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1. Congenital Heart Disease
By, Ahmed Sodha
M.Sc.(N). – M.S.N.
Prepared By - Mr. Ahmed Sodha

2.  CONGENITAL HEART DISEASE
Prepared By - Mr. Ahmed Sodha

3. Prepared By - Mr. Ahmed Sodha

4. Prepared By - Mr. Ahmed Sodha

5.  CONGENITAL HEART DISEASE (CHD)
•It Is Structural Malformation Of Heart (A Hole In The Heart
Wall) & Issues With The Blood Vessels (Too Many Or Too
Few, Blood Flowing Too Slowly, To The Wrong Place Or In
The Wrong Direction) Present At Birth.
•It Can Be Detected Before Birth, Soon After Birth Or
Anytime Throughout Life.
•CHD Is The Most Common Type Of Birth Defect, Affecting 8
To 9 Per 1,000 Live Births.
•All CHD Can Be Classified Into 3 Broad Groups.
• 1. Group-I – Acyanotic Heart Disease
• 2. Group-II – Cyanotic Heart Disease
• 3. Group-III – Obstructive Defects
Prepared By - Mr. Ahmed Sodha

6.  Group-I – Acyanotic Heart Disease Or Defect With
Increased Pulmonary Blood Flow:-
•Blood Shunt From High Pressure Left Side Of Heart To Low
Pressure Right Side Of Heart, So Only Oxygenated Supply To
Body.
•There Is Increased Pulmonary Blood Flow Due To Left To
Right Shunt.
•Examples Of Acyanotic Heart Disease Are:
•PDA – Patent Ductus Arteriosus
•ASD – Atrial Septal Defect
•VSD – Ventricular Septal Defect
Prepared By - Mr. Ahmed Sodha

7.  PDA – Patent Ductus Arteriosus
Prepared By - Mr. Ahmed Sodha

8.  PDA – Patent Ductus Arteriosus
•An Abnormal Connection Between Pulmonary Artery &
Aorta After Birth Due To Failure Of Fetal Ductus Arteriosus
To Close Within The First Week Of Life.
•Normally Functional Closure (Physiological Closure) Of
Ductus Arteriosus Occur Soon 10-15 Hours After Birth.
Anatomical Closure Of Ductus Arteriosus Occur 1-3 Months
After Birth.
•Blood Shunt From High Pressure Aorta To Low Pressure
Pulmonary Artery (Left To Right Shunt).
•It’s Common In Pre-term Baby & Baby With Body Weight
Less Than 1.5kg. More Common In Female Baby.
•[Ductus Arteriosus – Its Normal Shunt Between Aorta &
Pulmonary Artery During Fetal Life To Bypass The Immature
Fetal Lungs]
Prepared By - Mr. Ahmed Sodha

9.  PDA – Patent Ductus Arteriosus
•Clinical Manifestations:-
•Murmur At Second Intercostal Space.
•Neck Pulsation
•Bounding Pulse
•Enlargement Of Heart
•Treatment:-
•Indomethacin – Administer Indomethacin 0.1mg/Kg Body
Weight IV Slowly For 3 Days. It Is Prostaglandin Inhibitor
Drug Which Closes PDA By Smooth Muscle Contraction.
•Surgical Management:- Ligation Of Patent Vessel
(Preferably At 6 Month Of Age) Via A Lateral Thoracotomy.
Prepared By - Mr. Ahmed Sodha

10.  PDA – Patent Ductus Arteriosus
Prepared By - Mr. Ahmed Sodha

11.  ASD – Atrial Septal Defect
•Abnormal Opening Between Both Atria, Resulting Into Left
(Higher Pressure) To Right (Low Pressure) Shunting Of
Blood.
•It Increases Burden On The Right Side Of Heart, Which
Leads To Pulmonary Congestion And Right Ventricular
Hypertrophy.
•Types:-
•ASD1 (Ostium Primum):- Abnormal Opening At Lower End
(Bottom) Of The Septum.
•ASD2 (Ostium Secundum):- Abnormal Opening At Center Of
Septum.
•ASD3 (Sinus Venous Defect):- Opening At Top Of Atrial
Septum, Between Superior Vena Cava And Right Atrium.
Prepared By - Mr. Ahmed Sodha

