04/15/23 DR. M. S. PRASAD 50

PDA: DiagnosisPDA: Diagnosis

• ECG: Normal/LVH/BVH

• CXR: Prominent PA & Increased PVM.

• Echocardiogram: from the suprasternal notch.

• Colour & Pulsed Doppler Examination.

• Cardiac Catheterization.

04/15/23 DR. M. S. PRASAD 51

04/15/23 DR. M. S. PRASAD 52

Coarctation of Aorta (COA)

04/15/23 DR. M. S. PRASAD 53

COACOA• COA is a localized or segmental

constriction [narrowing] of aorta

• The size of constriction may vary.

04/15/23 DR. M. S. PRASAD 54

COACOA• It may be at one point or multiple points.

• It may involve a long segment continuously.

• Involvement of long segment is known as “Tubular Hypoplasia”.

• Sometimes, the the aorta becomes completely atretic and results in an “Interrupted Aortic Arch”.

04/15/23 DR. M. S. PRASAD 55

COACOA• The COA may occur at any point from the

Transverse Arch to the iliac bifurcation.

• 98% occur just below the origin of the left subclavian artery at the origin of the ductus arteriosus [juxtaductal COA].

04/15/23 DR. M. S. PRASAD 56

Coarctation of Aorta

• Two times more common in males.

• M:F = 2:1

04/15/23 DR. M. S. PRASAD 57

Types of COATypes of COA

o Infantile Type.

COA associated with arch hypoplasia was referred to as Infantile Type because its severity led to its recognition in early infancy.

o Adult Type.

Adult Type referred to isolated juxtaductal COA, which if mild, was not usually recognized until later childhood.

04/15/23 DR. M. S. PRASAD 58

COA: Clinical Manifestations

• Weakness and pain after exercise.

• Hypertension on routine physical examination.

• Classis Sign: Disparity in pulsation and B. P. in the arms and legs.

04/15/23 DR. M. S. PRASAD 59

COA: Diagnosis

• Mainly on clinical grounds.

• CXR & ECG: not much helpful.

• Pulsed and continuous wave Doppler studies are helpful.

04/15/23 DR. M. S. PRASAD 60

Typical clinical findings in common CHD

Lesion PulseVentricular dominance

Heart Sounds

MurmurRadiation of murmur

VSD Normal Both N/↑P2 PSMApex & Back

ASD Normal RVHwide & fixed 2nd sound

ESM Back

PDA Collapsing RVH ↑ P2 Continuous Back

COADelayed Femoral

LVH Normal ESM Back

PS Normal RVH Normal ESM Back

04/15/23 DR. M. S. PRASAD 61

या� दे�वी� सवीभू�ते�षु� विवीद्या�रूपे�ण स�स्थि�ते�, नमस्तेस्या� नमस्तेस्या� नमस्तेस्या� नम� नम� ||

04/15/23 DR. M. S. PRASAD 62

Did you meet your objectives?Did you meet your objectives?

• Can you define Congenital Heart Disease (CHD)? and

• Can you describe common types of Acyanotic CHD?

• Yes, very good. • No, discuss again next time.