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Blue babies and pink kids copy

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Over view of Congenital heart Disease

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Blue babies and pink kids copy

  1. 1. BLUE BABIESBLUE BABIES AND PINK KIDSAND PINK KIDS Dr Ravi NarayanDr Ravi Narayan Senior Consultant Ped.Cardiologist,&Senior Consultant Ped.Cardiologist,& Assoc. Prof. CardiologyAssoc. Prof. Cardiology RAMAIAH NARAYANA HRUDAYALAYARAMAIAH NARAYANA HRUDAYALAYA
  2. 2. OVERVIEW OF MANAGEMENT INOVERVIEW OF MANAGEMENT IN COMMON CHDCOMMON CHD
  3. 3. IntroductionIntroduction  CongenitalCongenital—means from birth—means from birth  Congenital heart defects (CHD) canCongenital heart defects (CHD) can vary fromvary from small holessmall holes in the heart toin the heart to veryvery serious malformationsserious malformations  Some defects can manifest in teenageSome defects can manifest in teenage or adults (GUCH)or adults (GUCH)
  4. 4. Cyanosis)—Cyanosis)—note the nails are very bluenote the nails are very blue because of deoxygenated blood entering thebecause of deoxygenated blood entering the aortaaorta
  5. 5. Pink Kid!!!!Pink Kid!!!! IS HIS MURMUR INNOCENT???IS HIS MURMUR INNOCENT???
  6. 6. CLASSIFICATIONCLASSIFICATION • ACYANOTIC//CYANOTIC • SHUNT LESIONS • ASD,VSD,PDA • STENOSIS-- AS, PS, • Narrowing of a pipe -- COA of aorta • Weak heart muscle Cardiomyopathy
  7. 7. CYANOTICCYANOTIC • TOF,TGA, TAPVC, • Truncus,Tricuspid Atresia • E’S –EBSTEIN EISENMENGER • SINGLE ATRIUM • SINGLE VENTRICLE
  8. 8. How big is theHow big is the problemproblem ????  CHD—1/1000 live birthsCHD—1/1000 live births  India---180,000 babies/yearIndia---180,000 babies/year  KARNATAKA STATE—5-8,000KARNATAKA STATE—5-8,000  EstimatedEstimated 5,000/year will have5,000/year will have shunt lesions(“Holes in heart”)shunt lesions(“Holes in heart”)  Easy to diagnoseEasy to diagnose  Reasonably easy to treat unlikeReasonably easy to treat unlike complex heart diseasecomplex heart disease
  9. 9. HISTORY AND EXAMHISTORY AND EXAM  CYANOSIS PRESENT OR NOTCYANOSIS PRESENT OR NOT  DYSPNOEA//TACHPNEADYSPNOEA//TACHPNEA  FAILURE TO THRIVEFAILURE TO THRIVE  MURMUR, CREPS++MURMUR, CREPS++  CCFCCF  CHEST XRAYCHEST XRAY
  10. 10. WHAT IS ECHO??WHAT IS ECHO??  ULTRASOUND OFULTRASOUND OF HEART.HEART.  M MODE, 2D,M MODE, 2D, DOPPLER ANDDOPPLER AND COLOURCOLOUR DOPPLERDOPPLER  3 D3 D  TEETEE
  11. 11. EchocardiographyEchocardiography  Second Stethoscope  ** ExquisiteExquisite anatomy even inanatomy even in neonatesneonates •••Structure and•••Structure and functionfunction  More than 95% ofMore than 95% of cases can be sentcases can be sent for surgery withoutfor surgery without cath.cath.
  12. 12. MANAGEMENTMANAGEMENT • MEDICAL • INTERVENTION • SURGERY
  13. 13. ASD--- left to right shuntASD--- left to right shunt
  14. 14. ASD •TYPES •Secundum •Primum •Sinus venosus •SIZE •PAH
  15. 15. ASD –ManagementASD –Management • >> 10mm • Volume overload • 3-5 years—Device//surgery • 12-15 kg • Moderate ASD or large with good rims >> Device
  16. 16. ASD—SPECIALASD—SPECIAL CIRCUMSTANCESCIRCUMSTANCES SPECIAL CIRCUMSTANCES •SYMPTOMATIC IN INFANCY •PFO AND STROKE •AGE MORE THAN 50 YEARS
  17. 17. Pinhole surgery—another term forPinhole surgery—another term for cardiac interventionscardiac interventions • Key hole—laparoscopic surgery • Pin hole surgery--- like doing angioplasty AND STENT in adults • Small tubes called catheters are passed through the leg veins • A Device is then put into the catheter and released in the heart to block the hole(ASD,VSD,PDA)
  18. 18. ASD Device PDA Device © 2012 Vascular Innovations 22
  19. 19. ASD DEVICEASD DEVICE Clockwise from above: Transcatheter delivery of Amplatzer device, which is positioned across the atrial septal defect Left: Amplatzer device in place
  20. 20. ASD CASEASD CASE  10 YEAR OLD BOY10 YEAR OLD BOY  16 MM SECUNDUM ASD16 MM SECUNDUM ASD  ALL RIMS (EXCEPT AORTICALL RIMS (EXCEPT AORTIC RIM ) MORE THAN 5 MMRIM ) MORE THAN 5 MM  POST. AND INF RIMSPOST. AND INF RIMS SLIGHTLY FLOPPYSLIGHTLY FLOPPY  PLAN– 20 MM ASD DEVICEPLAN– 20 MM ASD DEVICE
