PRINCIPLE OF CONGENITAL

HEART DISEASES
SASMITO
CONGENITAL HEART DISEASE
INCIDENCE : 4-8 / 1000 LIVE BIRTH

ETYOLOGIC FACTORS :
ENVIROMENT
GENETIC /CHROMOSSOMAL ABNORMALITY

CLINICALLY TYPE : ACYANOTIC CHD

CYANOTIC CHD
THE TYPE OF CHD

BASED ON FLOW OF THE SHUNT

1. DEFECT WITH LEFT TO RIGHT SHUNT
2. DEFECT WITH RIGHT TO LEFT SHUNT
3. DEFECT WITH MIXING SHUNT

BASED ON ANATOMY
1. DEFECT AT THE VENTRICLE LEVEL
2. DEFECT AT THE ATRIAL LEVEL
3. DEFECT AT THE ARTERIAL LEVEL
4. DEFECT AT THE VALVE

BASED ON CLINICAL APPEARANCE

1. CYANOTIC HEART DEFECT
2. ACYANOTIC HEART DEFECT
CYANOTIC CHD

1. COMMON CYANOTIC HEART DEFECT ( TOF,TRUNCUS

TAPVD, PA-VSD,TA)
2. CRITICALLY CYANOTIC HEART DEFECT ( TGA,PA-IVS)
3. COMPLEX CYANOTIC HEART DEFECT
 DIAGNOSTIC APPROACH
ANAMNESTIC PHYSICAL RADIOLOGY ECG ECHO CAT
EXAMINATION ANG

1. Cough 1. Inspection Chest X ray RVH Anatomical

2. dyspnea 2. Pulse - Cardiomegaly LVH defect
Thrill - Normal
3. Edema 3. Auscultation : murmur Plethora RAH Myocard
4. Ascites 4. Down Syndrome etc LAH contraction
5. Cyanotic 5. cataract dysrithmic LV func
6. Squatting
Cyan . spell
7. Cataract
8. Deafness
 PDA

Diastolic : Ins. Pulm

Ins. Aorta 1
2
3 Systolic : VSD
Systolic
4
ASD I, ASD II,
5
Pulm sten, Aorta
sten,
Co-Arc

Systolic Diastolic
Systolic Diastolic
Mitral ins Mitral stenotic
Tricuspid ins Tricuspid stenotic
 Bayangan jantung

CTR = Ka +Ki
Posterior Anterior
Th
Mengukur rasio Kardio Thorax (CTR)

a a = cekungan pulmonal

Kontur Jantung dengan hipertrofi ventrikel kanan

Blood
pressure

Oxygen
saturation
CLINICAL SYMPTOM :

Ussually asimptomative

Physical Exam : S 2 wide fixed split, ESM 2-3/6 LSB 2

ECG : RAD ( 90-180), RVH volume type

CXR : PA prominent, RAE,RVE, plethorik

Echo : anatomical and type of ASD

Natural hystory :

14-55 % closed spontaneously in 4 years old

ASD found in months old :

- < 3mm 100% closed in 1 year old
- 3-8 mm 80% closed in 1,5 years old th
- > 8 mm rare closely spontaneously

Management:

No activity limitation
Not need prophylaxis SBE unless associated MVP
Heart failure infant anti congestive is recomended
ASD closure by ASDOS or surgical after 4 years
old
VSD ( Ventricular septal defect)

15-20 % CHD

Type : peri membran , muscular, sub arterial ( 30 %)

Size : small, moderate, large

Clinical symptom :

Small defect asymptomative

Moderate-large defect : failure to thrive, repeated Pulm inf

decreased exercise tolerance

Large defect cause heart failure in infant

PH : cyanotic , decreased exercise tolerance

DSVPM
DSV MUSCULAR
Physical Examination

Bulging and hyperactivity precordial in large defect

PSM 3- 4/6 in LSB 3

ECG : small defect : normal

moderate defect : LAH, LVH
large defect : BVH
PH : RVH

CXR : Cardiomegaly, PVM plethoric

PH: normal heart size , PVM : pruning

Echo : anatomy, defect size, number and type of defect

Natural history:

Spontaneous closure : 30-40 % before 6 months

Heart failure in infant after 6 months

PH in large defect after 6-12 months

PS infundibular

Endocarditis infective

VSD associated by AI in 4 years of age

Management :

Medicamentosa in heart failure patient

No limitation activity unless PH

Oral hygiene and SBE prophylaxis.

Defect closure:
- non surgical
- surgical : as soon as possible if not respond with ant
congestive
> 1 year if respond to anti congestive
> 4 years if not closure spontaneously
 PDA( ductus arteriosus persistent)

5-10% CHD
M :FM : 1 : 3
Very common in premature baby

Clinical symptom:
Small defect asymptomative
Large defect : repeated lung infection, H failure

Physical examination:
tachycardia, dyspnea on effort
cyanotic differential in PH
hyperactive precordial
. Continuous machinery murmur inL infra clavicle
Bounding pulse
ECG : small sz normal, moderate/large : LVH/BVH

CXR : small size normal

moderate/large : cardiomegaly, plethoric, PA prominent

ECHO : anatomy, type, defect size

Natural history :
Spontaneous closure in premature baby with small defect
heart failure in large defect, pneumonia
PH
endocarditis

Management:
Indomethacin in premature baby
SBE prophylaxis
ADO
Ligation : in 6 months - 2 years, as soon as posible in H.fail