Transcript 11th lecture

CONGENITAL HEART
DISEASE
DR. Mohamed Seyam PhD. PT.
Assistant Professor Of Physical Therapy
For Cardiovascular /Respiratory Disorder
Relative Frequency of Lesions
septal defect 25-30% • Transposition of great arteries 3-5
1-3
• Atrial septal defect
6-8% • Hypoplastic left ventricle
• Ventricular
• Patent
ductus arteriosus
• Coarctation
• Tetralogy
of Fallot
• Pulmonary
• Aortic
of aorta
valve stenosis
valve stenosis
6-8%
• Hypoplastic
5-7%
• Truncus
5-7 %
•
5-7%
right ventricle
arteriosus
1-3
1-2
Total anomalous pulm venous return 1-2
• Tricuspid
atresia
1-2
4-7 % • Double-outlet right ventricle 1-2
• Others
5-10
Classification
Noncyanotic CHD (L →R)
Cyanotic CHD (R →L)
•
Ventricular Septal Defect
•
Tetralogy of Fallot
•
Atrial Septal Defect
•
Fallot triology
•
Pulmonic stenosis (PS)
•
Tricuspid atresia (TA)
•
Aortic stenosis (AS)
•
Pulmonary atresia (PA)
•
Patent ductus arteriosus (PDA)
1- Atrial Septal Defect
Most commonly asymptomatic
 Three major types
1. Ostium secundum
• most common
• In the middle of the septum
2- Ostium primum
• Low position
3- Sinus venosus
• Least common
• Positioned high in the atrial septum
•
2- Ventricular Septal Defect
• Single
most common congenital heart malformation,
accounting for almost 30% of all CHD
• Defects
can occur in both the membranous portion of the
septum and the muscular portion
Types of Ventricular Septal Defect
•
Three major types
•
Small, hemodynamically insignificant
Between 80% and 85% of all VSDs
• < 3 mm in diameter
• All close spontanously
•
50% by 2 years
• 90% by 6 years
• 10% during school years
•
•
Muscular close sooner than membranous
Moderate VSD
• 3-5
mm in diameter
• Least common group of children (3-5%)
• Without evidence of CHF or pulmonary hypertension,
may be followed until spontaneous closure occurs
Large VSD
• 6-10
mm in diameter
• Usually requires surgery,
• otherwise… Will develop
congestive heart failure (CHF) and
failure to thrive( FTT)
by age 3-6 months
Ventricular Septal Defects
• Clinical findings
• Grade II-IV/VI,
medium- to
high-pitched, harsh murmur
• heard best at the left sternal
border with radiation over the
entire precordium
Treatment of Ventricular Septal Defect
•Indicated
for closure of a VSD associated with
CHF and FTT or pulmonary hypertension
•Patients with cardiomegaly, poor growth, poor
exercise tolerance,
•typically undergo surgical repair at 3-6 month.
3- Patent Ductus Arteriosus
Patent Ductus Arteriosus
• Persistence
the
of normal fetal vessel joining
pulmonary artery to the aorta artery.
• Closes
spontaneously in normal term infants at 3-5 days of age
• Accounts
• Higher
• More
for about 6-8% of all cases of CHD
incidence of PDA in infants born at high altitudes (> 10,000 feet)
common in females
Patent Ductus Arteriosus
• Treatment consists
of surgical correction when the PDA is
large except in patients with pulmonary vascular obstructive
disease
• Transcatheter closure
of small defects has become standard
therapy
• In
preterm infants indomethacin is used (80-90% success in
infants > 1200 grams)
4- Tetralogy of Fallot
• This
malformation consists the
following tetralogy:
• (1)
Pulmonary artery Stenosis
• (2)
Interventricular defect
• (3)
Deviation of the origin of the
aorta to the right
• (4)
Hypertrophy right ventricle.
Tetralogy of Fallot
•
Most common cyanotic lesion
•
(5 to 7 % of all CHD)
• Typical features
• Cyanosis after
the neonatal
period
• Hypoxemic spells during infancy
Tetralogy of Fallot
•
start around 4 to 6 months of age and are
characterized by
1.
2.
3.
4.
Sudden onset or deepening of cyanosis
Sudden onset of dyspnea
Alterations of consciousness
Decrease in intensity of systolic murmur