2. Table of contents
Definition
Pathology
Clinical features
Signs
investigations
Complications
treatment
3. Introduction:-
Congenital heart diseases is the abnormality
of the heart at birth
It is the most common and important form of
heart diseases in the early years of life and is
present about 0.5% of new born children
4. Causes:-
1) Rubella infection to the mother when
pregnant
2) Drugs taken by the mother
3) Heavy alcohol drinking by the mother
5. Congenital heart diseases may be divided as
following
1) Coarctation of Aorta
2)Patent Ductus Arteriosus
3)Ventricular Septal Defect
4)Atrial Septal Defect
5)Tetralogy of Fallot
7. Definition:-
The word coarctation means contracted or
compressed
Coarctation of the aorta is defined as the
narrowing of the lumen of the aorta
It can occur anywhere on the length of the
aorta
But it is commonly located immediately below
the origin of the of the left subclavian artery
8.
9. Pathology:-
Morphological features:-
1) Post ductal type or adult type :- the
obstruction is just distal to the point of entry of
ductus arteriosus which is often closed
The condition is recognized in adulthood ,
characterized by hyper tension in the upper
extremities , weak pulses and low blood
pressure in the lower extremities and effects of
arterial insufficiency such as claudication and
coldness
10. in time there is development of collateral
circulation between pre stenotic and post
stenotic arterial branches
2) Pre Ductal or Infantile type:- the
manifestations are there in early life . The
narrowing is proximal to the ductus arteriosus
which usually remains patent .
the narrowing is generally gradual and
involves larger segment of the proximal aorta
11. Preductal coarctation results in right ventricular
hypertrophy while the left ventricle is small
Cyanosis develops in the lower half of the body
while the upper half remains unaffected since
it is supplied by vessels
12.
13. Clinical features:-
Physical examination
Differential cyanosis
Signs of cardiac shock
Reduced or absent femoral pulses
Lower BP in lower limb compare to upper limb
14. Mild COA Is asymptomatic and chronic hypertension
Headache
Epistaxis
Leg fatigue
Stroke secondary to rupture of cerebral aneurysm
in adults
Chronic COA
Presented about 7 to 10 days
Circulatory collapse and shock
15. Signs:-
Lower segment of the body is under developed
Weak and delayed femoral pulses
Prominent pulsations in the neck
Cork screw shaped retinal arteries
Heaving apical pulses
Suzman sign is dilated tortuous . Pulsatile
arteries seen around the scapula and intercoastal
regions in the back . It is seen better once the
patient bent forward
16. Investigations:-
The following investigations are of the
following
1) echocardiography
2) electro cardiography
3) angiogram
4) radiological findings
Cardiac catherisation and aortagraphy can be
used to locate the site of coarctation of aorta
17. The following features of radiological findings are
as follows
Rib notching or dock sign is the notching of the
undersurface of the posterior ribs , extending from
third to ninth ribs
Post stenotic dilatation of the aorta distal to the
coarctation
3 sign is a combination of the dilated subclavian
artery above , stenosed , coarcted segment in the
middle and dilated post stenotic aorta below
18.
19.
20. Complications:-
Hypertension
Left ventricular failure
Aortic dissection and rupture of the aorta
Infective endocarditis
Persistent renal damage
21. Treatment:-
Coarctation of the heart can be treated as
follows
In symptomatic new born PGE1 is given to re
open the ductus arteriosus and also promote
the blood flow to the lower extremities
Digoxin can also be given
Surgical repair can be done by procedure such
as
Balloon angioplasty and stenting
23. DEFINITION:-
Ductus arteriosus is a vessel leading from the
bifurcation of the pulmonary artery to the aorta
just distal to the origin of left subclavian artery
This is functional in foetus as it diverts
desaturated blood from main pulmonary artery
into the descending aorta and placenta for
oxygenation
It closes after birth . Persistence of the patency
is also known as patent ductus arteriosus
24.
25. Pathology:-
Morphological features:-
The ductus arteriosus is a normal vascular
connection between the aorta and the bi
furcation of the pulmonary artery
the persistence of the duct after 3 months is
abnormal
The continued presence of PGE2 maybe the
cause of the ductus arteriosus
26. Morphological features :- the effects of PDA is that
the left to right shunt at the level of the ductus
arteriosus is increased .
There is increased volume and increased
pulmonary flow
the following effects are as follows
1) Volume hypertrophy of the left atrium
2) Enlargement and haemodynamic change in the
mitral valve
3) Enlargement of the ascending aorta
27. Clinical Features:-
Dyspnea
Collapsing pulse
Continuous thrill at the upper left sternal edge
First heart sound is loud
Left ventricular third heart sound and a mid
diastolic flow murmur at the apex
Retardation of growth
More common in females
29. In electrocardiogram frequently shows left
atrial enlargement .
It also includes features such as left ventricular
hypertrophy
Chest x rays shows plethoric fields
31. Management:-
Surgical ligation of division of the ductus
Use of diuretics
In pre mature babies a medical closure of the
ductus may be done by using indomethacin
Surgical management is done by thoracotomy
32. References
Harsh mohan textbook of pathology 6 th
edition
K George mathew
Davidson principles and practice of medicine