This document discusses congenital heart defects, including atrial septal defects (ASD) and ventricular septal defects (VSD). It notes that congenital heart defects are caused by abnormal embryonic development and occur in approximately 1 in 125 births. ASDs and VSDs allow abnormal blood flow between the left and right sides of the heart and can cause heart failure if left untreated. They are typically repaired via catheterization or open heart surgery between ages 4-6 months. Post-operative care involves monitoring for complications and administering medications.

1. CONGENITAL HEART
DEFECTS

2. CONGENITAL HEART DISEASE:
▪ Congenital cardiac malformations resulting from defective embryonic
development without obvious cause.
▪ Between 3-8 weeks “gestation” - the fetal heart structures are formed
“organogenesis”

3. INCIDENCE:
 1/125 live births in approximately.
 Most common birth defect.
Incidence is more in :-
a-Premature
b-abortions
c-still births
Incidence increased for siblings.

4. CLASSIFICATION OF CHD:
▪ ACYANOTIC CONGENITAL HEART DEFECTS
▪ CYANOTIC CONGENITAL HEART DEFECTS

5. ACYANOTIC CHD:
▪ Pink Baby (L → R shunt)
▪ L → R shunts cause CHF and pulmonary hypertension.
▪ This leads to RV enlargement, RV failure
▪ These babies present with CHF and respiratory distress.
▪ They are not typically cyanotic
▪ Examples: Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus Arteriosus (PDA)

6. ATRIAL SEPTAL DEFECT:
▪ WHAT IS ASD?
▪ EFFECTS?
▪ CAUSES?

7. CONT:

9. TYPES OF ASD:
▪ OSTIUM SECUNDUM ASD: Defect in the middle of the atrial septum.
▪ OSTIUM PRIMUM ASD: Defect in the lower part of the atrial septum.
▪ 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.
▪ CORONARY SINUS ASD: Located within the walls of the coronary sinus.

10. TYPES OF ASD:

11. CONT:
▪ SIGNS AND SYMPTOMS?
▪ DIAGNOSTIC TESTS?
▪ MANAGEMENT:

12. MANAGEMENT:
▪ 20% Of ASD will close spontaneously in the first year of life.
▪ ASD may close spontaneously as a child grows.
▪ 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.
▪ Pulmonary arteries become thickened and obstructed due to increased flow,
from L to R for many years.

13. MEDICAL MANAGEMENT :
▪ 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;
DIGOXIN: Helps strength the heart muscle enabling to pump more efficiently.
DIURETICS: Relieve pulmonary congestion.
ANTI-COAGULANTS: Reduce the risk of blood clots.
AFTER LOAD REDUCING AGENTS.

14. CONT…
▪ INFECTION CONTROL: Prophylactic antibiotics to prevent bacterial
endocarditis before dental procedure and other invasive procedures.
▪ NUTRITIONAL MGT:
▪ ADEQUATE NUTRITION:
▪ High calorie formula or breast milk.
▪ Supplemental tube feedings.

15. SURGICAL MGT:
▪ PRE OP MGT:
▪ Informed consent is a legal document that explains the tests, treatments, or
procedures that you may need.
▪ Blood tests.
▪ NPO.
▪ An IV is a small tube placed in your vein that is used to give you medicine or
liquids.
▪ General anaesthesia.
▪ A Foley catheter.

16. MANAGEMENT:
PERCUTANEOUS CLOSURE(CATH BASED):
OPEN HEART PROCEDURE(SURGERY BASED):

17. PERCUTANEOUS CLOSURE:
TRANSCATHETER MGT: Right heart cath is done.
▪ This technique involves implantation of one of several devices using cardiac
catheterization.
▪ 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. CONT…
 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.
 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. CONT…
▪ Catheter is removed and procedure is completed.
▪ Within a few days, the body’s 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 patient’s heart.

20. TYPES OF CLOSURE DEVICES:
Amplatzer Septal Occluder

21. CONT…
CardioSEAL Occluder

22. PROCEDURE:

23. OPEN HEART PROCEDURE:
▪ 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 ASD’s may be the patient’s own
pericardium, commercially bovine or synthetic material. Eventually tissue of the heart
heals by 6 months.

24. CONT:

25. CONT…
▪ POST OP MGT:
▪ Chest tubes may be put into chest during surgery. They are used to remove
air, blood, or fluid from around lungs or heart.
▪ To wear pressure stockings or inflatable boots after surgery.
▪ Deep breathing and coughing.
▪ To eat and drink gradually after surgery.
▪ REGULAR FOLLOW UP.