12.  ASD – Atrial Septal Defect
•Clinical Manifestations:-
•Systolic Ejection Murmur Near 2nd And 3rd Intercostal
Space Or Upper Left Sternal Border
•Enlargement Of Right Atrium And Right Ventricle
•Decrease Peripheral Pulse
•Pale Cool Extremities
•Complications - Congestive Cardiac Failure, Pulmonary
Hypertension
•Treatment:- Correct Defect In 2-5 Year Of Age By Purse
String Closure (Small Defect).
•Knitted Dacron Patch Is Sewn Over The Defect (Large
Defect).
Prepared By - Mr. Ahmed Sodha

13.  VSD – Ventricular Septal Defect
•An Abnormal Opening Between Right And Left Ventricles.
•It Is Most Common Acyanotic Heart Disease With Left
(Higher Pressure) To Right (Low Pressure) Shunt.
•In VSD, When Shunt Reverses From Right To Left, Due To
Increase Pulmonary Vascular Resistance It Known As
‘Eisenmenger's Complex’ (Cyanotic Defect With VSD).
•Clinical Manifestations:-
•Pansystolic Murmur - A Heart Murmur (An Abnormal
Sound) Heard Throughout Systole, At Mid To Lower Left
Sternal Border
•Palpitation And Dyspnea On Exertion
•Recurrent Chest Infections & Poor Weight Gain
•Right Ventricular Hypertrophy
Prepared By - Mr. Ahmed Sodha

14.  VSD – Ventricular Septal Defect
•Treatment:-
•In 70-80% Cases Of Small VSD Will Spontaneous Closure
During First Year Of Life.
•Surgery In Larger Defect A Synthetic Dacron Patch Is Used
To Close The Defect By Open Heart Surgery.
•Cardiac Tissue May Cover The Patch Completely Within 6
Months Of Surgery.
•Complications - Congestive Cardiac Failure
Prepared By - Mr. Ahmed Sodha

15.  Group-II – Cyanotic Heart Disease Or Defect With
Decreased Pulmonary Blood Flow:-
•Pressure In Right Side Of Heart Is Greater Than Left Side Of
Heart Due To Obstructed Pulmonary Blood Flow, Causing
Blood To Shunt From Deoxygenated Right Side To Left.
•So Deoxygenated Blood From Left Side To Circulate Into
Systemic Circulation, Causing Hypoxia And Cyanosis.
Cyanosis Is Clinically Evident.
•Peripheral Cyanosis (Seen In Hands, Feet & Nails). Central
Cyanosis Seen In Mouth, Inner Side Of Lips And Gums.
•Cause Of Central Cyanosis Is Usually Pulmonary (Cyanosis
Decrease With Crying) And Cardiac (Cyanosis Increase With
Crying) In Origin.
•Examples Of Cyanotic Heart Disease Are Tetralogy Of Fallot,
Tricuspid Atresia And Transposition Of Great Vessels.
Prepared By - Mr. Ahmed Sodha

16.  Tetralogy Of Fallot
•It Was Described In 1888 By The French Physician E. L. A.
Fallot.
•It Is A Commonest Cyanotic Heart Disease (6-10% Of All
CHD).
•It Includes Four Defects, They Are:-
•1. Pulmonary Stenosis
•2. Right Ventricular Hypertrophy
•3. Ventricular Septal Defect
•4. Overriding Of Aorta Or Extraposition Of Aorta (Aorta
Arises From The Right Ventricle And The Pulmonary Artery
Arises From The Left Ventricle)
Prepared By - Mr. Ahmed Sodha

17.  Pathophysiology Of Tetralogy Of Fallot:-
Due To Pulmonary Stenosis Blood Flow From Right Ventricle
To Lungs Is Restricted
It Causes Right Ventricular Hypertrophy
Blood Start To Shunt From Right To Left Ventricle Due To
Increase Pressure In The Right Ventricle
Unoxygenated Blood Start To Reaching The Systemic
Circulation Through Overriding Aorta
Cause Cyanosis In The Body
Prepared By - Mr. Ahmed Sodha

