Cong. Heart diseases
Acyanotic: USD1 ASD
AV
,
card
CoA
detect
, PDA
☒☐systolic small large
restrictive non -
neserrctrne
1. Ventricular septal defect (VSD): 2
< 0.5cm >1cm ?
M.C cardiac malformation (25%)
-
↳ Rt
types: Iggy .
RV P=LH Direction based
– position: membranous (M.C), Muscular QP :Qs 4.75.1 QP :Qs > 2:\
– Size: small, large
Nl others RV&P°'m HTN
imarnpvlm
-
-
ar
✓ -
Small: restrictive, <0.5cm2, L->R shunt (LV pressure > RV), Qp:Qs <1.75:1, Nl pulmonary arterial and RV pressure, normal Pulmonary vascular bed, N
SMALL)
Large non restrictive: >1cm2, RV and LV pressure equalize, Direction of shunt determined by ratio of pulmonary to systemic vascular resistance, Qp
Main pulmonary artery-LA-LV enlarged.
Ix:
CXR: small VSD: normal or minimal Cardiomegaly. Borderline increase in Pulmonary vasculature.
- -
Large VSD: Gross cardiomegaly (RV, LV, LA, PA), Prominent pulmonary vascularity.
-
-
ECG: Small VSD: normal or may suggest LV hypertrophy
Large VSD: biventricular hypertrophy, P wave notched or peaked
-
*Right atrium enlargement: Peaked p wave
*Left atrial will be broad or biphasic p wave
*Both = both
Thank
-
Site 1 Size , direction pressure
Doppler catheter
2D & pulsed doppler Echo:
associated lesions .
,
Position and size of defect
- - ↳ when she unconcern
, Done when:
Size of shunt uncertain
Lab data not fit with clinical findings
Pulmonary vascular disease is suspected
Tx:
reassure / conevol It -6
Small: reassure and encourage encourages closure
on direct
PA banding
•
Protection against endocarditis Large
:
→
regular follow up
-
surgery
follow up
Large: control symptoms of H.F
Surgery (PA banding or direct closure defect)
Closure of defect:
– any age with large defect with uncontrolled S/S
– Infant: 6-12 months w/ are defect associated w/ Pulmonary HTN
–
- -
Pt >24m w/ Qp:Qs >2:1
– Supracristal VSD
Prognosis and complications:
small VSD:
÷
– spontaneous closure: 30-50%, mostly during first 2 years of life (small muscular more likely to close 80% than membranous 35%)
– most often asymptomatic
– infective endocarditis
-
Moderate - large VSD:
– may —> smaller, 8% may close repeated chest infection
–
-
repeated chest infection, H.F, FTT It f
.
Acyanotic: USD1 ASD
AV
,
card
CoA
detect
, PDA
☒☐systolic small large
restrictive non -
neserrctrne
1. Ventricular septal defect (VSD): 2
< 0.5cm >1cm ?
M.C cardiac malformation (25%)
-
↳ Rt
types: Iggy .
RV P=LH Direction based
– position: membranous (M.C), Muscular QP :Qs 4.75.1 QP :Qs > 2:\
– Size: small, large
Nl others RV&P°'m HTN
imarnpvlm
-
-
ar
✓ -
Small: restrictive, <0.5cm2, L->R shunt (LV pressure > RV), Qp:Qs <1.75:1, Nl pulmonary arterial and RV pressure, normal Pulmonary vascular bed, N
SMALL)
Large non restrictive: >1cm2, RV and LV pressure equalize, Direction of shunt determined by ratio of pulmonary to systemic vascular resistance, Qp
Main pulmonary artery-LA-LV enlarged.
Ix:
CXR: small VSD: normal or minimal Cardiomegaly. Borderline increase in Pulmonary vasculature.
- -
Large VSD: Gross cardiomegaly (RV, LV, LA, PA), Prominent pulmonary vascularity.
-
-
ECG: Small VSD: normal or may suggest LV hypertrophy
Large VSD: biventricular hypertrophy, P wave notched or peaked
-
*Right atrium enlargement: Peaked p wave
*Left atrial will be broad or biphasic p wave
*Both = both
Thank
-
Site 1 Size , direction pressure
Doppler catheter
2D & pulsed doppler Echo:
associated lesions .
,
Position and size of defect
- - ↳ when she unconcern
, Done when:
Size of shunt uncertain
Lab data not fit with clinical findings
Pulmonary vascular disease is suspected
Tx:
reassure / conevol It -6
Small: reassure and encourage encourages closure
on direct
PA banding
•
Protection against endocarditis Large
:
→
regular follow up
-
surgery
follow up
Large: control symptoms of H.F
Surgery (PA banding or direct closure defect)
Closure of defect:
– any age with large defect with uncontrolled S/S
– Infant: 6-12 months w/ are defect associated w/ Pulmonary HTN
–
- -
Pt >24m w/ Qp:Qs >2:1
– Supracristal VSD
Prognosis and complications:
small VSD:
÷
– spontaneous closure: 30-50%, mostly during first 2 years of life (small muscular more likely to close 80% than membranous 35%)
– most often asymptomatic
– infective endocarditis
-
Moderate - large VSD:
– may —> smaller, 8% may close repeated chest infection
–
-
repeated chest infection, H.F, FTT It f
.
