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Acyanotic Congenital Heart Disease

Acyanotic Congenital Heart Disease. Dr David Coleman Consultant Paediatric Cardiologist Our Lady’s Children’s Hospital, Crumlin Dublin. Common Shunt Lesions. ♥ Ventricular septal defect (VSD) ♥ Atrial septal defect (ASD) ♥ Patent ductus arteriosus (PDA).

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Acyanotic Congenital Heart Disease

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  1. AcyanoticCongenital Heart Disease Dr David Coleman Consultant Paediatric Cardiologist Our Lady’s Children’s Hospital, Crumlin Dublin

  2. Common Shunt Lesions ♥Ventricular septal defect (VSD) ♥ Atrial septal defect (ASD) ♥ Patent ductus arteriosus (PDA) * All 3 lesions can lead to Eisenmenger’s Syndrome if a large lesion is not detected and treated early enough

  3. Common Stenotic Lesions ♥ Pulmonary stenosis (PS) ♥ Aortic stenosis (AS) ♥ Coarctation of the aorta (CoA)

  4. VSD’s ♥Commonest form of CHD ♥Commonest types: membranous (perimembranous) ~75% muscular ♥Can be single or multiple

  5. VSD’s ♥ Symptoms relate to the degree of shunt (VSD size, pulmonary vascular resistance) if small: no symptoms if large (high pulmonary blood flow, CHF): tachypnoea dyspnoea slow feeding failure to thrive sweating

  6. VSD’s ♥Exam (smaller VSD): pink normal pulses normal S1 and S2 ±systolic thrill harsh pansystolic murmur LLSE ♥ ECG: normal (smaller VSD) or LVH ± RVH (larger VSD)

  7. VSD’s ♥Larger defect: MDM @ apex (mitral flow murmur) narrowly split S2 and loud P2 ± S3 CXR: cardiomegaly increased pulmonary vascularity

  8. VSD’s ♥Treatment options: Nil (spontaneous closure) Surgical closure Device closure

  9. ASD’s ♥ Three types: secundum primum sinus venosus ♥ Commonest: secundum ♥ Primum: a form of atrioventricular septal (canal) defect

  10. Secundum ASD ♥Usually no symptoms in childhood ♥ Exam: pink normal pulses wide ±‘fixed’ split S2 soft ESM @ ULSE ♥ECG:incomplete RBBB (95%) ♥ CXR: often normal sometimespulmonary plethora

  11. Secundum ASD ♥Haemodynamic significance of ASD is assessed to decide if closure appropriate ♥ Usually closed age 3-5 years (earlier if symptomatic) or when diagnosed if later ♥Two options for closure: surgery - suture or patch interventional catheter - device

  12. Amplatzer ASD Occluder

  13. PDA ♥CHF symptoms if large ductus in very young infant, otherwise often asymptomatic ♥Exam: pink full volume pulses harsh systolic (1st few weeks) or continuous ‘machinery’ murmur loudest under left clavicle ♥ECG:normal (small PDA) LVH ± RVH (large PDA)

  14. PDA ♥ CXR: ±cardiomegaly, pulm plethora ♥Options for closure: surgery - ligation interventional catheter - coil(s) or device

  15. Pulmonary Stenosis ♥Usually asymptomatic ♥ Exam: pink normal pulses ±systolic ejection click ESM loudest @ ULSE if severe, S2 widely split (not fixed)

  16. Pulmonary Stenosis ♥ECG: RAD, RVH ♥ CXR: normal ± prominent MPA (post-stenotic dilatation) ♥ Treatment of valvar PS (moderate/severe): balloon valvuloplasty preferred uncommonly surgical valvotomy

  17. Aortic Stenosis ♥ Often asymptomatic; otherwise SOB, syncope or chest pain on exertion ♥Exam: pink small volume pulse, small pulse pressure ±LV lift ±systolic thrill (suprasternal, URSE) ± systolic ejection click harsh ESM loudest @ URSE & radiating to carotids if severe, narrow split S2 (even reversed)

  18. Aortic Stenosis ♥ ECG: normal (mild AS) LVH ± strain (more severe AS) ♥ CXR: often normal ± dilated ascending aorta ♥Treatment of valvar AS (moderate/severe): balloon valvuloplasty surgical valvotomy

  19. Coarctation of the Aorta ♥CHF in neonate if severe CoA; often asymptomatic in older child ♥Exam:pink reduced or absent femoral pulses soft systolic murmur mid LSE and/or mid left back ♥ECG: RVH in 1st few months of life, LVH if older

  20. Coarctation of the Aorta ♥CXR: cardiomegaly evidence of CHF rib notching (older child) ♥Treatment: surgery for ‘native’ CoA balloon angioplasty for re-CoA

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