18.  Clinical Manifestations Of Tetralogy Of Fallot:-
•‘Hypoxic-Anoxic Spell’ Or ‘Hypercyanotic Spell’ Or ‘Blue
Spell’ Or ‘Tet Spell’
[Blue Coloring Of Neonate Or Infant When Oxygen
Requirement Increases, Ex. During Feeding, Crying,
Defecation And Painful Procedure.]
•Dyspnea On Exertion Or During Exercise
•Small Boot Shaped Heart (Due To RVH)
•Child Feels Comfort In Squatting Position
•Systolic Ejection Murmur Heard
•Clubbing Of Finger (An Indicator Of Chronic Hypoxia)
•Poor Growth
Prepared By - Mr. Ahmed Sodha

19.  Treatment Of Tetralogy Of Fallot:-
•Priority Nursing Actions During Hypercyanotic Spell:-
•Give Humidified 100% O2 &
•Place The Infant In Knee-Chest Position.
•Administer Morphine Sulphate 0.1 To 0.2 mg/Kg Body
Weight.
•I.V. Fluids For Correction Of Dehydration.
•Acidosis Can Be Treated By Sodium Bicarbonate.
•Surgical Management:- It Includes
•A. Palliative Surgery / Palliative Shunt
•B. Definitive Corrective Surgery
Prepared By - Mr. Ahmed Sodha

20. •Surgical Management:-
•A. Palliative Surgery / Palliative Shunt - Palliative Means
Relieving A Painful Condition Without Curing. It Is Used If
Infant Is Too Young To Full Repair. This Includes:
•1. Blalock Taussig Shunt - Anastomosis Of Right Or Left
Subclavian Artery To Pulmonary Artery
•2. Pott's Shunt - Anastomosis Of Left Pulmonary Artery To
Upper Descending Aorta.
•3. Waterson's Shunt - Side To Side Anastomosis Of
Ascending Aorta With Right Pulmonary Artery.
•B. Definitive Corrective Surgery:- Close Ventricular Defect
And Repair Pulmonary Stenosis By Pulmonary Valvotomy.
Prepared By - Mr. Ahmed Sodha

21.  Tricuspid Atresia
Prepared By - Mr. Ahmed Sodha

22.  Tricuspid Atresia
•Congenitally Absence Of Tricuspid Valve, So No Direct
Communication Between Right Atrium To Right Ventricle.
•Mixing Of Unoxygenated Blood (Right Atrium) To
Oxygenated Blood (Left Atrium) By Atrial Septal Defect Or
Patent Foramen Ovale.)
•Mixing Of Deoxygenated To Oxygenated Blood Also Occur
Through VSD.
•Clinical Manifestations:-
•Cyanosis
•Dyspnea
•Tachycardia
•Clubbing Of Finger In Old Children)
•Acidosis
Prepared By - Mr. Ahmed Sodha

23.  Treatment:-
•Palliative Surgery:-
•Blalock Taussig Shunt - An Anastomosis Of A Subclavian
Artery To The Pulmonary Artery On The Same Side.
•Glenn's Shunt - SVC (Superior Vena Cava) Anastomosis With
Right Pulmonary Artery.
•Corrective Surgery:-
•Create Communication Between Right Atrium And
Pulmonary Artery At 4-5 Years S Of Age.
•This Repair Is Known As ‘Fontan Procedure’.
•[Fontan Procedure – It Is A Procedure Used To Repair
Complex Congenital Heart Defects).
Prepared By - Mr. Ahmed Sodha

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25.  Transposition Of Great Arteries (TGA)
Prepared By - Mr. Ahmed Sodha

26.  Transposition Of Great Arteries (TGA)
•Pulmonary Arteries Arise From Left Ventricle, And Aorta
From Right Ventricle.
•There Is No Communication Between Systemic And
Pulmonary Circulation.
•Communication Occurs If Associated Anomalies Are Present
like ASD, VSD, PDA And Patent Foramen Ovale.
•Common In Male Babies, With High Birth Weight.
•Clinical Manifestations:-
•Hypoxic Spell Especially Crying
•Clubbing Of Fingers
•Metabolic Acidosis And Cardiomegaly
•Cyanosis At Birth
Prepared By - Mr. Ahmed Sodha

27.  Treatment:-
•Administer I.V. Prostaglandin To Keep The Ductus Arteriosus
Open.
•Oxygen Therapy May Be Harmful Because It May Enhance
Closure Of PDA (PDA Is The Only Source Of Mixing Of Blood
In TGA).
•Surgical Management:-
•Balloon Septostomy (Surgical Formation Of An Opening In A
Septum).
•Arterial Switch Operation - The Pulmonary And Aorta Are
Transected Above The Respective Valve And Switched Back
To The Appropriate Ventricle By Open Heart Surgery.
Prepared By - Mr. Ahmed Sodha

