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    Sithu ko Sithu ko Presentation Transcript

    • Frequency of congenital heart diseases in Tuschinskaya Children’s hospital from the year 2000 to 2009
    • Classification of congenital cardiac defects Left to right shunts Right to left shunts Obstructive lesions Mixing
      • Ventricular septal defect
      • Atrial septal defect
      • Atrioventricular septal defect
      • Patent ductus arteriosus
      • Tetralogy of Fallot
      • Transposition of great arteries
      • Tricuspid atresia
      • Aortic stenosis
      • Pulmonary stenosis
      • Coarctation of aorta
      • Truncus arteriosus
      • Total anomalous pulmonary venous return
      • Hypoplastic left heart syndrome
    • The worldwide incidences of different types of congenital heart diseases VSD=Ventricular Septal Defect ASD=Atrial Septal Defect AVSD=Atrioventricular Septal Defect TOF=Tetralogy of Fallot COA=Coarctation of Aorta PS=Pulmonary Stenosis PDA=Patent Ductus Arteriosus AS=Aortic Stenosis TGA=Transposition of Great Arteries TAPVR=Total anomalus Pulmonary Venous Return HLV=Hypoplastic Left Heart
    • Aim of the study
      • To find out the frequency and types of congenital heart diseases in newborns in Tuschinskaya Children’s Hospital from the year 2000 to 2009
      • Study Design
      • There are total 2582 newborns admitted in Tuschinskaya Children’s Hospital from the year 2000 to 2009
      • The number of newborns with congenital Heart diseases => 113
    • Frequency of congenital heart diseases in newborns in Tuchinskaya Childrean’s Hospital from 2000 to 2009
    • Difference in frequency of congenital heart diseases between boys and girls
    • Different types of Congenital Heart Diseases within 10 years in Tuschinskaya Children’s Hospital
      • All newborns with congenital heart diseases = 113 patients
      • (a) Septal Defects in all years = 108 patients(95.6%)
      • Atrial septal defects ( open foramen ovale) = 85 patients(75.2%)
      • Atrial septal defects =11 patients(22.1%)
      • All atrial septal defects =91 patients(80.5%)
      • Ventricular septal defects =25 patients(13.2%)
      • Atrioventricular septal defects =15 patients(9.7%)
      • ( b)Non-spetal defects in all years = 23 patients(20.3%)
      • Patent ductus arteriosus = 13 patients(11.5%)
      • Tetralogy of Fallot = 1 patients(0.88%)
      • Aortic stenosis = 1 patients(0.88%)
      • Hypoplastic left ventricle = 1 patients(0.88%)
      • Septal aneurysms = 3 patients(2.6%)
      • Cardiac Rhabdomyoma = 1 patients(0.88%)
      • Truncus arteriosus = 1 patients(0.88%)
      • Syndromes =3 patients(2.6%)
      •  
    • T ypes of congenital heart diseases in newborns in Tuchinskaya Children’s hospital from the year 2000 to 2009
      • In ASD,
      • small defects = <5mm (diameter)
      • Medium defects = 5-8mm (diameter)
      • Large defects = >8mm ( diameter)
      • Small to moderate sized ostium secundum septal defects =>spontaneous closure or reduction in size =>no medical intervention is needed.
      • Such patients should be followed until age 3-4 years then =>consider either device use or surgical closure.
      • No specific medications
      • There are only 3 patients with congenital heart diseases who presented Heart Failure (3.5%)
      • They are _
      • 2 newborns with Open ductus arteriosus and
      • A newborn with Truncus arteriosus
      • If patients with congenital heart diseases develop heart failure,
      • oxygen,
      • diuretics (frusemide, spironolactone, ACE inhibitors, thiazides) and
      • digoxin can be given
      • Digoxin dose=> 0.05mg/kg for 3 days
      • After 3 rd day, if the pulse is normal full dose/5 is given
      • If Bradycardia (+), 1/6-1/7 from full dose is given
      • If Tachycardia (+), ¼ from full dose is given
    • Clinical pictures of congenital heart diseases
      • Left to right shunts => Frequent chest infections
      • => Tendency to develop congestive
      • heart failure( Tricuspid or mitral delayed diastolic murmur )
      • => No cyanosis
      • Right to left shunts => Cyanosis => polycythemia, clubbing
      • Ejection systolic murmur
      • (1) Cyanosis with normal or
      • decreased pulmonary pressure=> moderate to severe cyanosis
      • (2) Cyanosis with increased
      • pulmonary pressure => mild cyanosis=>irreversible pulmonary
      • hypertension
      • Obstructive lesions => Heaving cardiac impulse <= concentric hypertrophy of the ventricles (Without Cardiomegaly)
      • =>No Frequent chest infections , no cyanosis
      • Ejection systolic murmur
    • Investigations for Congenital Heart Diseases