  21. 21. ASD Device closureASD Device closure
  22. 22. Fluoroscopy showing ASDFluoroscopy showing ASD devicedevice
  23. 23. Atrial Septal Defect Patch Repair
  24. 24. VSDVSD
  25. 25. Large VSD
  26. 26. VSD --Doppler
  27. 27. VSD—ManagementVSD—Management • Small to moderate VSD and no PAH • Wait upto 5-6 years • Moderate VSD, Mod PAH • Operate 1-2 years of age • Large VSD, severe PAH, preferably 4-5 kg. weight
  28. 28. VSD deviceVSD device
  29. 29. Ventricular Septal Defect RepairVentricular Septal Defect Repair
  30. 30. Patent DuctusPatent Ductus Arteriosus (PDA)Arteriosus (PDA) PDA(connectionPDA(connection between the 2 greatbetween the 2 great arteries—aorta andarteries—aorta and pulmonary artery)pulmonary artery)
  31. 31. PDA -- ManagementPDA -- Management • PDA preterm,Indomethacin//Ibugesic • Term neonate • Large << 5 Kg -- surgery, • >> 5 Kg -- device • Small and moderate –1-2 years, • Device// coil
  32. 32. COILING OF PDACOILING OF PDA Left, top: Catheter crosses the PDA from the aortic side and delivers a coil. Left, bottom: Withdrawal of catheter, leaving coil in PDA
  33. 33. Amplatzer Ductal OccludersAmplatzer Ductal Occluders Amplatzer ductal occluder Illustration courtesy AGA Medical Group Aorta angiogram with device occlusion of PDA, lateral view
  34. 34. Note—dumbell device closingNote—dumbell device closing the PDAthe PDA
  35. 35. Cable has been detached—Cable has been detached— device in good positiondevice in good position
  36. 36. Hypertensive PDA – Closed with 16/18 Device 49© 2012 Vascular Innovations
  37. 37. 50© 2012 Vascular Innovations
  38. 38. PS (pulmonary stenosis—narrowing ofPS (pulmonary stenosis—narrowing of pulmonary valve)pulmonary valve)
  39. 39. Valvuloplasty Pulmonary Balloon Valvuloplasty Lateral angiograms
  40. 40. Aortic stenosis(AS– narrowing of aorticAortic stenosis(AS– narrowing of aortic valve)valve)
  41. 41. Coarctation(narrowing of aorta)Coarctation(narrowing of aorta)
  42. 42. Angioplasty Aortic Coarctation Angioplasty Angiograms showing (left) post-surgical coarctation of the aorta and (right) angioplasty balloon inflated across coarctation site
  43. 43. Intravascular Stents Coarctation of the Aorta Left: uninflated angioplasty balloon and stent within coarctation Middle: expansion of balloon and stent Right: deflation of balloon leaving stent wide open
  44. 44. Advantages of InterventionsAdvantages of Interventions • Short hospital stay • Child can start walking sam day or the next day • Almost 95-99% success can be achieved by interventions
  45. 45. Cardiac Surgery
  46. 46. Breakthroughs in CardiacBreakthroughs in Cardiac SurgerySurgery • Heart lung machine • Cardioplegia • Deep Hypothermia • Circulatory arrest
  47. 47. Tetralogy of FallotTetralogy of Fallot 1 – ventricular septal defect (VSD), 2 –pulmonary stenosis 2a – infundibular stenosis, 3 – enlarged aorta overriding VSD 4 – right ventricular hypertrophy
  48. 48. Tetralogy of Fallot Repair (Above) With Transannular Patch (Right) With Pulmonary annulus retained
  49. 49. In the “pink of health”In the “pink of health”
  50. 50. TGA “Switch operation”TGA “Switch operation”
  51. 51. How do we reach theHow do we reach the common man?common man?
  52. 52. Take Diagnosis to the door stepTake Diagnosis to the door step Mobile Cardiac ClinicMobile Cardiac Clinic
  53. 53. INFECTIVE ENDOCARDITISINFECTIVE ENDOCARDITIS PROPHYLAXISPROPHYLAXIS • REQUIRED • CHD---VSD/PDA • VALVE—BICUSPID AV AND AS • RHD—MR • OPERATED AND DEVICE CLOSURE OF ASD AND PDA , • FIRST 6 MTHS • PROSTHETIC VALVE
  54. 54. IE PROPHYLAXIS NOT REQDIE PROPHYLAXIS NOT REQD • ASD/ PS • MVP WITH NO MR • POST CABG OR STENTING • PACEMAKER
  55. 55. REGIMEREGIME • AMPICILLIN OR AMOXYCILLIN • WITH OR WITHOUT GENTA • CEFATOXIME • 1 HR BEFOR PROCEDURE • 2 DOSES AFTER PROCEDURE
  56. 56. CONCLUSIONS •Early diagnosis •Intervention//surgery •Hybrid//minimally invasive
  57. 57. Team Effort
  58. 58. A parent’s dream---A parent’s dream---

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