PENYAKIT JANTUNG BAWAAN

PADA ANAK
Structures of the heart
Normal Heart
 Atrial Septal defect
( ASD )

• Insidence : + 10 %
• ♀: δ ratio = 2 : 1
• Anatomy :
 Defect on foramen ovale : Secundum ASD
 Defect at SVC and RA junction: sinus
venosus ASD
 Defect at ostium primum : primum ASD
 Atrial septal Defect

RA LA

RA LA

RV LV
RV LV
 Atrial septal Defect

 Clinical findings
Asymptomatic
Auscultation :
Normal 1st HS or loud
Widely split and fixed
2nd HS
Ejection systolic murmur
 Atrial Septal defect

Management
Surgery : Preschool age
Recent treatment: transcatheter closure using
ASO (Amplatzer septal occluder)
 Ventricular septal defect
• Insidence
 20 % of all CHD
 No sex influence
 Ventricular septal defect

RA
LA
RA LA

RV LV RV LV
 Ventricular Septal Defect

• Clinical findings
Day 1st after birth: murmur (-)
After 2-6 weeks : murmur (+)
Murmur : pansystolic grade 3/6 or higher
at LSB 3
Small muscular defect: early systolic murmur
Significant defect: Mid diastolic murmur at apex
 Ventricular septal defect

Management:

Definitive : VSD closure

 Surgery

 Transcatheter closure
 Patent Ductus Arteriosus

Insidence
+ 10%
Female : Male = 1.2 to 1.5 : 1
Premature and LBW higher

Anatomy
Fetus: ductus arteriosus connects PA and aorta.
If ductus does not closs  Patent Ductus arteriosus
 Patent Ductus Arteriosus

RA LA
RA LA

RV LV
RV LV
 Patent Ductus Arteriosus

• Clinical findings

Small defect:
Symptom (-)
Growth and development normal
Significant defect:
Decreased exercise tolerant
Weigh gained not good
Frequent URTI
Specific case: pulsus seler at 4th extremities
 Patent Ductus Arteriosus

Diagnosis
Pulsus seler and continuous murmur heard
 Tetralogy Fallot
Insidence
5-8% from all CHD

Sindroma consist of 4 items:

 VSD
 pulmonary stenosis
 aortic over-riding
 RVH
 Tetralogy Fallot

Hemodynamic acyanotic Hemodynamic cyanotic

 Tetralogy Fallot

• Diagnosis

Clinically : cyanosis
Single 2nd HS, ejection systolic murmur
 Tetralogy Fallot
CXR :

Boot-shaped
 Transposition of Great
Artery
Insidence
5% of CHD

Anatomy
Abnormality of formation of trunkal septum that cause
aorta arising from RV and PA arising from LV
Transposition of Great artery
 Transposition of Great artery

Hemodynamic normal Hemodynamic of TGA

“series” “parallel”
 Transposition of Great artery

TGA with large VSD TGA with VSD and PS

 Transposition of Great artery

• Clinical aspects

More frequent in male

Birth weight usually normal normal or bigger
Cyanotic vary from mild to severe
Auscultation : single 2nd HS and loud
Murmur vary from silent to pansystolic murmur or
continuous murmur
 Transposition of Great artery

• Diagnosis
Clinically :
Suspicious if neonates presents with cyanotic
with birth weight normal or bigger
Murmur (-)
Single 2nd HS and loud
Transposition of Great artery

CXR :
Cardiomegaly
Egg-on-side
heart