Post on 24-Nov-2015
Structures of the heart
Normal Heart
Atrial Septal defect( ASD )Insidence : + 10 % : ratio = 1,5 to 2 : 1Anatomy : Defect on foramen ovale : Secundum ASD Defect at SVC and RA junction: sinus venosus ASD Defect at ostium primum : primum ASD
ASD
Atrial Septal Defect
Atrial Septal DefectDiagram of ASD
LALVRVRAPAAOSystemicLungsQp > QsAtrial septal defect
RARVLALVRARVLALVAtrial septal Defect
Atrial septal DefectClinical findingsAsymptomaticAuscultation : Normal 1st HS or loudWidely split and fixed 2nd HSEjection systolic murmur
Atrial Septal DefectAuscultation :1st HS N or loudwidely split and fixed 2nd HS Ejection Sistolic Murmur
ECG : IRBB , right ventricular hypertrophyAtrial Septal Defect
Right atrial enlargementProminence the MPA segmentIncreased pulmonary vascular marking Atrial Septal DefectChest X-Ray
Atrial Septal DefectDiagnosis Differential
Primary Atrial Septal DefectECG : LADPartial Anomalous Pulmonary Vein DrainagePulmonary StenosisInnocent Murmur
Atrial Septal defect
ManagementSurgery : Preschool ageRecent treatment: transcatheter closure using ASO (Amplatzer septal occluder)
ASDSmall ShuntLarge ShuntObservationEvaluationAt age 5-8 yrsCathFR1.5ConservativeInfantsChildren/AdultsHeart Failure (-)Heart Failure (+)Age >1yrsW >10kgTranscatheter closure (Secundum ASD) /Surgical Closure(others)ConservativeAnti failureFailSuccessPH (-)PH (+)PVD (-)PVD (+)HyperoxiaReac-tiveNonreactiveSurgicalClosure
Atrial septal defect
Ventricular septal defectInsidence 20 % of all CHD No sex influencedAnatomy Subarterial defect : below pulmonary andaortic valve Perimembranous defect: below aortic valve at pars membranous septum Muscular defect
VSD
Ventricular Septal Defect
SystemicLungsQp > QsVentricular Septal defect
LA
LV
RV
RA
PA
AO
RARVRALALARVLVLVVentricular septal defect
Ventricular Septal Defect
Ventricular Septal DefectClinical findingsDay 1st after birth: murmur (-)After 2-6 weeks : murmur (+)Murmur : pansystolic grade 3/6 or higher at LSB 3 Small muscular defect: early systolic murmurSignificant defect: Mid diastolic murmur at apex
Small VSD Large VSD Ventricular Septal DefectMurmur: pansystolic grade 3/6 or higher at LSB 3
Ventricular septal DefectDiagnosis Differential
PDA with PHTetralogy Fallot non cyanoticInoscent murmur
Ventricular septal defectManagement:
Definitive : VSD closure Surgery Transcatheter closure
Patent Ductus Arteriosus Insidence+ 10%Female : Male = 1.2 to 1.5 : 1Premature and LBW higherAnatomyFetus: ductus arteriosus connects PA and aorta. If ductus does not closs Patent Ductus arteriosus
PDA
LALVRVRAPAAOSystemicLungsQp > QsPatent Ductus Arteriosus
RARVLALVRALARVLVPatent Ductus Arteriosus
Patent Ductus ArteriosusClinical findings
Small defect: Symptom (-) Growth and development normalSignificant defect:Decreased exercise tolerantWeigh gained not goodFrequent URTISpecific case: pulsus seler at 4th extremities
Patent Ductus Arteriosus DiagnosisPulsus seler and continuous murmur heard
Patent Ductus ArteriosusChest X- RaySimilar to VSD
Patent Ductus ArteriosusAuscultation : continuosus murmur at upper LSB 2
Patent Ductus ArteriosusDiagnosis DifferentialAP-windowArterio-venous fistulae
Management premature: indometasinPDA closure : surgery transcatheter closure
PDANeonates/InfantsChildren/AdultsHeart failure (+)Heart failure (-)PrematureFull termAnti failureIndometacinSuccessFailSpontaneous closureAnti failureSuccessFailSurgical ligationTranscatheter closurePH (-)PH (+)LRRLHyperoxiaReactiveNonreactiveConservativeAge >12wksW >4kg
Patent Ductus Arteriosus
Patent Ductus Arteriosus
Pulmonary Stenosis Incidence : 8-10%
Anatomy:Pulmonary stenosis valvular : Bicuspid pulmonary valve Valve leaflet thickening and adhession Pulmonary stenosis infundibular : Hyperthropy infundibulum
Pulmonary Stenosis Clinical findingsValvular stenosis Mild : Ejection systolic Wide 2nd HS ejectiin clickModerate: ejection systolic, early systolic clickSevere : ejecstion systolic, ejection click (-) Stenosis infundibular Ejection click ( - )1st HS normal, 2nd HS weak, ejection systolic Pulmonary stenosis periphery1st & 2nd HS normal, ejection systolic
Pulmonary StenosisMild : ejection systolic 2nd HS wide split ejection clickModerate: ejecsi systolic , early ejection click Severe : ejection systolic, click ejection (-)
Poulmonary StenosisDiagnosisAsymptomatic patient:click systolic (stenosis valvular)systolic murmurwide split 2nd HS vary with respiration
Pulmonary Stenosis ECG : RADEchocardiograhhy : confirmation diagnosisCatheterization: increased RV pressure without increased oxygen saturation
Pulmonary StenosisManagement
Medicamentosa : uselessMild stenosis: intervention (-)Moderate stenosis: observationSevere stenosis: balloon valvuloplasty
Pulmonary Stenosis
Tetralogy FallotInsidence5-8% from all CHD
AnatomyCause: Left-anterior deviation of infundibular septum
Sindroma consist of 4 items: VSD pulmonary stenosis aortic over-riding RVH
Tetralogy Fallot
Tetralogy FallotHemodynamic acyanoticHemodynamic cyanotic
Tetralogy FallotDiagnosis
Clinically : cyanosis Single 2nd HS, ejection systolic murmur
Tetralogy FallotSingle 2nd HS, ejection systolic murmur
Tetralogi Fallot
Tetralogy FallotCXR : Boot-shapedConcave pulmonary segmentApex upturnedDecreased pulmonary blood flow
Tetralogy FallotECG : RADEchocardiography : to confirm diagnosis
Tetralogy FallotDiagnosis Differential Pulmonary Atresia Double outlet right ventricle and pulmonary stenosis Transposisi of great arteri and pulmonary stenosis
Management Paliative treatment: Blalock-Taussig shunt Definitive: total correction
Tetralogy of Fallot< 1 yr> 1 yrspell (+)spell (-)propranololfailedsucceedBTStotal correction cathsmall PAgood sized PA clinically ECG CXR echoage 1 yrcathBTS/PDA Stentevaluation
Tetralogy Fallot
Tetralogy Fallot