      • Chest X Ray => Size and shape of the Heart
      • => Pulmonary complications
      • Electrocardiogram => state of atriums and ventricles
      • => Pulmonary Hypertension +/_
      • => Rhythm abnormalities +/_
      • Echocardiogram => Type and size of the lesions
      • => Associated lesions +/_
      • Cardiac catheterization => Detailed abnormal anatomy
      • Angiography => Detailed abnormal anatomy
    • Treatment Options For Congenital Heart Diseases
      • Treatments depend on =>Type , Size , Severity of lesions
      • =>Associated lesions +/_
      • =>Complications (Pulmonary hypertension,
      • Heart failure, Arrhythmias) +/_
      • Medical Treatments =>Nutrition
      • =>Treatment of associated anemia or infections
      • =>prevention of Infective Endocarditis
      • =>Treatment of complications
      • Surgical Treatments=> Options depend on Type, size , severity , (+/_) of complications, Age of the Patient
      • Palliative or
      • Corrective Surgery
      • Cardiac Catheterization=> Minimal
      • Invasive Treatment
    • A case of newborn with Atrioventricular septal defect with patent ductus arteriosus in the Intensive care Unit of Tuschinskaya Children’s Hospital ( 03.03.2010 to 21.03.2010)
      • 10 days old boy- birth weight 2540g , body length 49cm was admitted in neonatal intensive care unit of Tuschinskaya Children’s Hospital from 03.03.2010 to 21.03.2010 (18 days)
      • Diagnosis => Congenital heart Disease( Atrioventricular septal defect and pulmonary hypertension ) with Heart Failure (Grade II) and also associated with Dawn’s syndrome and polydactaly.
      • Mother is 34 years old and had medical and gynecological problems such as chronic cholecystitis, arterial hypertension, adnexitis, uterine erosion.
      • Clinical Features
      • General condition of the child after birth is poor(serious)
      • Systolic murmur was heard on the 1 st day of life
      • Meconium aspiration syndrome (+) and
      • initially treated by suction with endotracheal intubation
    • Investigations
      • Investigations include Blood analysis, Chest X ray, Electrocardiogram(ECG), and Echocardiogram
      • Chest X ray ( 21.03.2010) ,
      • right sided pneumonia with
      • atelectasis , Congenital Heart
      • disease and Cardiomegaly
      • was diagnosed
    • Electrocardiogram (ECG)
      • Sinus tachycardia and acute P wave demonstrating the right atrial hypertrophy
    •  
      • Left axis deviation in V5 and V6 demonstrating the right ventricular hypertrophy
    • Echocardiogram
      • In Echocardiogram(05.03.2010),
      • Atrioventricular septal defect is diagnosed and Atrial septal defect is more significant.
      • In the Echocardiogram(16.03.2010) blood flow through the ASD is noted.
      • Pulmonary artery _ 12mm
      • Patent Ductus arteriosus_3mm
      • the aorta arising from the left
      • ventricle and the pulmonary
      • trunk from the right ventricle
      • with aorto-pulmonary
      • communication which is
      • demonstrating feature of
      • atrioventricular septal defect.
      • Ineffective functioning of the valves during systole.
    • Management in Intensive Care Unit (ICU)
      • Monitoring
      • The patient was monitered by_
      • 2 Hourly Blood pressure,
      • Hourly Pulse Rate,Respiratory Rate,Temperature, and SaO2
      • Hematocrit, Hemoglobin(Hb), pH, PCO2, PO2 are also monitored
    • Treatment
      • Nutrition - Frisopre 40ml 7 times=280 ml/day
      • Infusion Therapy - Fluid Volume => 121 ml/kg/day (2.5kg)
      • 20% Glucose - 15ml
      • 10% Aminoven infant - 5ml
      • 4% KCL - 5ml
      • 10% Ca-gluconate - 4ml
      • Genapin(200units) - 4ml
      • Rate=> 1,5 ml per hour
      • Antibiotic Treatment
      • IV Maksicef(MgSO4) 150mg (1,5ml) .. 2 times/ day
      • IV Angesin 40mg (0.8ml) + 5% glucose (4.2ml ) .. 3 times/ day
      • IV Diflucan 26mg (13 ml) .. 1 time per day
      • Treatment for heart failure
      • IV Digoxin 0,001% … 0.5 ml .. 2 times per day
    • Conclusion
      • From the year 2000 to 2009, the medium frequency of congenital heart diseases in newborns in each year is 4% .
      • It is found that septal defects(95.6%) are more common than non-septal defects(20.3%) and there are newborns with both septal and non-septal defects(15.9%).
      • Among the defects, atrial septal defects are the commonest form (80.5%) and ventricular septal defects are the second commonest ( 13.2%).
      • 2.8% of newborns with congenital heart diseases are associated with Syndromes.
      • Patients are treated medically to relieve symptoms and to be ready for proper surgical treatment.
    •