pathophysiology of CHD

1. Congenital Heart Diseases

3. Classification
1-Acyanotic congenital heart disease
• Patent ductus arteriosus
• Coarctation of the aorta
• Atrial septal defects
• Ventricular septal defects
2-Cyanotic congenital heart disease
• Fallot’s tetralogy
• Transposition of the great vessels
• Total anomalous pulmonary venous drainage
• Eisenmenger’s syndrome

4. Cyanotic congenital heart diseases
1-Fallot’s tetralogy
• This is the most common cyanotic congenital
heart disease, the four intracardiac lesions
include:
• VSD (ventricular septal defect)
• overriding aorta
• pulmonary stenosis
• Right ventricular hypertrophy.

6. Clinically:
•1-there may be no signs
•2-cyanosis typically develops within
the first year of life.
•3-Lethargy and tiredness
•4-Squatting is an adaptation by the
child to hypoxic spells.

7. Diagnosis
•Chest x-ray show boot- shape heart
•Echocardiography is definitive
diagnosis
•Treatment:
•Surgical correction of the anomaly

8. 2-Transposition of the greatvessels
• Is the second most common cyanotic congenital
heart disease and is the most common cause of
cyanosis from a congenital cardiac defect
discovered in the newborn period.
• TGV results from abnormal development and
typically occurs when the aorta arises from the
right ventricle and the pulmonary artery from
the left ventricle

10. Clinically:
• Severe central cyanosis occurring in the
first 48 hours of life.
• Diagnosis:
• Cardiac catheterization
• echocardiography
• Treatment:
Arterial switch procedure.

11. 3-Total anomalous
pulmonary venous drainage
•1-2 per cent of congenital heart
disease.
•The pulmonary venous drainage has
become disconnected from the left
atrium and drains into the systemic
venous circulation at some other
point (inferior vena cava, superior
vena cava, coronary sinus or right
atrium)

13. Clinically:
•Cyanosis
•cardiac failure
•recurrent chest infections
•failure to thrive
•feeding difficulties

14. •Diagnosis:
•Echocardiography and cardiac
(pulmonary) angiography are
necessary to confirm the diagnosis
and establish the location of the
anomalous drainage.
•Treatment: surgery

15. Acyanotic congenital heart disease
1-Patent ductus arteriosus
• Normally, functional closure of the ductus occurs within a few
hours of birth.

16. Clinically:
•1-Machinery murmur in the
left second intercostal space
•2-larger ducts cause heart
failure.
•3-shunt reversal causes
cyanosis and clubbing.

17. Diagnosis:
•echocardiography with color flow
Doppler imaging.
•Cardiac catheterization.
•Treatment:
• interventional radiology via coil or
umbrella , or surgical correction if
the lesion is very large

18. 2-Coarctation of the aorta
•Defined as a hemodynamically
significant narrowing of the aorta.
The coarctation typically puts a
pressure load on the left ventricle,
which can ultimately fail.

20. Clinically:
• The child may appear well in the first few days of
life because the coarctation is bypassed by the
ductus arteriosus.
• Hypertension is a common presenting problem
in older children.
• A radio-femoral delay and a murmur that is
continuous and heard best over the thoracic
spine or below the left clavicle.

21. •Diagnosis:
•Chest x-ray
•Echocardiography
•Cardiac catheterization
•Treatment: surgery

22. 3-Atrial septal defect
• A defect in the septum between the left and right atria leading
to a left-to-right shunt

23. •Clinically:
•Typically presenting in middle age
with congestive cardiac failure
secondary to pulmonary hypertension
or with atrial arrhythmias
•Dyspnea and recurrent chest
infections
•Diagnosis: echocardiography
•Treatment: surgery

24. 4-Ventricular septal defect
• A defect in the interventricular septum
that allows a
• left-to-right shunting of blood.
• The VSD permits a left-to-right shunt at
the ventricular level, with subsequent
right ventricular volume overload and
increased pulmonary blood flow. This may
lead to progressive pulmonary oedema
and congestive cardiac failure.

26. • Clinically:
• A loud pansystolic murmur can be detected at
the left sternal border
• Large defects typically present with congestive
cardiac failure
• Diagnosis:
• Echocardiography
• Cardiac catheterization
• Treatment: surgery