Congenital Heart Disease pictures

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Congenital Heart Disease Mrs.Treesa Joseph

ANATOMY OF THE HEART: 

ANATOMY OF THE HEART

Fetal cardiac physiology: 

Fetal cardiac physiology Fetal circulation: Blood flows from the placenta  IVC  RA  through the PFO  LA  LV  ascending aorta  brain  returns via the SVC

Fetal cardiac physiology: 

Fetal cardiac physiology Fetal circulation: From the SVC  RA  RV  pulm aa  through the PDA  descending aorta  lower extremities and placenta

Fetal cardiac physiology: 

Fetal cardiac physiology Fetal circulation: Only a very small amount of blood is directed through the right and left pulmonary aa’s to the lungs.

Neonatal cardiac physiology: 

Neonatal cardiac physiology Neonate circulation: The transformation to neonatal circulation occurs with the first few breaths. The two remaining remnants of the fetal circulation are a patent foramen ovale... and ductus arteriosus.

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ACYANOTIC WITH INCREASED PULMONARY BLOOD FLOW

Patent Ductus Arteriosus(PDA): 

Patent Ductus Arteriosus(PDA)

IN GROSS: 

IN GROSS

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Structural Defects and Cardiac Circulation with PDA Where does the blood shunt to? Is the shunted blood oxygenated or deoxygenated? What happens to the blood flow in the aorta?

SURGICAL REPAIR :DEVICES: 

SURGICAL REPAIR :DEVICES

REPAIR: 

REPAIR

Ventricular Septal Defect(VSD): 

Ventricular Septal Defect(VSD)

Atrial Septal Defect(ASD): 

Atrial Septal Defect(ASD)

GROSS SPECIMENS: 

GROSS SPECIMENS

Atrial Septal Defect: 

Atrial Septal Defect Secundum ASD Sinus Venosus ASD

SURGICAL REPAIR:DEVICES: 

SURGICAL REPAIR:DEVICES

REPAIR: 

REPAIR

ROBO REPAIR: 

ROBO REPAIR

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ACYANOTIC WITH OBSTRUCTION TO BLOOD FLOW FROM VENTRICLES

Aortic stenosis: 

Aortic stenosis

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AORTIC STENOSIS

Pulmonary Stenosis: 

Pulmonary Stenosis

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Balloon Dilatation of Pulmonic Valve

Coarctation of the Aorta: 

Coarctation of the Aorta Hemodynamics Obstruction of left ventricular outflow  pressure hypertrophy of the LV.

Coarctation of the Aorta: 

Coarctation of the Aorta Rib notching on X-ray

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Resection with end-to-end anastomosis 2. Patch-graft aortoplasty

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3. Subclavian flap aortoplasty 4. Extended resection with end-to-end anastomosis

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6. Resection with end-to-end conduit interposition. 5. Direct aortoplasty by transverse suture repair.

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CYANOTIC WITH DECREASED PULMONARY BLOOD FLOW

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Four Structural Defects of Tetralogy of Fallot Why is there right ventricular hypertrophy? Which way does the blood shunt?

Tetralogy of Fallot: 

Tetralogy of Fallot The classic CXR finding in TOF is the boot-shaped heart. Pulmonary vasculature is typically decreased .

Tetralogy of Fallot: 

Tetralogy of Fallot The classic CXR finding in TOF is the boot-shaped heart. Pulmonary vasculature is typically decreased .

“Tet Spell”: 

“Tet Spell” “Tet spells” at 2-3yo, child becomes cyanotic, may experience syncope

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November 29, 1944 Thomas-Blalock-Tuassig

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Dr. Blalock does the Blalock (Johns Hopkins)

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Systemic to Pulmonary Shunts

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Modified Bidirectional

Rastelli operation: 

Rastelli operation An example of a repair of complex CHD with two ventricles. This one had a big VSD, TGA and PS. The severe sub-pulmonary stenosis precluded an arterial switch (it would become the neo-aortic valve), so a conduit joins RV to PA, and the VSD is patched.

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Brock’s procedure

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Modified

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CYANOTIC WITH MIXED BLOOD FLOW

Transposition of the Great Arteries: 

Transposition of the Great Arteries

Transposition of the Great Arteries: 

Transposition of the Great Arteries Most common form of cyanotic congenital heart disease (5 to 7% of all congenital heart defects ) which presents in the newborn period. More common in males Babies are usually normal birth weight and size. Aorta emerges from RV 5. PDA PA emerges from LV VSD ASD

Transposition of the Great Arteries: 

Transposition of the Great Arteries Deoxygenated blood redirected to LA LV  Lungs Oxygenated blood from lungs redirected to RA RV  Body Surgicalprocedures:Arterial Switch:

Transposition of the Great Arteries: 

Transposition of the Great Arteries Deoxygenated blood redirected to LA LV  Lungs Oxygenated blood from lungs redirected to RA RV  Body Surgical procedures:Mustard Procedure

Transposition of the Great Arteries: 

Transposition of the Great Arteries VSD closed with patch Conduit Surgical procedures:Rastelli Procedure:

Totally anomalous pulmonary venous drainage (infradiaphragmatic): 

Totally anomalous pulmonary venous drainage (infradiaphragmatic) All four pulmonary veins drain to the right side. Below the diaphragm they are always obstructed. Infant presents in first days with cyanosis, circulatory and respiratory failure and collapse.

Total Anomalous pulmonary venous return : 

Total Anomalous pulmonary venous return

Norwood procedure: 

Norwood procedure Atrial septectomy Ductus arteriosus ligation Form a neoaorta Aortopulmonary shunt

Prosthetic Heart Valves: 

Prosthetic Heart Valves

Caged-Ball Valve: 

Caged-Ball Valve

Disc Valve: 

Disc Valve

Bio-prosthetic Valve: 

Bio-prosthetic Valve

Conclusion: 

Conclusion . With newer surgical and catheter techniques, advancing medical therapy and improved risk stratification, overall prognosis and hence insurability will continue to improve for adults with congenital heart disease.

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Look for cyanosis and dysmorphology Examination of CVS in the newborn

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Diagnosis?

Facial features- of what?: 

Facial features- of what?

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Feel the pulses especially brachial and femoral

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Look at the respiratory pattern and for evidence of recession

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Feel the precordium for hyperactivity and for thrills

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Locate the apex beat

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Feel for hepatomegally

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Listen carefully

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Do what is necessary to calm the baby down!

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Listen at the back for radiation of murmurs

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3 months old- severe failure to thrive

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Special tests- echocardiography

Pulmonary veins - colour Doppler: 

Pulmonary veins - colour Doppler Subcostal view Apical view

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Thank You