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Nama
Current Education :
Internist
Cardiologist
Cardiologist Consultant
Current Position:
Clinical Approach to
Grown Up Congenital
Heart Disease (GUCH)
Lucia Krisdinarti
Cardiology Department and Vascular Medicine
Medical Faculty UGM/Sarjito Hospital
YOGYAKARTA
Introduction
GUCH can be divided into 2 groups : those who
have not previously had an intervention and
those who have.
Age
Gender
(Hidayati et.al, 2015)
Children
Adult
(Hidayati et.al, 2015)
(ESC, 2010)
Clinical Examination
Plays a major role and includes, during follow up, careful evaluation with
regard to any changes in auscultation findings, blood pressure, and
development of sign of heart failure
Chest X-ray
Performed on indication but helpful during follow up
( ESC guidelines , 2010)
Further Examination
Echocardiography
- First line investigation, providing morphology of cardiac anatomy,
Cardiac MRI
- Alternative to echo when both provide similar information but echo
cannot be obtained with sufficient quality
Computed Tomography
Cardiopulmonary Exercise Testing
Cardiac catheterization
- assesment of PAP, PVR, shunt quantification particularly in shunt lesion
- testing of vasoreactivity
- coronary angiography before surgery in men>40 y.o, post menopausal
women, and patients with risk factors for CAD
(ESC guidelines, 2010)
Commonly asymptomatic
Essentials of diagnosis:
Right ventricular heave
S2 widely split and usually fixed
Grade I-III/VI systolic murmur at the pulmonary area
RBBB in ECG; RAD for secundum type and LAD for primum
type
Cardiac enlargement on CXR
(Rao, 2005)
(Rao, 2005)
12
Closure
contraindicated in
severe PAH
Previously surgical;
now often closed
percutaneously using
device
Clinical findings
Grade II-IV/VI, medium- to
high-pitched,
harsh
pansystolic murmur heard
best at the left sternal border
with radiation over the entire
precordium
15
Epidemiology facts
Accounts for about 10% of all cases of CHD
Higher incidence of PDA in infants born at high altitudes
(> 10,000 feet)
More common in females
Mortality Rate
Pregnancy in GUCH
Mode of delivery
Caesarean
Spontaneus
PH /ES
7 (25%)
non PH
5 (22%)
18 (78%)
16 (75%)
Mortality
6 (27%)
Survive
SeverePH
Died
17 (73%)
Eisenmenger Syndrome
Eisenmenger syndrome is pulmonary hypertension with a reversed central
shunt
Based on RHC; total number of the patients July 2012 Dec 2014: 124
45
no PH
39
40
patients No.
35
30
23
25
21
20
15
8
10
5
10
6
3
0
0
<20
21-40
41-60
Age Category
>61
(Krisdinarti & Anggrahini, 2014)
<20
21-40
17
41-60
19
>61
31
(75%)
<20
21-40
41-60
>61
Hemoptysis (15%)
Pregnancy
Perioperative mortality of non-cardiac surgery
Infectious diseases
PH severe/
Eissenmenger Right Heart Failure
Lung Infection
6%
PA dissection
Sudden Cardiac Death
Arrythmia VF
Sepsis
Death
7%
No PH 1%
SUMMARY
GUCH still become a big problem in Indonesia.
Case finding is important
Special issue : pregnancy, pulmonary
hypertension, high mortality rate.
Thank You
Infective Endocarditis
Cardiac conditions associated with the highest risk of adverse
outcome from endocarditis for which prophylaxis with dental
procedures is reasonable
Condition
30
Infective Endocarditis
Congenital Cardiac Lesions and Preoperative Risk for Noncardiac Surgery
High risk
Pulmonary hypertension, primary or secondary
Cyanotic congenital heart disease New York Heart
Association class III or IV
31
32
33