Strict Standards: Declaration of JParameter::loadSetupFile() should be compatible with JRegistry::loadSetupFile() in /home/medquart/public_html/mq88/libraries/joomla/html/parameter.php on line 0

Strict Standards: Non-static method JSite::getMenu() should not be called statically in /home/medquart/public_html/mq88/components/com_joodb/router.php on line 60

Strict Standards: Non-static method JApplication::getMenu() should not be called statically in /home/medquart/public_html/mq88/includes/application.php on line 539

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/router.php on line 60

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/router.php on line 61
Congenital heart disease - N-CardioVascular - Medquarterly

Medquarterly

Switch to desktop

Strict Standards: Declaration of SubtemplateHelper::replaceField() should be compatible with JoodbHelper::replaceField(&$joobase, &$part, $field, $itemlink, $id) in /home/medquart/public_html/mq88/components/com_joodb/helpers/subtemplate.php on line 0

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/administrator/components/com_joodb/helpers/joodb.php on line 174

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/models/article.php on line 39

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/administrator/components/com_joodb/tables/joodb.php on line 75

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/models/article.php on line 45

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/models/article.php on line 48

Strict Standards: Declaration of JCacheControllerView::get() should be compatible with JCacheController::get($id, $group = NULL) in /home/medquart/public_html/mq88/libraries/joomla/cache/controller/view.php on line 0

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/views/article/view.html.php on line 29

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/views/article/view.html.php on line 30

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/views/article/view.html.php on line 33

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/views/article/view.html.php on line 35

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/views/article/view.html.php on line 38

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/views/article/view.html.php on line 41

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/views/article/view.html.php on line 53

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/helpers/joodb.php on line 314

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/helpers/joodb.php on line 94

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/helpers/joodb.php on line 94

Strict Standards: Only variables should be assigned by reference in /home/medquart/public_html/mq88/components/com_joodb/helpers/joodb.php on line 560

Print

Congenital heart disease

Congenital heart disease

Congenital heart defects have an incidence of 6-8 per 1000 live born infants. They may present in the first year of life or remain asymptomatic

Contents

1.Left to right shunts

2.Right to left shunts



Left to right shunts


L-R shunts very rarely cause cyanosis


Atrial Septal Defects (ASD)

ASD is caused by a failure of the proper closure of the foramen ovale or by a defect in the septum secundum. Blood moves from the left atrium to the right atrium due to pressure differences. ASD’s make up 10% of all CoHD. Frequently, the child is asymptomatic but clinical features can include:

  • Recurrent chest infections

  • Heart failure

  • Arrhythmia

  • Fixed, widely split 2nd heart sound

  • Ejection systolic murmur

ASD can be diagnosed and confirmed using:

  • Electrocardiology

  • Chest radiography

  • Echocardiology

ASD can be treated:

  • Via catheter delivered devise

  • Surgery



Ventricular Septal Defects (VSD)

VSD is a failure of fusion of the interventricular septum or endocardial cushions. VSD’s make up 30% of all CoHD. The patient may be asymptomatic, but clinical features can include:

  • Heart failure

  • Failure to thrive

  • Recurrent chest infections

  • Palpable parasternal thrill

  • Loud pansystolic murmur at lower left septal edge

VSD can be diagnosed and confirmed using:

  • Electrocardiology

  • Chest radiography

  • Echocardiology

Treatment:

  • Most VSD close within first 2 years of life

  • 10% will require drug therapy or surgery

Complications:

  • If large L-R shunt, there may be a large amount of blood entering the right ventricle and pulmonary circulation causing pulmonary hypertension. This can then lead on to cyanosis.

[image]



Patent Ductus Arteriosus (PDA)

PDA is caused by an open ductus by an open ductus arteriosus which allows the communication of blood between the systemic and pulmonary circulations. It accounts for 10% of CoHD’s. PDA is associated with the following clinical signs:

  • Continuous murmur beneath the left clavicle

  • Collapsing pulse

PDA can be diagnosed and confirmed using:

  • Echocardiology

Treatment:

  • In preterm infants the PDA will usually close

  • It can be closed with a catheter delivered device

  • Infective endocarditis may result if the duct doesn’t close



Atrioventricular Septal Defect (AVSD)

AVSD results from failure of the superior and inferior endocardial cushion fusion. This is a pathognomonic of Down syndrome. AVSD can be diagnosed and confirmed using:

  • Electrocardiology

  • Chest radiography

  • Echocardiology

Treatment:

  • Surgical repair is complex and hazardous



Right to left shunts


Right to left (R-L) shunts usually cause cyanosis



Tetralogy of Fallot (TOF)

TOF is a combination of:

  1. Pulmonary Valve stenosis

  2. Right ventricle hypertrophy

  3. Aorta overcrowding the interventricular septum

  4. Large ventricular septal defect

[image]

TOF occurs in 6% of children with CoHD. Severe cyanosis with hypercyanotic episodes may result. A loud ejection systolic murmur is heard in the third left intercostals space and finger clubbing may result. Corrective surgery is required which can be started at 4-6 months of age.



Transposition of the Great Arteries

Transposition of the great arteries occurs when the truncoconal septum develops but it fails to spiral. The LV pumps blood into the pulmonary trunk and the RV pumps blood into the aorta. There is usually an atrial septal defect, ventricle septal defect or patent ductus arteriosus to allow blood to mix, otherwise this would be incompatible with life.

Transposition of the great arteries occurs in 4% of CoHD’s. Severe cyanosis may result. There may be finger clubbing and numerous murmurs.

Transposition of the great arteries is treated with an atrial switch procedure called a Mustard/Senning Procedure.



Persistent Truncus Arteriosus

The truncoconal septum fails to form, leading to a common outflow tract for both ventricles. There is also a ventricular septal defect in this very rare condition.



Tricuspid Atresia

In tricuspid atresia there is an absence of the tricuspid valve, causing poor pulmonary circulation. The neonate has duct dependant circulation (i.e. other communications are needed between the arterial and venous systems to prevent serious cyanosis). Surgery is required to place a tricuspid valve.



Obstructive Congenital Defects

Coarctation of the Aorta

Coarctation of the aorta is a narrowing of the aorta around the area of the ductus arteriosus. It frequently is associated with a ventricular septal defect and a bicuspid aortic valve. Coarctation occurs on 7% of children with CoHD. The diagnosis can be made from weak or absent femoral pulses. There is also an ejection systolic murmur. Surgery is required to correct the defect.



Pulmonary Stenosis with Intact Interventricular Septum

Of those children with heart defects, 7% present with a stenosis of the pulmonary valve. Most are asymptomatic. An ejection systolic click may be heard. Treatment is indicated when right ventricular hypertrophy occurs or stenosis worsens.



Aortic Stenosis

Stenosis of the aortic valve occurs in 6% of CoHD. Usually there is associated mitral stenosis and coarctation of the aorta. There may be heart failure, syncope and chest pain. Clinical features also include slow rising pulses, an ejection click and ejection systolic murmur. Eventually valve replacement surgery is needed.

 
 

» Back

© MedQuarterly | 2014. All rights reserved.

Top Desktop version