Congenital Heart Disease

= CHD

~ an Overview
mtsdarmawan
dept anak fk uii

CHD Abbreviations

VSD ventricular septal defect

ASD atrial septal defect
PS pulmonary stenosis
AS aortic stenosis
HLHS hypoplastic left heart syndrome
TAPVC/D totally anomalous pulmonary venous connection/drainage
TGA transposed great arteries
PFO patent foramen ovale
PDA patent ductus arteriosus
CAVC- complete Atrioventricular canal defect (PAPVC- partial= ostium
primum ASD)
AV valve- atrioventricular valve (usually mitral or tricuspid)

Congenital Heart Disease

Commonest group of life threatening anomalies

8-10 / 1000 live births

VSD 30-50%
PDA 10%
ASD 7%.
PS 7%
Coarctation 6%, AS 5%
Tetralogy 5%, TGA 5%
AV canal defects 3%

Penyakit Jantung Bawaan

Pertanyaan penitng :
Apakah sianotik ?
Apakah ada bising ?
Aliran darah paru : normal, atau ?
Bagian jantung mana saja yang terlibat ?

Blood Vessels

Angiogenesis

Proyeksi jantung pd
dinding dada

PDA

ASD
VSD
RHD

Proyeksi Jantung
Jenis bising :

PDA : kontinue
ASD : sistolik
VSD : sistolik
RHD : pansistolik

PDA
ASD
VSD

RHD

Anatomi Jantung

Listrik Jantung

Listrik Jantung

Listrik Jantung

Listrik Jantung

Atrial Flutter

Aktivitas Listrik Jantung

How Does Heart Work ?

Blood Flow

Jenis Kelainan

Structural mal~alignment
Lubang

Jenis Kelainan

Structural mal~alignment

Transposition of great arteries

Tetralogy of Fallot
Truncus arteriosus
Total anomalous pulmonary venous return
Atrioventricular canal

Jenis Kelainan

Lubang

Atrial septal defect

Ventricular septal defect

Jenis Kelainan

Coarctation
Patent ductus arteriosus (PDA)
Valves

Stenosis
Regurgitation
Absence/atresia

Tricuspid (hypoplastic right heart)

Mitral +/- aortic (hypoplastic left heart)

Arrhythmias

Heart block
Supraventricular tachycardia

Transposition of great arteries

Transposition of great arteries

Aortic Stenosis

Tetralogy of Fallot ~ TOF

Clubbing Finger

Hemodinamik

Mengukur JVP

Mengukur JVP

Alfred Blalock

Helen Taussig

Blalock-Taussig Shunt

Modified Blalock-Taussig Shunt

Hi,IHaveaTetralogyofFallot

Truncus arteriosus

Total anomalous pulmonary venous return

Septal Defect

Atrial septal defect ~ ASD

ASD

Occluder ~ Amplatzer

Occluder pada ASD

ASD Occluder

1
2
3

4
4

ASD Occluder

ASD Occluder

ASD Occluder

Ventricular septal defect ~ VSD

VSD

Atrioventricular canal

Single Ventricle

Coarctation of aorta

Patent ductus arteriosus ~ PDA

Patent ductus arteriosus ~ PDA

Normal

Penutupan PDA Normal

Blood Flow pd PDA

Blood Flow pd PDA

Occluder pada PDA

Patent Ductus Arteriosus

-Failure of the ductus to close in the face of
increased O2 saturation and drop in PG
-abnormal smooth muscle composition

Patent Ductus Arteriosus

Usually causes a left to right shunt
Volume overload of the left heart

Rarely causes severe pulmonary hypertension

Cyanosis, chronic hypoxia, polycythemia

PDA
Ao

PA

RV
LV

Management
Indomethacin in premature infant
Transcatheter closure/ non surgical
closure:
Coil embolization
Amplatzer ductal occluder (ADO)

Surgical closure

PDA
Neonates/Infants

Heart failure (-) PH (-)

Heart failure (+)

Premature
Anti failure
Indometacin
Success

Children/Adults

Full term

Fail

Hyperoxia
Success
Age >12wks
W >4kg

Spontaneous
closure

Surgical
ligation

RL

LR

Anti failure
Fail

PH (+)

Reactive

Transcatheter closure

Non
reactive

Conservative

Prostaglandin E1

Helps maintain PDA

Reasons for PGE1

To increase pulmonary blood flow

To allow for mixing (allowing better oxygen
delivery)
To maintain systemic flow (even though
deoxygenated blood)

Prostaglandin contd

Usual dose is 0.03 mcg/kg/min - 0.05

mcg/kg/min
Apnea is common - intubation often
necessary
Fever is side effect

Transcatheter PDA occlusions

Rashkind umbrella device

Stainless steel coils
Amplatzed ductal occluder

Gianturco coils

Amplatzer ductal
occluder

Procedure
AO

PDA
AO

ADO

ADO

Aortogram of PDA

During deploying coil

After deployed of ADO

Tricuspid atresia

Hypoplastic left heart syndrome

Cyanosis vs acyanotic

Cyanosis requires
shunting or mixing
(except?)

Cyanosis vs acyanotic

Must have

Septal defect (atrial or

ventricular)
PDA
Driving force for right to left
shunting

Cyanotic Spell ~
Serangan Sianosis

Evaluation possible congenital heart

ABCs
Periksa : frekuensi, irama, impulse, bising,
nadi (brachial and femoral)
Satura O2 (pre and postductal)
BGA
Chest xray
Echocardiogram

Initial management considerations

Too much pulmonary blood flow?

Too little pulmonary blood flow?
Too little systemic flow?
Mixing?

Increased pulmonary flow (Qp)

ASD
VSD
TGA
Truncus
Double outlet right ventricle
Atrioventricular canal ~ single ventricle
PDA

Decreased pulmonary flow

Right sided obstruction

Pulmonary atresia/stenosis

Tetralogy of Fallot
Tricuspid atresia

Decreased systemic flow (Qs)

Left sided obstruction

TAPVR with or without obstruction
Hypoplastic left heart

Mitral atresia, aortic atresia, interrupted aortic

arch, coarctation of aorta

Bentuk Anomali Dada

Pectus excavatum

Pigeon Chest

Pigeon Chest

Pigeon Chest

Pigeon Chest

Edema paru

Edema paru pd
Gagal jantung

CTR = AB : normal < 0,5

CD

Edema paru

Tellme,Iforget
Showme,Iremember
Involveme,Iunderstand
Chineseproverb

Terima Kasih