2. CONGENITAL HEART DISEASE:
âȘ Congenital cardiac malformations resulting from defective embryonic
development without obvious cause.
âȘ Between 3-8 weeks âgestationâ - the fetal heart structures are formed
âorganogenesisâ
3. INCIDENCE:
ïŒ 1/125 live births in approximately.
ïŒ Most common birth defect.
ïŒIncidence is more in :-
a-Premature
b-abortions
c-still births
ïŒIncidence increased for siblings.
5. ACYANOTIC CHD:
âȘ Pink Baby (L â R shunt)
âȘ L â R shunts cause CHF and pulmonary hypertension.
âȘ This leads to RV enlargement, RV failure
âȘ These babies present with CHF and respiratory distress.
âȘ They are not typically cyanotic
âȘ Examples: Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus Arteriosus (PDA)
9. TYPES OF ASD:
âȘ OSTIUM SECUNDUM ASD: Defect in the middle of the atrial septum.
âȘ OSTIUM PRIMUM ASD: Defect in the lower part of the atrial septum.
âȘ SINUS VENOUS ASD: Defect in the upper part of the atrial septum near
where a large vein brings Oxygen poor blood from upper body to RA.
âȘ CORONARY SINUS ASD: Located within the walls of the coronary sinus.
12. MANAGEMENT:
âȘ 20% Of ASD will close spontaneously in the first year of life.
âȘ ASD may close spontaneously as a child grows.
âȘ Usually, an ASD will be repaired if it has not closed on its own by the time the
child starts school- to prevent lung problems that will develop from long time
exposure to extra blood flow.
âȘ Pulmonary arteries become thickened and obstructed due to increased flow,
from L to R for many years.
13. MEDICAL MANAGEMENT :
âȘ While medicines cannot cure an ASD, they may be used to control symptoms until
the hole either closes on its own or until it can be closed using a cath based or
surgical procedure. The main medications used are;
ïŒDIGOXIN: Helps strength the heart muscle enabling to pump more efficiently.
ïŒDIURETICS: Relieve pulmonary congestion.
ïŒANTI-COAGULANTS: Reduce the risk of blood clots.
ïŒAFTER LOAD REDUCING AGENTS.
14. CONTâŠ
âȘ INFECTION CONTROL: Prophylactic antibiotics to prevent bacterial
endocarditis before dental procedure and other invasive procedures.
âȘ NUTRITIONAL MGT:
âȘ ADEQUATE NUTRITION:
âȘ High calorie formula or breast milk.
âȘ Supplemental tube feedings.
15. SURGICAL MGT:
âȘ PRE OP MGT:
âȘ Informed consent is a legal document that explains the tests, treatments, or
procedures that you may need.
âȘ Blood tests.
âȘ NPO.
âȘ An IV is a small tube placed in your vein that is used to give you medicine or
liquids.
âȘ General anaesthesia.
âȘ A Foley catheter.
17. PERCUTANEOUS CLOSURE:
ïTRANSCATHETER MGT: Right heart cath is done.
âȘ This technique involves implantation of one of several devices using cardiac
catheterization.
âȘ CARDIAC CATHETERIZATION - involves slowly moving a catheter (a long,
thin, flexible, hollow tube) into the heart. The catheter is initially inserted into a
large vein through a small incision made usually in the inner thigh (groin area)
and then is advanced into the heart.
18. CONTâŠ
ïŒ An ASD closure device is moved
through the catheter to the heart and
specifically to the location of the
heart wall defect. Once in the correct
location, ASD closure device is
pushed out of the catheter.
ïŒ The device open and expand it shape
to sit each side of the hole. It stops
the abnormal flow of blood between
the two atria chambers of the heart.
19. CONTâŠ
âȘ Catheter is removed and procedure is completed.
âȘ Within a few days, the bodyâs own tissue will begin to grow over the device.
By 3 to 6 months, the device is completely covered by heart tissue and at that
point becomes a part of the wall of the patientâs heart.
23. OPEN HEART PROCEDURE:
âȘ SURGICAL PROCEDURE:
Done to repair primum or sinus venosus ASD.
INCISION: MEDIAN STERNOTOMY.
SURGERY: OPEN HEART SURGERY.
CPB MACHINE is used. The right atrium is then opened to allow access to the atrial
septum below.
DEFECT may be closed with STITCHES(IF THE DEFECT IS TOO SMALL) or a
SPECIAL PATCH(IF THE DEFECT IS TOO LARGE).