28.  Group-III – Obstructive Defects:-
•Stenosis (Anatomical Narrowing) In Those Areas Of Heart
From Where Blood Exit The Heart Ex. Aorta And Pulmonary
Artery, So It Called Obstructive Heart Defects.
•Obstructive Heart Disease Decreases Pulmonary And Aortic
Blood Flow, Ex. Coarctation Of Aorta, Pulmonary Stenosis
And Aortic Stenosis.
Prepared By - Mr. Ahmed Sodha

29.  Coarctation (Stricture) Of Aorta:-
Prepared By - Mr. Ahmed Sodha

30.  Coarctation (Stricture) Of Aorta:-
•A Localized Congenital Narrowing Of The Aorta, Near The
Junction Of Ductus Arteriosus.
•Because Branches Of Aorta Supply To Brain And Upper
Extremities Are Branched Before Narrowing (Obstruction)
Of Aorta, So There Is Increased BP & Bounding Pulse In
Upper Extremity And Lower BP & Weak Or Absent Pulse In
Lower Extremity.
•Clinical Manifestations:-
•Hypertension
•Dyspnea On Running, & Cool Lower Extremities
•Weak Or Absent Femoral Pulse
•Management:-
•Surgical Management - Anastomosis Of Normal Parts After
Removing Narrow Portion.
Prepared By - Mr. Ahmed Sodha

31.  Aortic Stenosis:-
•An Impairment Of Blood Flow From The Left Ventricle To
Aorta Due To Narrowing Or Obstructions Of Aortic Valve.
•Due To Increase Resistance Of Blood Flow From Left
Ventricle To Aorta Causes Left Ventricular Hypertrophy,
Pulmonary Vascular Congestion And Decrease Cardiac
Output.
•Types:-
•Valvular Stenosis - Most Common Type, Caused By
Malformed Cusps So Valves Looks Like Bicuspid (Aortic
Valve Are Tricuspid).
•Subvalvular Stenosis - Obstruction Due To Fibrous Ring
Below Normal Valve.
•Superavalvular Stenosis - Obstruction Above The Normal
Valve. Prepared By - Mr. Ahmed Sodha

32.  Aortic Stenosis:-
•Clinical Manifestations:-
•Dyspnea
•Decreased Cardiac Output
•Hypotension
•Management:-
•Aortic Balloon Valvuloplasty (Palliative) - Catheter Is Placed
Into Narrowed Aorta And Inflamed To Separate The Leaflet.
•Valve Replacement- A Permanent Curative Procedure.
Prepared By - Mr. Ahmed Sodha

33.  Pulmonary Stenosis:-
•Pulmonary Stenosis Is The Narrowing Of Pulmonary Artery
At Its Entrance.
•Resistance To Blood Flow Causes Hypertrophy Of Right
Ventricle And Decrease Pulmonary Blood Flow.
•Pulmonary Atresia Is An Extreme Form Of Pulmonary
Stenosis, There Is No Blood Flow To The Lungs.
•Clinical Manifestations:-
•Mild Cyanosis & Poor Exercise Tolerance
•Congestive Heart Failure
•Exertional Dyspnea Due To Insufficient Blood Flow To Lungs
•Management:-
•Pulmonary Balloon Valvuloplasty.
Prepared By - Mr. Ahmed Sodha

34.  Home Care After Child Have Cardiac Surgery For Cardiac
Heart Disease:-
•Avoid Play Outside For Several Weeks.
•Avoid Crowded Place For 2 Weeks After Discharge.
•Avoid Activity Which Could Have Chance Of Injury Like Bike
Riding For 2 To 4 Weeks.
•Follow A Non-Added Salt Diet.
•Child Will Return To School After 3 Weeks Of Discharge.
•Avoid Immunization And Any Invasive Procedure For 2
Months.
•Call The Pediatrician If Coughing, Tachypnea, Cyanosis,
Vomiting Or Fever Occurs.
Prepared By - Mr. Ahmed Sodha

35. Prepared By - Mr. Ahmed Sodha