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1. Congenital Heart Defects
DR. SAHAR ADHAM

2. Congenital heart defects are problems with
the heart's structure that are present at birth.
Congenital heart defects change the normal flow
of blood through the heart. There are many
types of congenital heart defects. They range
from simple defects with no symptoms to
complex defects with severe, life-threatening
symptoms.

3. They affect 8 out of every 1,000 newborns. Each
year, more than 35,000 babies in the United
States are born with congenital heart defects.
Many of these defects are simple conditions.
They need no treatment or are easily fixed.
Some babies are born with complex
congenital heart defects. These defects
require special medical care soon after birth.

4. What is Atrial Septal Defect?
An atrial septal defect is a birth defect of the heart in which there is a hole in
the wall (septum) that divides the upper chambers of the heart (atria). A
hole can vary in size and may close on its own or may require surgery.
As a baby develops during pregnancy, there are normally several openings in
the wall dividing the upper chambers of the heart (atria). These usually
close during pregnancy or shortly after birth. If one of these openings
does not close, a hole is left, and it is called an atrial septal defect.
The Centers for Disease Control and Prevention (CDC) recently estimated that
each year about 1,966 babies in the United States are born with an atrial
septal defect.

5. Signs and symptoms of a large or untreated atrial
septal defect may include the following:
 Frequent respiratory or lung infections
 Difficulty breathing
 Tiring when feeding (infants)
 Shortness of breath when being active or exercising
 Skipped heartbeats or a sense of feeling the
heartbeat
 A heart murmur, or a whooshing sound that can be
heard with a stethoscope
 Swelling of legs, feet
 Stroke

6. Diagnosis:
It is possible that an atrial septal defect might not be diagnosed until
adulthood an atrial septal defect is found by detecting a murmur
when listening with a stethoscope . The most common test is an
echocardiogram which is an ultrasound of the heart.
Treatments
• Sometimes medications are prescribed to help treat symptoms.
• Surgery involves fixing the hole and may be done through cardiac
catheterization or open-heart surgery. After surgery, follow-up care
will depend on the size of the defect, person’s age, and whether the
person has other birth defects.

7. ventricular septum defect
A ventricular septal defect (VSD) is a defect in the
ventricular septum, the wall dividing the left and
right ventricles of the heart.
The ventricular septum consists of an inferior muscular
and superior membranous portion
The membranous portion, which is close to the
atrioventricular node, is most commonly affected in
adults and older children in the United States. It is
also the type that will most commonly require
surgical intervention, comprising over 80% of cases.

8. • Pathophysiology
• During ventricular contraction, or systole, some of the blood
from the left ventricle leaks into the right ventricle, passes
through the lungs and reenters the left ventricle via the
pulmonary veins and left atrium. First, the circuit refluxed of
blood causes volume overload on the left ventricle. Second,
because the left ventricle normally has a much higher systolic
pressure (~120 mmHg) than the right ventricle (~20 mmHg),
the leakage of blood into the right ventricle therefore elevates
right ventricular pressure and volume, causing pulmonary
hypertension with its associated symptoms.
• In serious cases, the pulmonary arterial pressure can reach
levels that equal the systemic pressure. This reverses the left
to right shunt, so that blood then flows from the right
ventricle into the left ventricle, resulting in cyanosis.
breathlessness, poor feeding and failure to thrive in infancy.
Patients with smaller defects may be asymptomatic.

9. Signs & Symptoms :
 Shortness of breath,
 Fast or heavy breathing,
 Sweating,
 Tiredness while feeding, or
 Poor weight gain.

10. • Treatments
• Treatments for a ventricular septal defect depend on the size of the hole
and the problems it might cause. Many ventricular septal defects are small
and close on their own; if the hole is small and not causing any symptoms,
check the infant regularly to ensure there are no signs of heart failure and
that the hole closes on its own. If the hole does not close on its own or if it
is large, further actions might need to be taken.
• Depending on the size of the hole, symptoms, and general health of the
child, cardiac catherization or open-heart surgery to close the hole and
restore normal blood flow.
• Medicines
• Some children will need medicines to help strengthen the heart muscle,
lower their blood pressure, and help the body get rid of extra fluid.

11. Tetralogy of Fallot (TOF)
Congenital heart defect which is classically
understood to involve four anatomical
abnormalities of the heart (although only three
of them are always present). It is the most
common cyanotic heart defect and the most
common cause of blue baby syndrome. TOF is
usually a right-to-left shunt, in which higher
resistance to right ventricular outflow results in
more severe cyanosis symptoms.

12. • Signs and symptoms
• clubbing with cyanotic nail beds results in low oxygenation of blood
due to the mixing of oxygenated and deoxygenated blood in the left
ventricle via the ventricular septal defect (VSD) and preferential
flow of the mixed blood from both ventricles through the aorta
because of the obstruction to flow through the pulmonary valve.
This is known as a right-to-left shunt. The primary symptom is low
blood oxygen saturation with or without cyanosis from birth or
developing in the first year of life.
• heart murmur which may range from almost imperceptible to very
loud, difficulty in feeding, failure to gain weight, retarded growth
and physical development, dyspnea on exertion, clubbing of the
fingers and toes, and polycythemia.
• Children with tetralogy of Fallot may develop "spells." results from
a transient increase in resistance to blood flow to the lungs with
increased preferential flow of desaturated blood to the body. spells
are characterized by a sudden, marked increase in cyanosis
,dyspnea followed by syncope, and may result in hypoxic brain
injury and death.

13. Management of spell:
 Put child in knee- chest position (squatting) loosened
clothes
 Oxygen inhalation
 Morphine 0.1-0.2mgkg s.c. or im
 Correct acidosis
 Propranol : 0.1-0.2mgkgdose given iv
 Antibiotic for infection

14. Surgical treatment
1- total correction of fallot
2-Palliative procedures:
 Brock procedure – ps
 Waterson operation- creation of a shunt between the
aorta and pulmonary circulation
 Blalock –Tussig procedure anastomosing the
subclavian artery to the pulmonary artery

15. Coarctation of the aorta
• Coarctation of the aorta is a narrowing of part of the
aorta (the major artery leading out of the heart). It is
a type of birth defect with unknown case

16. In milder cases, symptoms may not develop until the
child has reached adolescence. Symptoms include:
 Chest pain
 Cold feet or legs
 Dizziness or fainting
 Decreased ability to exercise
 Failure to thrive
 Leg cramps with exercise
 Nosebleed
 Poor growth
 Pounding headache
 Shortness of breath
Note: There may be no symptoms.

17. Tests to diagnose this condition may include:
• Cardiac catheterization and aortography
• Chest x-ray
• Echocardiography is the most common test to
diagnose this condition, and it may also be
used to monitor the patient after surgery
• Heart CT may be needed in older children
• MRI or MR angiography of the chest may be
needed in older children

18. Treatment
• Surgical graft this is called an end-to-
end anastomosis.
• widened inside the blood vessel. This type of
procedure is called a balloon angioplasty
• medicines needed to treat high blood pressure after
surgery

19. Patent ducts arteriosus PDA
S&S:
Exertional Dyspnea
Growth retardation
Precordail pain
Pulse pressure wide
Cyanosis of feet
Murmur and thrill
correction by ligation or division
Complication : endocarditis ,aneurysm calcification of
duct, thorbo-embolism and Eisenmenger syndrome