Congential heart diseases

CONGENITAL HEART
DISEASES
Presented by,
Nikhil Govind

Table of contents
 Definition
 Pathology
 Clinical features
 Signs
 investigations
 Complications
 treatment

Introduction:-
 Congenital heart diseases is the abnormality
of the heart at birth
 It is the most common and important form of
heart diseases in the early years of life and is
present about 0.5% of new born children

Causes:-
1) Rubella infection to the mother when
pregnant
2) Drugs taken by the mother
3) Heavy alcohol drinking by the mother

 Congenital heart diseases may be divided as
following
 1) Coarctation of Aorta
 2)Patent Ductus Arteriosus
 3)Ventricular Septal Defect
 4)Atrial Septal Defect
 5)Tetralogy of Fallot

Definition:-
 The word coarctation means contracted or
compressed
 Coarctation of the aorta is defined as the
narrowing of the lumen of the aorta
 It can occur anywhere on the length of the
aorta
 But it is commonly located immediately below
the origin of the of the left subclavian artery

Pathology:-
 Morphological features:-
 1) Post ductal type or adult type :- the
obstruction is just distal to the point of entry of
ductus arteriosus which is often closed
 The condition is recognized in adulthood ,
characterized by hyper tension in the upper
extremities , weak pulses and low blood
pressure in the lower extremities and effects of
arterial insufficiency such as claudication and
coldness

 in time there is development of collateral
circulation between pre stenotic and post
stenotic arterial branches
 2) Pre Ductal or Infantile type:- the
manifestations are there in early life . The
narrowing is proximal to the ductus arteriosus
which usually remains patent .
 the narrowing is generally gradual and
involves larger segment of the proximal aorta

Preductal coarctation results in right ventricular
hypertrophy while the left ventricle is small
Cyanosis develops in the lower half of the body
while the upper half remains unaffected since
it is supplied by vessels

Clinical features:-
 Physical examination
 Differential cyanosis
 Signs of cardiac shock
 Reduced or absent femoral pulses
 Lower BP in lower limb compare to upper limb

Mild COA Is asymptomatic and chronic hypertension
 Headache
 Epistaxis
 Leg fatigue
 Stroke secondary to rupture of cerebral aneurysm
in adults
 Chronic COA
 Presented about 7 to 10 days
 Circulatory collapse and shock

Signs:-
 Lower segment of the body is under developed
 Weak and delayed femoral pulses
 Prominent pulsations in the neck
 Cork screw shaped retinal arteries
 Heaving apical pulses
 Suzman sign is dilated tortuous . Pulsatile
arteries seen around the scapula and intercoastal
regions in the back . It is seen better once the
patient bent forward

Investigations:-
 The following investigations are of the
following
 1) echocardiography
 2) electro cardiography
 3) angiogram
 4) radiological findings
 Cardiac catherisation and aortagraphy can be
used to locate the site of coarctation of aorta

 The following features of radiological findings are
as follows
 Rib notching or dock sign is the notching of the
undersurface of the posterior ribs , extending from
third to ninth ribs
 Post stenotic dilatation of the aorta distal to the
coarctation
 3 sign is a combination of the dilated subclavian
artery above , stenosed , coarcted segment in the
middle and dilated post stenotic aorta below

Complications:-
 Hypertension
 Left ventricular failure
 Aortic dissection and rupture of the aorta
 Infective endocarditis
 Persistent renal damage

Treatment:-
 Coarctation of the heart can be treated as
follows
 In symptomatic new born PGE1 is given to re
open the ductus arteriosus and also promote
the blood flow to the lower extremities
 Digoxin can also be given
 Surgical repair can be done by procedure such
as
Balloon angioplasty and stenting

PERSISTENT
DUTUS
ARTERIOSUS

DEFINITION:-
 Ductus arteriosus is a vessel leading from the
bifurcation of the pulmonary artery to the aorta
just distal to the origin of left subclavian artery
 This is functional in foetus as it diverts
desaturated blood from main pulmonary artery
into the descending aorta and placenta for
oxygenation
 It closes after birth . Persistence of the patency
is also known as patent ductus arteriosus

Pathology:-
 Morphological features:-
The ductus arteriosus is a normal vascular
connection between the aorta and the bi
furcation of the pulmonary artery
the persistence of the duct after 3 months is
abnormal
The continued presence of PGE2 maybe the
cause of the ductus arteriosus

 Morphological features :- the effects of PDA is that
the left to right shunt at the level of the ductus
arteriosus is increased .
 There is increased volume and increased
pulmonary flow
the following effects are as follows
1) Volume hypertrophy of the left atrium
2) Enlargement and haemodynamic change in the
mitral valve
3) Enlargement of the ascending aorta

Clinical Features:-
 Dyspnea
 Collapsing pulse
 Continuous thrill at the upper left sternal edge
 First heart sound is loud
 Left ventricular third heart sound and a mid
diastolic flow murmur at the apex
 Retardation of growth
 More common in females

Investigations:-
 Chest radiography
 Electrocardiogram
 Electrocardiography

 In electrocardiogram frequently shows left
atrial enlargement .
 It also includes features such as left ventricular
hypertrophy
 Chest x rays shows plethoric fields

Complications:-
 Cardiac failure
 Infective endocarditis
 Paradoxical embolism
 Pulmonary hypertension
 Rupture of the ductus

Management:-
 Surgical ligation of division of the ductus
 Use of diuretics
 In pre mature babies a medical closure of the
ductus may be done by using indomethacin
 Surgical management is done by thoracotomy

References
 Harsh mohan textbook of pathology 6 th
edition
 K George mathew
 Davidson principles and practice of medicine

Congential heart diseases

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