The material utilized for a patch closure of ASDâs may be the patientâs own
pericardium, commercially bovine or synthetic material. Eventually tissue of the heart
heals by 6 months.
25. CONTâŠ
âȘ POST OP MGT:
âȘ Chest tubes may be put into chest during surgery. They are used to remove
air, blood, or fluid from around lungs or heart.
âȘ To wear pressure stockings or inflatable boots after surgery.
âȘ Deep breathing and coughing.
âȘ To eat and drink gradually after surgery.
âȘ REGULAR FOLLOW UP.
31. TYPES OF VSD:
ï±MUSCULAR VSD:
ïŒCommon type of VSD.
ïŒOpening in the muscular portion of lower section of ventricular septum.
ïŒCloses spontaneously and donât require surgery.
32. CONTâŠ
ï±PERIMEMBRANOUS VSD:
ïŒOpening in an area of upper section of the ventricular septum called the
membranous septum, located near valves.
ïŒTreated by surgery.
ï±ATRIOVENTRICULAR CANAL TYPE VSD:
ïŒAssociated with AV canal defect.
ïŒVSD is located underneath the tricuspid and mitral valves.
33. CONTâŠ
ï±OUTLET VSD:
ïŒFound in part of the ventricle where the blood leaves the heart.
ïŒRare type of VSD.
ï±CONAL SEPTAL VSD:
ïŒSubarterial, Supracristal, Infundibular.
ïŒRarest VSD.
ïŒOccurs in the ventricular septum just below the aortic valve.
ïŒEffect from L to R shunt causing aortic valve leaflet to prolapse into VSD resulting in
aortic valve regurgitation.
36. TREATMENT:
ï±INDICATIONS FOR SURGERY:
âȘ If VSD remains large and unrestrictive-surgical closure at age
4 to 6 months.
ï§ VSD with pulmonary stenosis.
ï§ Large VSD with pulmonary HTN.
ï§ VSD with aortic regurgitation.
39. CONTâŠ
âȘ PRE OP MGT:
âȘ Informed consent is a legal document that explains the tests, treatments, or
procedures that you may need.
âȘ Blood tests.
âȘ NPO.
âȘ An IV is a small tube placed in your vein that is used to give you medicine or
liquids.
âȘ General anaesthesia.
âȘ A Foley catheter.
40. MANAGEMENT:
âȘ SURGICAL MGT:
ïŒTRANSCATHETER CLOSURE: Cardiac cath is done.
ïŒ Device used to close the hole is moved through the catheter to the heart and specifically to
the location of the heart wall defect. Once in the correct location, VSD closure device is
pushed out of the catheter.
ïŒ The device open and expand it shape to sit each side of the hole. It stops the abnormal
flow of blood between the two VENTRICULAR chambers of the heart.
41. CONTâŠ
âȘ Catheter is removed and procedure is completed.
âȘ The device will remain in the heart permanently closing the hole in the heart
wall.
âȘ Full closure of the ventricular defect within the 24hrs of placement.
42. TYPES OF VSD CLOSURE:
âȘ AMPLATZER MUSCULAR VSD OCCLUDER:
44. SURGICAL MGT:
âȘ Surgical closure of a perimembranous VSD is performed on CPB.
âȘ Incision: Median sternotomy.
âȘ Surgery: Open heart surgery.
âȘ Surgical exposure is achieved through the right atrium. The tricuspid valve septal
leaflet is retracted or incised to expose the defect.
âȘ Defect is closed by sewn a patch native or bovine pericardium.
âȘ Suture techniques: horizontal pledged mattress sutures and running polypropylene
suture.
45. CONTâŠ
âȘ Critical attention is necessary to avoid injury to the conduction system.
âȘ Care is given to avoid injury to aortic valve with sutures.
âȘ Intraoperative TEE is used to confirm secure closure of the VSD, normal
functioning of aortic and tricuspid valves,good ventricular function.
âȘ The sternum, fascia and skin are closed.
46. CONTâŠ
âȘ POST OP MGT:
âȘ Chest tubes may be put into chest during surgery. They are used to remove air,
blood, or fluid from around lungs or heart.
âȘ To wear pressure stockings or inflatable boots after surgery.
âȘ Deep breathing and coughing.
âȘ To eat and drink gradually after surgery.
âȘ REGULAR FOLLOW UP.