Introductory lecture with overview of congenital heart diseases including fetal circulation and the changes that occur after birth.
Simple approach to CHD
2. Learning objectives:
• At the end of this lecture, the learner should be able
to:
• Describe fetal circulation and changes that occur at birth.
• Highlight the salient differences between fetal and
neonatal circulation.
• Describe the classification of CHD.
• Enlist common acyanotic and cyanotic congenital heart
diseases.
• Approach to a child with suspected CHD.
• Describe the hemodynamics of Lt to Rt shunts
3. Fetal circulation and difference between fetal
and neonatal circulation.
• Parallel vs series circulation.
• Structures responsible for parallel circulation.
• Ductus venosus
• Foramen ovale
• Ductus arteriosus.
5. • After birth
• Lung expansion -- ↓ in pulmonary pressure.
• Increase in paO2 of blood.
• Loss of low pressure placental circulation.
• Functional closure of foramen ovale.
• Closure of ductus venosus and arteriosus.
• Series circulation.
6. Heart diseases in children:
• Heart, Pericardium, blood vessels.
• Congenital or acquired.
• Isolated or as a part of other systemic diseases.
8. 8
Congenital Heart Diseases:-
• Incidence and prevalence:-
-Initial estimate 6-8 per 1000 live births.
-Recent estimate1/100 live births.
-Accounts to 15-20% of cardiac cases.
9. Etiology:-
-90% cases etiology not known.
-Both sexes are equally affected.
-Rt. Sided lesions common in female and left sided in male.
10. 10
• Heredity
• Environmental factors
• Maternal diseases or factors
• Intrauterine infections:- TORCH group
• Drugs like thalidomide
• Metabolic factors like idiopathic hypercalcemia.
• Genetic diseases:- Marfan syndrome, Ehlers-Danlos syndrome,
Hurler syndrome
• Chromosomal aberrations:- Turner, Down and other trisomy
syndromes.
11. Presenting complaints/signs
• Failure to thrive
• Exercise intolerence
• Easy fatigability
• Chest indrawing
• Sweating during feeding
• Bluish spells
• Fever with rigor
• Palpitation
• Convulsion
• Fast breathing
• Oedema
• Hepatomegaly,
• spleenomegaly
• Clubbing
• Cyanosis
• Focal neurological lesion
• Other organ defects
• Chromosomal anomalies
12. 12
Nadas` Criteria:-
• Major
i. Systolic murmur grade
III or more specially
with a thrill.
ii. Diastolic murmur
iii. Cyanosis
iv. Congestive cardiac
failure
• Minor
i. Systolic murmur less
than grade III
ii. Abnormal S2
iii. Abnormal ECG
iv. Abnormal X ray
v. Abnormal BP
13. Cyanosis: is it a cardiac cause or lung cause
• Hyperoxia test
• Neonates with cyanotic congenital heart disease usually do not have
significantly raised arterial Pao2 during administration of 100% oxygen.
18. Cyanotic heart disease with increase
pulmonary flow.
• Clinical features similar to acyanotic heart diseases with left to right
shunt. In addition the patient is cyanosed.
19. Cyanotic heart disease with decreased blood
flow:
• Cyanosis
• Age of onset or age at which cyanosis noticed.
• Cyanotic spells or squatting episodes.
• Exertional dyspnea.
• Clubbing.
• Precordium silent
• Single second heart sound.
• Murmur of collaterals.
20. Some common chromosomal diseases
associated with CHD.
Which is the commonest CHD
associated with Down syndrome?
