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Pediatric Cardiology and Congenital Heart Disease
Department of Cardiology and Vascular Medicine
Faculty of Medicine University of Indonesia
CONGENITAL HEART
DISEASE
Anomalies of the heart structure and
History
Physical Examination
ECG
Chest X-Ray
Echocardiography
Cardiac Catheterization
UNDERSTAND
CARDIOVASCULAR
ANATOMY
PHYSIOLOGY
PATHOPHYSIOLOGY
NON
NON SURGICAL
SURGICAL
AND
AND
SURGICAL
SURGICAL
INTERVENTION
INTERVENTION
CHANGES IN CIRCULATION
AFTER BIRTH
Shift of blood flow for gas exchange from placenta to the lungs
1. Interruption of the umbilical cord
Increase of SVR
Closure of ductus venosus
2. Lung expansion
Reduction of PVR
Functional closure of PFO
Closure of PDA
Fetal
Circulation
Shunts:
1. Placenta
2. Ductus Venosus
3. Foramen Ovale
4. Dustus
Arteriosus
ELECTROCARDIOGR
AM
NEONATE
RV dominant
INFANT
ADULT
LV dominant
HEART AUSCULTATION
HEART SOUNDS AND MURMURS
vibrations produced by cessation or
propulsion of blood within the heart
radiates through the thorax skin
stethoscope
evaluation of heart disease
HEART SOUNDS
First Heart Sound (S1)
closure of the Mitral and Tricuspid valves
HEART MURMURS
Turbulent blood flow
produces vibrations
stenosis
regurgitation
shunt
Classification
timing during cardiac cycle
- systolic murmur
- diastolic murmur
- continuous murmur
ECHOCARDIOGRAPHY
ECHOCARDIOGRAPH
Y
CARDIAC
CATHETERIZATION
cyanotic
Non Cyanotic
Left to Right Shunt
Atrial Septal Defect
Ventricle Septal Defect
Patent Ductus
Arteriosus
Outflow tract Obstruction
Pulmonal stenosis
Aorta stenosis
oligaemic
oligaemic lung
lung
RVH
RVH
ToF
ToF
PA
PA +
+ VSD
VSD
DORV
DORV +
+ PS
PS
ASD/VSD
ASD/VSD +
+
PS
PS
LVH
LVH
TA
TA +
+ PS
PS
PA
PA +
+ RV
RV
hipoplastik
hipoplastik
plethoric
plethoric lung
lung
RVH
RVH
TGA
TGA -- IVS
IVS
DORV
DORV +
+ VSD
VSD
TAPVD
TAPVD
BVH
BVH
Truncus
Truncus Art
Art
TGA
TGA +
+ VSD
VSD
Non Cyanotic
HEMODYNAMIC
Left to Right Shunt
- size of the defect
- compliance of RV is greater than LV
sianosis
EISENMENGER SYNDROME
AUSCULTATION
Widely split and fixed S2
relative TS
large left to right shunt
Accentuated P2
pulmonary hypertension
CHEST X-RAY
RA, RV and PA dilatation
prominent pulmonary artery
segment
increased pulmonary
vascular marking (plethora)
HEMODYNAMIC
Left to Right Shunt
- size of the defect
- level of pulmonary vascular resistance
AUSCULTATION
Small VSD
Small VSD
normal P2 intensity
holosystolic murmur
produced by left to right shunt
Large VSD
Large VSD
CHEST X-RAY
LA, LV and PA dilatation
prominent pulmonary artery
segment
increased pulmonary
vascular marking (plethora)
HEMODYNAMIC
Left to Right Shunt
- size of the ductus diameter, length and turtuosity
- level of pulmonary vascular resistance
AUSCULTATION
Normal P2 intensity
CHEST X-RAY
LA, LV, ascending Ao and PA
dilatation
prominent pulmonary artery
segment
increased pulmonary vascular
marking (plethora)
NONCYANOTIC CHD
OUTFLOW TRACT OBSTRUCTION
narrow split S2
ejection systolic click
harsh ejection systolic murmur
AUSCULTATION
asymptomatic
symptomatic
depend of
severity of lesion
myocardial function
dyspneu
dyspneu
Feeding
Feeding difficulty
difficulty
Failure
Failure to
to thrive
thrive
Heart
Heart Failure
Failure
Syncope
Syncope pain
pain
chest
chest
Sudden
Sudden death
death
NEONATUS
duct dependent systemic circulation
Closed duktus arteriosus
deteriorate systemic
circulation
hypoperfusion
valvar
infundibular
supravalvar
RV pressure overload
RVH
NEONATUS critical PS
duct dependent pulmonary circulation
closed duktus arteriosus
severe cyanosis acidosis
BABY and CHILD
asymptomatic mild lesion
symptomatic :
Right Heart failure
oedema
hepatomegaly
acites
Cyanosis
bila ada PFO
S2 weak
ejection systolic click
AUSCULTATION
PGE1
sementara dipersiapkan intervensi
non-bedah / bedah)
Cyanotic
FKUI International
Oligemic
Pulmonary Stenosis
or Atresia
Tetralogi Fallot
PS + PFO / ASD
PA + VSD
cyanosis
spell hypoxia
squatting
Spell cyanotic
Emergrncy
Serious complication
CVD
KEMATIAN
knee-chest position
Oxigen
Sedasion : diazepam
or morfin
acidosis correction : \
Bic Nat
Propranolol
BT Shunt/ surgery
deviasion
deviasion of
of infundibulum
infundibulum septum
septum
to
to anterior
anterior
malrotasi
malrotasi bulbus
bulbus
VSD
VSDperimembranus
perimembranus
Ao
Aooverriding
overriding
PS
PSvalvular-infundibular
valvular-infundibular
RV
RVhipertrof
hipertrof
PALIATIF operation
BT SHUNT
spell hypoxia
< 6 month
small PA size
TOTAL CORRECTION
> 6 month
good size of PA
Plethora
TGA
TGA
COMMON
COMMONMIXING
MIXING
Common Mixing:
TAPVD
Univentricular Connection
Trunkus Arteriosus
Pulmonary
Pulmonary
vascular resistence
resistence
vascular
Paralel circulation
www.schneiderchildrenhospital.org
FKUI International
Above:
Upper left:
CardioSEAL occluder
Illustration courtesy NMT Medical
Lower left:
Amplatzer septal
occluder
Amplatzer septal
occluder
Balloon Pulmonary
valvuloplasty
Angioplasty
Aortic Coarctation Angioplasty
Angioplasty
Aortic Coarctation Angioplasty
Intravascular Stents
Coarctation of the Aorta