Congenital heart diseases

 Congenital heart diseases

Causes

1. Drugs 2. Hormones

3. Fever 4. X-ray

5. Uterine bleeding 6. Smoking

7. Repeated attack of abortion

8. Chromosomal abnormalities 9. Nutritional

Classifications

1. Cyanotic or not cyanotic

2. With or without shunt

3. According to the direction of the shunt

A. Right to left shunt

B. Left to right shunt

Specific congenital heart disease

1. Atrial septal defect (ASD)

Types

1. Ostium secondum.

2. Ostium premium.

3. Sinus venous.

4. Patent foramen ovale.

 

Figure (8): Atrial septal defect (ASD)

Hemodynamics

1. Left to right to shunt.

2. Rt . Atrial dilatation and hypertrophy.

3. Rt. Vent. dilatation and hypertrophy.

4. Pulmonary hypertension.

5. Functional tricuspid regure.

Manifestations

1. Repeated attacks of winter bronchitis.

2. Dyspnea on mild effort.

3. Underweight.

4. Central cyanosis in rare cases. 

Treatment

 Surgical by open heart technique and the defect is closed by direct sutures or by using synthetic material as tiphlon or darcon.

2. Ventricular septal defect (VSD)

Types

1. Membranous.

2. Muscular.

 

 Figure (9): Ventricular septal defect (VSD)

Hemodynamics

1. Left to right shunt.

2. Right vent. Hypertrophy and dilatation.

3. Massive pulmonary hypertension and as result Rt to Lt shunt (Eisenmengers Syndrome).

Manifestations

1. Recurrent attack of winter bronchitis.

2. Dyspnea.

3. Neglected cases of cyanosis.

Treatment

 * Surgical by open heart technique and the defect is closed by direct sutures or by using synthetic material as tiphlon or darcon.

 * In 20% of cases there is happy transformation (spontaneous closure if it is small or in the muscular part of the septum).

3. Patent ductus arterioses (PDA)

It is a duct between the arch of aorta and pulmonary artery.

 

 

Figure (10): Patent ductus arterioses (PDA)

Hemodynamics

1. Oxygenated blood passes from the aorta to the left pulmonary artery.

2. Pulmonary hypertension in rare cases and reverse of shunt, and as a result differential cyanosis.

Treatment

 Surgical by closed heart technique (excision and suture)

4. Coarcitation of aorta

It is stenosis (constriction) of the aorta distal to the left subclavian artery. It is a cyanotic heart disease without a shunt.

Manifestations 

1. Severe headache

2. Intermittent claudication.

3. Hypertension in upper part of the body.

4. Well developed upper half of the body and less developed lower half.

5. Abnormal delay between the femoral and radial pulsation.

Treatment

 Surgical by closed heart technique (excision of the coarcitation segment and end to end anastomosis)

5. Fallot tetrology (F4)

1. Severe pulmonary stenosis.

2. Ventricular septal defect.

3. Rt. Ventricular hypertrophy.

4. Overriding of aorta.

Hemodynamics

1. Severe pulmonary stenosis leads to Rt. vent. Hypertrophy.

2. VSD leads to overriding of aorta.

3. When Rt. Vent. Pressure exceeds that of Lt shunt will be reversed.

Manifestations

1. Cyanosis since birth.

2. Prefer squatting position.

3. Dyspnea on mild effort.

4. Clubbing of fingers and toes.

6. Hemoptysis.

7. Cyanotic spills.

 

Figure (12): Fallot tetrology (F4)

Treatment

Surgical treatment by:

1. Palliative operation: In Severe cases with cyanotic attacks in age below one year.

2. Total correction.

6. Fallot triology (F3)

1. Severe pulmonary stenosis.

2. Atrial septal defect.

3. Rt. Ventricular hypertrophy.

7. Fallot Pentology (F5)

1. Severe pulmonary stenosis.

2. Ventricular septal defect.

3. Atrial septal defect.

4. Rt. Ventricular hypertrophy.

5. Overriding of aorta.