Congenital Heart Disease

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Presentation Description

Case presentations highlighting common congenital heart problems

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Presentation Transcript

CONGENITAL HEART DISEASE : 

CONGENITAL HEART DISEASE Dr S Sen Specialist Registrar Paediatrics North Western Deanery

INCIDENCE : 

INCIDENCE CONGENITAL HEART DISEASE -8/1000 births CYANOTIC HEART DISEASE - 1/3rd of above

CASE HISTORY 1 : 

CASE HISTORY 1 10 day old ,male infant presents to A & E dept. H/O off feeds x 2 days Lethargic Pale

Pallor, dyspnoeic , grunting Irritable , weak cry, poor pulses RR 60/min , Liver 3 cm. 2/6 Pan Systolic murmur Left lower sternal border Bilateral basal crepitations. CASE HISTORY 1

OTHER SIGNS / SYMPTOMS : 

OTHER SIGNS / SYMPTOMS Tachycardia Gallop rhythm Sweating Wt. Loss

DD : 

DD Coarctation of aorta Severe Aortic Stenosis Interrupted Aortic Arch Hypoplastic Left Heart Myocarditis / Cardiomyopathy SVT A-V fistula : Vein of Galen Anaemia

MANAGEMENT : 

MANAGEMENT Airways , Oxygenation ! Volume / Diuretics Correct acidosis Blood sugar / Calcium / Potassium Sepsis / anaemia Prostaglandin Inotropes

COARCTATION OF AORTA : 

COARCTATION OF AORTA Balloon angioplasty End to end repair Subclavian flap repair Stent

CASE HISTORY 2 : 

CASE HISTORY 2 10 Yrs , male Asymptomatic Incidental murmur 2 yrs. Age O/E : HS normal , click 2nd. 3/6 ESM URSE, Carotid radiation

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AORTIC STENOSIS Valvar Supra-valvar Sub-valvar Balloon dilatation Surgery-valvotomy replacement - mechanical / Autograft resection

CASE 3 : 

CASE 3 5 day old baby Respiratory distress 3/6 systolic murmur Normal saturations Enlarged heart on Chest X Ray

Slide 13: 

HYPOPLASTIC LEFT HEART SYNDROME Under development of L heart structures Mitral Valve / LV / Aorta Duct dependant Norwood’s procedure Stage 1 & 2 Fontan’s Heart transplant

Slide 15: 

NORWOOD’S STAGE 1 Within 2 wks. Mortality 30% Accept Sats. 70-85 in air Oxygen only with greatest caution Treat resp. infections promptly Very low threshold for hospitalization

Slide 16: 

CYANOTIC HEART DISEASE

CASE HISTORY 3 : 

2 Yrs. Old, Asian female Cyanosis noted 2 wks. Age Asymptomatic , feeding well O/E : 1st.HS –N, 2nd.HS – single 4/6 ESM ULSE, 3/6 CM bilat. Infraclavicular CASE HISTORY 3

Slide 18: 

CENTRAL CYANOSIS Generalised Blueness Occurs in 30% of congenital heart disease patients TGA Complete AVSD

DIAGNOSIS : 

DIAGNOSIS Cyanosis Tachycardia Tachypnoea Acidosis Poor capillary refill time Hyopotension

DIFFERENTIAL DIAGNOSIS : 

DIFFERENTIAL DIAGNOSIS Respiratory Distress Syndrome Persistent Foetal Circulation Methaemoglobinaemia

PERSISTENT FOETAL CIRCULATION : 

PERSISTENT FOETAL CIRCULATION Causes: Meconium aspiration Asphyxia Polycythaemia Maternal drugs- Aspirin,Indomethacin etc Hypoplastic lung

PERSISTENT FOETAL CIRCULATION : 

PERSISTENT FOETAL CIRCULATION Marked cyanosis Respiratory distress B.P. normal Loud pansystolic murmur CXR Echocardiography

CYANOTIC CONGENITAL HEART DISEASE : 

CYANOTIC CONGENITAL HEART DISEASE Fallot’s Tetralogy Transposition of Great arteries Tricuspid Atresia Aortic/Mitral Atresia Total anomalous Pulmonary Venous drainage Pulmonary Atresia / intact septum Double outlet right ventricle Single Ventricle Anomalous systemic venous drainage Pulmonary Arterio-venous aneurysms

MURMURS : 

MURMURS Systolic Diastolic Fallot’s tetralogy Truncus arteriosus Tricuspid atresia Pulmonary atresia None Truncus arteriosus TGA DORV Ao /Mi. atresia TAPVD TAPVD Single ventricle

CHEST X-RAY ( Heart Size ) : 

CHEST X-RAY ( Heart Size ) Large TGA Tricuspid Atresia Ao/Mi. Atresia Single Ventricle Truncus Atreriosus Ebstein’s Anomaly Lt. -> Rt. Shunts Small Fallot’s tetralogy TAPVD-Infradiaphragmatic Normal TGA Pulmonary Atresia

CHEST X-RAY (LUNGS) : 

CHEST X-RAY (LUNGS) Oligaemic Plethoric Fallot’s Tetralogy Truncus Arteriosus Pulmonary Atresia TGA Tricuspid Atresia TAPVD Single ventricle Left -> Right Shunts

Fallot’s Tetralogy : 

Fallot’s Tetralogy Start Prostaglandin E1 5 Nanograms/Kg/min. Correct Acidosis Accept Sats. 75-85 in air Treat infection Maintain adequate hydration Hypercyanotic spell: IV Propranolol/ morphine oxygen / phenylephrine

FALLOT’S TETRALOGY : 

FALLOT’S TETRALOGY Balloon Pulmonary valvuloplasty Blalock Taussig shunt Correction

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TRANSPOSITION OF GREAT ARTERIES

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TGA Prostaglandin E1 Balloon atrial septostomy Arterial switch Atrial switch - Mustard’s / Senning’s Complex TGA - Fontan’s

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PULMONARY HYPERTENSION Primary / Secondary Reversible or not ? Cardiac catheterisation / Lung biopsy Active treatment of infections / immunisation hydration / diet Oxygen / Prostacyclin / Sildenafil Heart - lung transplant

Slide 37: 

ACQUIRED HEART DISEASE Myocarditis Rheumatic heart disease Kawasaki’s disease Endocarditis

Slide 38: 

INFECTIVE ENDOCARDITIS Symptoms Signs Investigations Treatment - 2 Antibiotics I.V. x 6 wks. Repair lesion Prevention

Slide 39: 

KAWASAKI’S DISEASE Mortality related to cardiac involvement Myocarditis / Pericarditis / Effusion Prox. Coronary dilatation Infarction Late coronary stenosis / thrombus / infarct. Immunoglobulin / Aspirin

Slide 40: 

COMMON CARDIAC SYNDROMES Down’s syndr.: AVSD / ASD / VSD / Fallot’s Turner’s : Coarct. Of Ao./ Ao. St. DiGeorge / VCF : Truncus / TGA / Fallot’s / VSD William’s : Supra valvar AS / PS / Coarct. Noonan’s : PS / Cardiomyopathy Alagille’s : peripheral PS

Slide 41: 

FOETAL CARDIAC TERATOGENS Alcohol : ASD / VSD / TGA Phenytoin : AS / PS / Coarct. / PDA Valproate : Fallot’s / VSD Lithium : Ebstein’s Warfarin : Foetal loss Viruses : Rubella / CMV

Slide 42: 

MATERNAL RISK FACTORS Diabetes : HCM / VSD / Coarct. SLE : Congenital complete heart block Phenylketonuria : Fallot’s

THANK YOU : 

THANK YOU