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Congenital Heart Diseases PowerPoint Presentation

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Description : Check out this medical presentation on Congenital Heart Defect, which is titled "Congenital Heart Diseases", to know about Congenital Heart Diseases, anatomic abnormalities of the heart and great vessels that present from birth.

Tags : Congenital Heart Defect, Congenital Heart Diseases, anatomic abnormalities, heart, great vessels, embryogenesis, cardiac defects

Published on : Jul 01, 2021 | Views : 3999 | Downloads : 23

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CONGENITAL HEART DISEASES Definition: Anatomic abnormalities of the heart and great vessels that present from birth.
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INTRODUCTION Congenital heart diseases are due to the defect in embryogenesis during 3-8 weeks of gestation during which development of CVS begins. Severe cardiac defects are incompatible with life leading to intra uterine death. And those who borne will have clinical symptoms soon after birth or in childhood life or adult life that depends on the severity of the defects
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INTRODUCTION Incidence: Congenital heart diseases most common type of heart disease among children. 6 – 8 per 1000 full term live births. Increased incidence in premature babies or stillborn babies. Ventricular septal defect (VSD) is the commonest congenital heart defect.
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ETIOPATHOGENESIS Genetic: Chromosomal abnormalities are associated with increased incidence of congenital heart disease. Eg :Trisomy 21 (Down syndrome) ,Turner syndrome. Environmental: Congenital rubella infection and teratogenic substances
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Genetic basis Mutations of the transcriptional factors. Developmental errors in mesenchymal tissue migration. Defects in extracellular matrix.
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CLASSIFICATION Congenital heart diseases can be broadly classified into three categories. Left to right shunt. Right to left shunt. Obstructive defects.
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Left to right shunts: Atrial septal defect (ASD). Ventricular septal defect (VSD). Patent ductus arteriosus (PDA). Right to left shunt: Tetralogy of Fallot (TOF). Transposition of great vessels (TGV). Truncus arteriosus. Tricuspid atresia. Obstructive defects: Coarctation of aorta. Aortic stenosis.
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MECHANISM Shunt: Is an abnormal communication between the heart chambers or vessels that facilitate the blood to flow from right to left or left to right depending on the pressure gradient.
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MECHANISM Right to left shunt venous blood mixes with the arterial blood leading to decreased pulmonary flow and mixing of venous blood causing cyanosis - cyanotic congenital heart diseases. In these types of shunts venous emboli can bypass pulmonary circulation and filtration causing paradoxical embolism. Clinically : cyanosis, clubbing and polycythemia.
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MECHANISM Left to right shunt arterial blood mixes with the venous blood causing increased pulmonary flow resulting in increased pulmonary pressure. Patient develops pulmonary hypertension and right ventricular failure.
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MECHANISM In the later course of the disease increased right ventricular pressure results in reversal of the shunt causing late cyanosis and so called as late cyanotic congenital heart disease. Reversal of shunt in a left to right shunt is called as Eisenmenger syndrome. Advanced and irreparable stage of shunt reversal leads to death.
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ATRIAL SEPTAL DEFECT (ASD) Atrial septal defect is a late cyanotic congenital heart disease. 8% of all CHDs. It is the commonest type of CHD that is asymptomatic till adulthood. In ASD there is an abnormal opening in inter atrial septum, which allow blood flow between left atrium and right atrium
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Morphology Morphologically three types. Secundum ASD: Most common type with 90% incidence. It is due to defect near fossa ovale. Primum ASD: Next common type of ASD. The defect is adjacent to AV valve. Sinus venosus type: Least common type and the defect is near the superior vena cava opening.
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Clinical course Cause left to right shunt as the right atrial pressure is less than left atrial pressure and right atrium is more distensible than left atrium leading to pulmonary flow 3-4 times of normal. These patients are asymptomatic till the age of 30 years and later develop right ventricular failure, pulmonary hypertension and reversal of shunt and cyanosis.
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Complications Right ventricular failure. Pulmonary hypertension. Paradoxical embolism. Treatment Surgical correction before the irreversible pulmonary vascular changes develops.
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VENTRICULAR SEPTAL DEFECT (VSD Late cyanotic congenital heart disease. commonest type of CHD. 30% of all CHDs. In VSD there is an abnormal opening in inter ventricular septum, which allow blood flow between left ventricle and right ventricle
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Morphology Morphologically three types Membranous VSD: Commonest type of VSD comprising 90% of VSD. The defect is present in the membranous part of interventricular septum. Infundibular VSD: The defect is present in the muscular part of interventricular septum. Swiss cheese VSD: Multiple fenestrations in the muscular part of interventricular septum
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Clinical course Smaller defects close spontaneously and unclosed smaller defect present late in life. Large defects cause significant left to right flow and present in infancy. If untreated later cause right ventricular failure, pulmonary hypertension and reversal of shunt and cyanosis and death. Treatment Surgical correction if the defect is large at the age of one year.
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PATENT DUCTUS ARTERIOSUS (PDA) Late cyanotic congenital heart disease 8% of all CHDs. There is persistence of communication between aorta and pulmonary artery, which is normally present in the intra uterine life -persistent ductus arteriosus. Persistence after 3 months is considered abnormal 90% of PDAs are isolated type. 10% are associated with other CHDs.
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FALLOT’S TETRALOGY It is the early cyanotic congenital heart disease Most common type of cyanotic CHD. Embryologically it is due to anterosuperior displacement of infundibular septum.
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Four morphological features VSD. Subpulmonary stenosis causing obstruction to right ventricular outflow. Overriding of aorta on VSD. Right ventricular hypertrophy.
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Clinical features Severity depends on subpulmonary stenosis. Mild stenosis behaves similar to VSD (left to right shunt) without cyanosis called as “pink tetralogy” as there is no cyanosis. Severe stenosis is associated with high right ventricular pressure, right to left shunt and cyanosis called as “classical tetralogy”. Heart is enlarged and boot shaped.
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TRANSPOSITION OF GREAT VESSELS (TGV) It is an early cyanotic congenital heart disease in which there is transposition of pulmonary artery and aorta. Also called as transposition of great arteries (TGA). Aorta arises from right ventricle and pulmonary artery arises from left ventricle.
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AV connections are normal (concordant). This kind of defect is incompatible with postnatal life. TGA with VSD is seen in 35% cases, which have stable shunt. TGA with PDA is seen in 65% cases, which have unstable and needs immediate surgical corrections.
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PERSISTENT TRUNCUS ARTERIOSUS Early cyanotic congenital heart disease. There is failure of separation of embryologic truncus arteriosus into aorta and pulmonary artery and a single great artery receives blood from both ventricles. The persistent truncus is always accompanied by a membranous ventricular septal defect
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TRICUSPID ATRESIA Early cyanotic congenital heart disease. Rare anomaly Complete occlusion of tricuspid valve due to an unequal division of AV canal that is associated with large mitral valve. Circulation is maintained by VSD or PDA and these cases have high mortality in first weeks or months of life.
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COARCTATION OF AORTA Obstructive CHD with narrowing or constriction of aorta. Male to female ratio is 2:1.
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Two types Infantile form: Coarctation is proximal to PDA. Adult form: Coarctation is opposite to closed PDA. Cases with coarctation with PDA have differential cyanosis. cases with coarctation without PDA have hypertension in upper limbs, weak pulse and hypotension in lower limbs
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