screening for CHD neocon 2023.pptx
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approach to structural heart defects for practicing neonatologist
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screening for CHD neocon 2023.pptx
- 1. SCREENINGOFCONGENITALHEARTDISEASE Dr Manish Chokhandre Consultant Pediatric Cardiologist Swasthyam Superspeciality Hospital, Nagpur
- 2. Introduction • CHD- most stressful situation/emergencies • Often complex • Coexisting pathology-heart lung interaction • High mortality • Early diagnosis and management –Key
- 4. Major Neonatal Cardiac Emergencies Blue Baby Grey Baby Pink Baby Cyanosis Shock Heart Failure Arrhythmias HR issue Duct dependent Pulmonary circ Duct dependent Systemic circ Left to right shunt Septicemia, respiratory disorders, persistent pulmonary hypertension of newborn, (PPHN),inborn errors of metabolism and so on
- 5. 5 BASIC QUESTIONS TO BE ANSWERED… • 1. Is it a CHD?? • 2. If yes: Cyanotic or acyanotic?? • 3. Pulmonary Blood flow: Increased? • 4. PAH: +/-?? • 5. Duct dependent lesion??
- 6. Cyanotic or acyanotic • Clinically: nail beds/lips/tongue blue • But if saturation between 85-93% the human eye cannot detect cyanosis • So, the gold standard of detection of cyanosis is PULSE OXIMETER • Infact the pulse-ox is called the 5TH VITAL SIGN
- 7. Classification of chd • Acyanotic • Increase PBF • ASD • VSD • PDA • AP window • Combined • Normal PBF • AS/PS Cyanotic Decrease PBF • TOF • Pulm Atresia Increase PBF TGA TAPVC Truncus arteriosus
- 10. (Diagnosing CHD) Murder mystery!!!!! • Suspects
- 12. Thoracoabdominal situs Associated anomaly Great Artery relationship AV connections Concordant, Discoradant,straddling, atresia Cardiac position Atrial situs Ventricular Looping Solitus/inversus/ambigous Solitus/inversus/ambigous Levo/Meso/Dextro D Looped L Looped VA connections Concordant, Discoradant/TGA, DORV D malposition L Malposition Antero-posterior
- 21. Veins • Systemic veins- (Subcoastal veiw) IVC, SVC, coronary sinus, hepatic veins
- 23. Pulmonary veins • Drains into LA Posteriorly • Best seen in AP4C, PSAX, Subcostal
- 24. Pulmonary veins • Subcostal, suprasternal, apical • Color Doppler: Distinguishes from atrial appendage • 4 in number • Left 2 veins may join: 3 entries into LA
- 25. TAPVC
- 27. Atrial segments and inter-atrial septum • Subcostal • AP4C • PSAX
- 31. ASD
- 32. AV valves and ventricles • AP4C, Subcostal
- 33. AV valves
- 37. AV connections
- 41. 50% rule • For the assessment of AV connections, an atrium is considered to join the ventricle into which >50% of the valve orifice empties • This rule states that a chamber is a ventricle if it receives 50% more of an inlet • The rule of 50% has also been used to define VA connections • Thus, if 50% or more of a great artery arises above a chamber, the great artery is defined as being connected to that chamber
- 50. NRGA- LAP (Left Anterior Pulmonary)
- 52. Arterial segment
- 67. Duct dependent systemic circulation
- 69. Conclusion • Structural Cardiac defect presents in newborn period – significant morbidity/mortality • Early diagnosis is key • Sequential segmental analysis- step wise approach
- 70. Thank you