FOR PRIMARY STUDENTS

1. Acyanotic
Congenital Heart
Diseases
Dr Rakesh Kotha
Associate Professor of neonatology
Niloufer hospital Hyderabad

2. » Paediatrician
» Shape/Size/NIBP/Energy for
cardiac muscle
» Incidence ?
» Cyanosis

3. » SERIES/ PARALLEL
» Cardiac output
» CCF,Which Chamber will fail?
» Increased Pulmonary blood flow

5. HISTORY
» Mother age
» male/female
» Consanguineous marriage
» Maternal history TORCH’S
» history of NSAIDS/valproate
» Time of appearance VSD 6 wks/ASD
pregnancy
» Nutrition history GROWTH AND
DEVELOPMENT

6. VSD ASD
EXAMINATION

8. type

9. LOCAL EXAMINATION
Femoral pulses in COA@birth
NIBP UL vs LL
SMALL ONE =BIG SOUND

10. Common Shunt Lesions
Ventricular septal defect (VSD)
Atrial septal defect (ASD)
Patent ductus arteriosus (PDA)
* All 3 lesions can lead to
Eisenmenger’s Syndrome if a large
lesion is not detected and treated early
enough
T

11. Common Stenotic Lesions
Aortic stenosis (AS)
Coarctation of the aorta
(CoA)

12. VSD’s
Commonest form of CHD
Commonest types:
membranous (perimembranous)
~75%
muscular (Aneurisum)
Can be single or multiple

13. Which chamber

14. VSD’s
Symptoms relate to the degree of shunt (VSD
size, pulmonary vascular resistance)
if small: no symptoms (Large murmur)
if large (high pulmonary blood flow, CHF):
tachypnoea
dyspnoea
slow feeding
failure to thrive
sweating

15. VSD’s
Exam (smaller VSD):
pink
normal pulses
normal S1 and S2
± systolic thrill
harsh pansystolic murmur LLSE
ECG: q wave normal (smaller VSD)
or LVH ± RVH (larger VSD)

16. VSD’s
Larger defect:
MDM @ apex (mitral flow murmur)
narrowly split S2 and loud P2
± S3
CXR: cardiomegaly
increased pulmonary vascularity

17. VSD’s
Treatment options:
Nil (spontaneous closure)
Surgical closure
Device closure

18. ASD’s
Three types: secundum
primum
sinus venosus
Commonest: secundum
Primum: a form of atrioventricular
septal (canal) defect

20. Secundum ASD
Usually no symptoms in childhood
Exam: pink
normal pulses
wide ± ‘fixed’ split S2
soft ESM @ ULSE
ECG: incomplete RBBB (95%)
CXR: often normal
sometimes pulmonary plethora

21. Secundum ASD
Haemodynamic significance of ASD is assessed to
decide if closure appropriate
Usually closed age 3-5 years (earlier if
symptomatic) or when diagnosed if later
Two options for closure:
surgery - suture or patch
interventional catheter - device

22. Amplatzer ASD Occluder

23. ECG
"Crochetage"
Axis?

24. PDA
CHF symptoms if large ductus in very
young infant, otherwise often
asymptomatic
Exam: pink
full volume pulses
harsh systolic (1st few weeks) or
continuous machinery’ ‘murmur
loudest under left clavicle
ECG: normal (small PDA)
LVH ± RVH (large PDA)

25. Which arch?

26. PDA
CXR: ± cardiomegaly, pulm
plethora
Options for closure:
surgery - ligation (RLN)
interventional catheter - coil(s)
or device

27. » Which age PDA will close ?
Mechanism?
» Is it necessary to close PDA or
VSD?Mechanism of VSD closure?
» NSAIDS -PGE2-PDA-PGE2

28. Pulmonary Stenosis
Usually asymptomatic
Exam: pink
normal pulses
± systolic ejection click
ESM loudest @ ULSE
if severe, S2 widely
split (not fixed)

30. Pulmonary Stenosis
ECG: RAD, RVH
CXR: normal
± prominent MPA (post-stenotic
dilatation)
Treatment of valvar PS
(moderate/severe):
balloon valvuloplasty preferred
uncommonly surgical valvotomy

32. Aortic Stenosis
Often asymptomatic;
otherwise SOB, syncope or chest pain on exertion
Exam: pink
small volume pulse, small pulse pressure
± LV lift
± systolic thrill (suprasternal, URSE)
± systolic ejection click
harsh ESM loudest @ URSE & radiating -
carotids
if severe, narrow split S2 (even reversed)

34. Aortic Stenosis
ECG: normal (mild AS)
LVH ± strain (more severe AS)
CXR: often normal
± dilated ascending aorta
Treatment of valvar AS (moderate/severe):
balloon valvuloplasty
surgical valvotomy

35. Coarctation of the Aorta
CHF in neonate if severe CoA;
often asymptomatic in older child
Exam: pink
reduced or absent femoral pulses
soft systolic murmur mid LSE
and/or mid left back
ECG: RVH in 1st few months of life,
LVH if older

38. Coarctation of the Aorta
CXR: cardiomegaly
evidence of CHF
rib notching (older child)
Treatment:
surgery
balloon angioplasty

40. Hepatization of lung
CCF

41. EF ?
Pedal edema