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Congenital Diseases Dr. Meg- Congenital Diseases Dr. Meg-

Congenital Diseases Dr. Meg- - PowerPoint Presentation

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Congenital Diseases Dr. Meg- - PPT Presentation

angela Christi Amores Congenital Heart Disease 0508 of live births incidence is higher in stillborns 34 abortuses 1025 and premature infants about 2 diagnosis is established by 1 wk of age in 4050 of patients with congenital heart disease and by 1 mo of age in 50 ID: 750741

lesions congenital heart pulmonary congenital lesions pulmonary heart left ductus blood patent septal acyanotic increased disease fetal pda arteriosus

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Slide1

Congenital Diseases

Dr. Meg-

angela

Christi

AmoresSlide2

Congenital Heart Disease

0.5-0.8% of live

births

incidence is higher in stillborns (3-4%),

abortuses

(10-25%), and premature infants (about 2

%)

diagnosis is established by 1 wk of age in 40-50% of patients with congenital heart disease and by 1 mo of age in 50-60%Slide3

Relative frequency of Major Congenital lesions

Ventricular

septal

defect25-30

Atrial

septal

defect (

secundum

)6-8

Patent

ductus

arteriosus6-8

Coarctation

of aorta5-7

Tetralogy

of Fallot5-7

Pulmonary

valve stenosis5-7

Aortic

valve stenosis4-7 Slide4

Relative Frequency of Major Congenital lesions

d-Transposition of great arteries3-5

Hypoplastic

left ventricle1-3

Hypoplastic

right ventricle1-3

Truncus

arteriosus1-2

Total anomalous pulmonary venous return1-2

Tricuspid atresia1-2

Single ventricle1-2

Double-outlet right ventricle1-2 Others5-10 Slide5

Fetal circulationSlide6

Congenital Disease

Most congenital defects are well tolerated in the

fetus

because of the parallel nature of the

fetal

circulation

only after birth when the

fetal

pathways (

ductus

arteriosus

and foramen

ovale

) are closed that the full hemodynamic impact of an anatomic abnormality becomes apparent Slide7

Etiology

Cause is unknown

There

is progress

in identifying

genetic basis of many congenital heart

lesions

small percentage - related to chromosomal abnormalities, in particular,

trisomy

21, 13, and 18 and Turner

syndrome

2-4% -associated with known environmental or adverse maternal conditions and

teratogenic

influences, including maternal diabetes mellitus,

phenylketonuria

, or systemic lupus

erythematosusSlide8

diabetic mothers are five times more likely to have congenital cardiovascular malformations

most congenital heart disease is still relegated to a

multifactorial

inheritance

pattern

Fetal

echocardiography improves the rate of detection Slide9

2 major groups

Acyanotic

Congenital heart lesions

Cyanotic Congenital heart lesionsSlide10

Acyanotic

Congenital heart lesions

Increased volume load:

ASD (

atrial

septal

defect)

VSD (ventricular

septal

defect)

AV

septal

defects

PDA (patent

ductus

arteriosus

)

Increased pressure load:

valvular

pulmonic

stenosis

valvular

aortic

stenosis

coarctation

of the aorta Slide11

Cyanotic Congenital heart lesions

Decreased

Pulmonary Blood Flow - obstruction to pulmonary blood flow and a pathway by which systemic venous blood can shunt from right to left and enter the systemic circulation

tricuspid

atresia

T

etralogy

of

Fallot

single ventricle with pulmonary

stenosis

Increased Pulmonary Blood flow

Transposition of the great

vessels

Total

anomalous pulmonary venous

return

Truncus

arteriosusSlide12

PDA (patent ductus

arteriosus

)Slide13

Pathophysiology

blood shunts left to right through the

ductus

from the aorta to the pulmonary

artery

pulmonary artery pressure may be elevated to systemic levels during both systole and

diastole

risk for the development of pulmonary vascular disease if left

unoperatedSlide14

Manifestations

small patent

ductus

does not usually have any symptoms

large PDA will result in heart failure

Cardiac enlargement

Classic continuous murmur (machinery-like)Slide15

Diagnosis

ECG

Left ventricular hypertrophy

Xray

prominent pulmonary artery with increased intrapulmonary vascular

markings

2D echocardiography

left

atrial

and left ventricular dimensions are

increased

Visualization of the patent

ductusSlide16

Treatment

Irrespective of

age, patients with PDA require surgical or catheter

closure

should not be unduly postponed after adequate medical therapy for cardiac failure has been

instituted

thoracoscopic

techniques to minimize scarring and reduce postoperative

discomfortSlide17

Other congenital lesions - acyanoticSlide18

Other congenital lesions - acyanoticSlide19

Other congenital lesions - acyanoticSlide20

Other congenital lesions -

cyanoticSlide21

Other congenital lesions -

cyanotic