ACYANOTIC CARDIAC

MALFORMATIONS

CK CHD

 VENTRICULAR

SEPTAL DEFECT
ATRIAL SEPTAL DEFECT
PATENT DUCTUS ARTERIOSUS
COARCTATION OF AORTA
VALVULAR LESIONS

CK CHD

VENTRICULAR SEPTAL DEFECT

MOST COMMON DEFECT (25%)
ACYANOTIC
LEFT TO RIGHT SHUNT
EARLY ONSET CONGESTIVE
CARDIAC FAILURE

CK CHD

PATHOPHYSIOLOGY

MAJORITY MEMBRANOUS TYPE

MUSCULAR TYPE ARE MULTIPLE
SMALL TO LARGE DEFECTS
PULMONARY HYPERTENSION: AT BIRTH
PERSISTENT/ DUE TO LARGE VOLUME

HAEMODYNAMICS
LEFT TO RIGHT SHUNT
DEPENDS ON SIZE OF DEFECT
DEGREE OF PULMONARY
HYPERTENSION
CK CHD

CLINICAL MANIFESTATIONS
ASYMPTOMATIC
FAILURE TO THRIVE
FEEDING DIFFICULTY
DYSPNOEA
RECURRENT LOWER RESPIRATORY
INFECTION
EARLY CONGESTIVE CARDIAC
FAILURE

CK CHD

CLINICAL SIGNS

PRAECORDIAL PROMINENCE
MAY HAVE LARGE VOLUME PULSE
APICAL IMPULSE:
HEAVING (LVH)
SHIFTED DOWN AND OUT

PARASTERNAL HEAVE (RVH)

SYSTOLIC THRILL LOWER LEFT
STERNAL BORDER
LOUD SECOND SOUND
SYSTOLIC MURMER AT LLSB
CK CHD

CLINICAL SIGNS(CONT)

MURMER:
HARSH AND LOUD IN SMALL DEFECTS
DOES NOT EXTEND TO 2ND SOUND
PANSYSTOLIC AND MAY MASK THE
SECOND SOUND
SHORTENED WITH PULMONARY
HYPERTENSION

SHORT APICAL MID DIASTOLIC

MURMER: FLOWMURMER
CK CHD

INVESTIGATIONS

CHEST XRAY(CARDIOMEGALY)
ECG(BIVENTRICULAR
HYPERTROPHY)
CARDIAC CATHETERISATION

CK CHD

TREATMENT

DEFINITIVE
SURGERY

SUPPORTIVE

ANTIFAILURE
TREAT THE INFECTIONS
NUTRITION
PROPHYLAXIS FOR INFECTIVE
ENDOCARDITIS
TREAT THE COMPLICATIONS
CK CHD

ASD
OSTIUM SECUNDUM TYPE
HAEMODYNAMICS

LARGE LEFT TO RIGHT SHUNT

PULMONARY BLOOD FLOW 2TO 4
TIMES SYSTEMIC FLOW
COMPLIANCE OF RIGHT VENTRICLE
DECIDING FACTOR OF DEGREE OF
SHUNT
CK CHD

CLINICAL MANIFESTATIONS

ASYMPTOMATIC
EXERSISE INTOLERANCE
SIGNS OF RIGHT/BIVENTRICULAR
HYPERTROPHY
THRILL IS VERY RARE
LOUD FIRST HEART SOUND
SECOND HEART SOUND WIDELY SPLIT
AND FIXED
SYSTOLIC MURMER
CK CHD

CLINICAL MANIFESTATIONS (CONT)

MURMER
DUE TO THE FLOW ACROSS THE
PULMONARY VALVE INTO THE
PULMONARY ARTERY
OVER MID OR UPPER LEFT STERNAL
BORDER
EJECTION SYSTOLIC
MEDIUM PITCHED
CK CHD

INVESTIGATIONS
CHEST XRAY-- LARGE RIGHT
VENTRICLE AND ATRIUM
LARGE PULMONARY ARTERY
PULMONARY PLETHORA
ECG -- NORMAL/ RIGHT AXIS
DEVIATION & RVH
EHCO
CATHETERISATION

CK CHD

PROGRESS & COMPLICATIONS

SYMPTOMS APPEAR IN 3RD TO 4TH
DECADE
PULMONARY HYPERTENSION
ATRIAL ARRHYTHMIAS
CCF -- RARE
TRICUSPID/ MITRAL
REGURGITATION -- RARE
INFECTIVE ENDOCARDITIS -- RARE

CK CHD

TREATMENT

ELECTIVE SURGERY
TREAT COMPLICATIONS

CK CHD

PATENT DUCTUS ARTERIOSUS

MOST COMMON ACYANOTIC CHD

FUNCTIONAL CLOSURE AT BIRTH
MOST COMMON CHD WITH MATERNAL
RUBELLA
FEMALE : MALE 2 : 1
BIFURCATION OF PA TO DISTAL TO LEFT
SUBCLAVION
PROBLEM IN PRETERM INFANTS
HIGH ALTITUDE
CK CHD

HAEMODYNAMICS

BLOOD FLOW FROM AORTA TO PA IN

SYSTOLE AND DIASTOLE
EXTENT OF SHUNT DEPENDS ON RATIO
OF SYSTEMIC TO PULMONARY VASCULAR
RESISTANCE
UPTO 70% OF LV OUTPUT CAN BE
SHUNTED
RA AND RV PRESSURES DEPEND ON THE
MAGNITUDE OF SHUNT
CK CHD

CLINICAL MANIFESTATIONS

ASYMPTOMATIC
PHYSICAL GROWTH RETARDATION
RECURRENT LOWER RESPIRATORY
INFECTION
CONGESTIVE CARDIAC FAILURE
WIDE PULSE PRESSURE
PROMINENT PRAECORDIUM
HEAVING APICAL IMPULSE
SYSTOLIC OR CONTINUOUS THRILL IN
SECOND LEFT SPACE
CK CHD

THRILL IS MAY RADIATE TO LEFT CLAVICLE,

LEFT STERNAL BORDER, APEX
CONTINUOS MACHINARY MURMER IN
SECOND LEFT SPACE, RADIATES TO LEFT
CLAVICLE OR DOWN THE STERNUM. STARTS
AFTER FIRST SOUND, ENDS VARIABLY IN
DIASTOLE
DIASTOLIC COMPONENT SOFT WITH PULM
HYPERTENSION
MITRAL DIASTOLIC FLOW MURMER
CK CHD

COURSE AND TREAT MENT

MAY CLOSE IN INFANCY

ASYMPTOMATIC
CONGESTIVE FAILURE
INFECTIVE ENDOCARDITIS
EMBOLIC MANIFESTATION

SURGERY

CK CHD