26. CONT…
▪ MEDICINES:
▪ ANAELGESICS.
▪ ANTIBIOTICS.
▪ ANTI EMETICS.
▪ BP MEDICATIONS.
▪ BLOOD THINNERS.
▪ DIURETICS.
▪ HEART MEDICINES.

27. VENTRICULAR SEPTAL
DEFECT

28. VENTRICULAR SEPTAL DEFECT:
▪ WHAT IS VSD?
▪ EFFECTS?
▪ CAUSES?

29. CONT…

30. CONT…

31. TYPES OF VSD:
MUSCULAR VSD:
Common type of VSD.
Opening in the muscular portion of lower section of ventricular septum.
Closes spontaneously and don’t require surgery.

32. CONT…
PERIMEMBRANOUS VSD:
Opening in an area of upper section of the ventricular septum called the
membranous septum, located near valves.
Treated by surgery.
ATRIOVENTRICULAR CANAL TYPE VSD:
Associated with AV canal defect.
VSD is located underneath the tricuspid and mitral valves.

33. CONT…
OUTLET VSD:
Found in part of the ventricle where the blood leaves the heart.
Rare type of VSD.
CONAL SEPTAL VSD:
Subarterial, Supracristal, Infundibular.
Rarest VSD.
Occurs in the ventricular septum just below the aortic valve.
Effect from L to R shunt causing aortic valve leaflet to prolapse into VSD resulting in
aortic valve regurgitation.

34. CONT…

35. CONT…
▪ SIGNS AND SYMPTOMS?
▪ DIAGNOSTIC TESTS?
▪ MANAGEMENT:

36. TREATMENT:
INDICATIONS FOR SURGERY:
▪ If VSD remains large and unrestrictive-surgical closure at age
4 to 6 months.
 VSD with pulmonary stenosis.
 Large VSD with pulmonary HTN.
 VSD with aortic regurgitation.

37. MANAGEMENT:
▪ MEDICAL MGT:
DIGOXIN.
DIURETICS.
ACE INHIBITORS.
INFECTION CONTROL: Prophylactic antibiotics to prevent bacterial
endocarditis before dental procedure and other invasive procedures.

38. CONT…
▪ NUTRITIONAL MGT:
▪ ADEQUATE NUTRITION:
▪ High calorie formula or breast milk.
▪ Supplemental tube feedings.

39. CONT…
▪ PRE OP MGT:
▪ Informed consent is a legal document that explains the tests, treatments, or
procedures that you may need.
▪ Blood tests.
▪ NPO.
▪ An IV is a small tube placed in your vein that is used to give you medicine or
liquids.
▪ General anaesthesia.
▪ A Foley catheter.

40. MANAGEMENT:
▪ SURGICAL MGT:
TRANSCATHETER CLOSURE: Cardiac cath is done.
 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.
 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. CONT…
▪ Catheter is removed and procedure is completed.
▪ The device will remain in the heart permanently closing the hole in the heart
wall.
▪ Full closure of the ventricular defect within the 24hrs of placement.

42. TYPES OF VSD CLOSURE:
▪ AMPLATZER MUSCULAR VSD OCCLUDER:

43. PROCEDURE:

44. SURGICAL MGT:
▪ Surgical closure of a perimembranous VSD is performed on CPB.
▪ Incision: Median sternotomy.
▪ Surgery: Open heart surgery.
▪ Surgical exposure is achieved through the right atrium. The tricuspid valve septal
leaflet is retracted or incised to expose the defect.
▪ Defect is closed by sewn a patch native or bovine pericardium.
▪ Suture techniques: horizontal pledged mattress sutures and running polypropylene
suture.

45. CONT…
▪ Critical attention is necessary to avoid injury to the conduction system.
▪ Care is given to avoid injury to aortic valve with sutures.
▪ Intraoperative TEE is used to confirm secure closure of the VSD, normal
functioning of aortic and tricuspid valves,good ventricular function.
▪ The sternum, fascia and skin are closed.

46. CONT…
▪ POST OP MGT:
▪ Chest tubes may be put into chest during surgery. They are used to remove air,
blood, or fluid from around lungs or heart.
▪ To wear pressure stockings or inflatable boots after surgery.
▪ Deep breathing and coughing.
▪ To eat and drink gradually after surgery.
▪ REGULAR FOLLOW UP.

47. CONT…
▪ MEDICINES:
▪ ANAELGESICS.
▪ ANTIBIOTICS.
▪ ANTI EMETICS.
▪ BP MEDICATIONS.
▪ BLOOD THINNERS.
▪ DIURETICS.
▪ HEART MEDICINES.