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Acyanotic Congenital Heart Disease

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Title: Interpretation of Paediatric Echo Reports Author: David Michael Coleman Last modified by: cardiac Created Date: 3/18/2003 10:21:19 AM Document presentation format – PowerPoint PPT presentation

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Title: Acyanotic Congenital Heart Disease


1
Acyanotic Congenital Heart Disease
Dr David Coleman Consultant Paediatric
Cardiologist Our Ladys Childrens Hospital,
Crumlin Dublin
2
Common Shunt Lesions
  • ? Ventricular septal defect (VSD)
  • ? Atrial septal defect (ASD)
  • ? Patent ductus arteriosus (PDA)

All 3 lesions can lead to Eisenmengers
Syndrome if a large lesion is not detected and
treated early enough
3
Common Stenotic Lesions
  • ? Pulmonary stenosis (PS)
  • ? Aortic stenosis (AS)
  • ? Coarctation of the aorta (CoA)

4
VSDs
  • ? Commonest form of CHD
  • ? Commonest types
  • membranous (perimembranous) 75
  • muscular
  • ? Can be single or multiple

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6
VSDs
  • ? Symptoms relate to the degree of shunt (VSD
    size, pulmonary vascular resistance)
  • if small no symptoms
  • if large (high pulmonary blood flow, CHF)
  • tachypnoea
  • dyspnoea
  • slow feeding
  • failure to thrive
  • sweating

7
VSDs
  • ? Exam (smaller VSD)
  • pink
  • normal pulses
  • normal S1 and S2
  • systolic thrill
  • harsh pansystolic murmur LLSE
  • ? ECG normal (smaller VSD)
  • or LVH RVH (larger VSD)

8
VSDs
  • ? Larger defect
  • MDM _at_ apex (mitral flow murmur)
  • narrowly split S2 and loud P2
  • S3
  • CXR cardiomegaly
  • increased pulmonary vascularity

9
VSDs
  • ? Treatment options
  • Nil (spontaneous closure)
  • Surgical closure
  • Device closure

10
ASDs
  • ? Three types secundum
  • primum
  • sinus venosus
  • ? Commonest secundum
  • ? Primum a form of atrioventricular septal
    (canal) defect

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13
Secundum ASD
  • ? Usually no symptoms in childhood
  • ? Exam pink
  • normal pulses
  • wide fixed split S2
  • soft ESM _at_ ULSE
  • ? ECG incomplete RBBB (95)
  • ? CXR often normal
  • sometimes pulmonary plethora

14
Secundum ASD
  • ? Haemodynamic significance of ASD is assessed
    to decide if closure appropriate
  • ? Usually closed age 3-5 years (earlier if
    symptomatic) or when diagnosed if later
  • ? Two options for closure
  • surgery - suture or patch
  • interventional catheter - device

15
Amplatzer ASD Occluder
16
PDA
  • ? CHF symptoms if large ductus in very young
    infant, otherwise often asymptomatic
  • ? Exam pink
  • full volume pulses
  • harsh systolic (1st few weeks) or
    continuous machinery murmur loudest under
    left clavicle
  • ? ECG normal (small PDA)
  • LVH RVH (large PDA)

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18
PDA
  • ? CXR cardiomegaly, pulm plethora
  • ? Options for closure
  • surgery - ligation
  • interventional catheter - coil(s) or device

19
Pulmonary Stenosis
  • ? Usually asymptomatic
  • ? Exam pink
  • normal pulses
  • systolic ejection click
  • ESM loudest _at_ ULSE if severe, S2 widely
    split (not fixed)

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21
Pulmonary Stenosis
  • ? ECG RAD, RVH
  • ? CXR normal
  • prominent MPA (post-stenotic dilatation)
  • ? Treatment of valvar PS (moderate/severe)
  • balloon valvuloplasty preferred
  • uncommonly surgical valvotomy

22
Aortic Stenosis
  • ? Often asymptomatic
  • otherwise SOB, syncope or chest pain on exertion
  • ? Exam pink
  • small volume pulse, small pulse pressure
  • LV lift
  • systolic thrill (suprasternal, URSE)
  • systolic ejection click
  • harsh ESM loudest _at_ URSE radiating to
    carotids
  • if severe, narrow split S2 (even reversed)

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24
Aortic Stenosis
  • ? ECG normal (mild AS)
  • LVH strain (more severe AS)
  • ? CXR often normal
  • dilated ascending aorta
  • ? Treatment of valvar AS (moderate/severe)
  • balloon valvuloplasty
  • surgical valvotomy

25
Coarctation of the Aorta
  • ? CHF in neonate if severe CoA
  • often asymptomatic in older child
  • ? Exam pink
  • reduced or absent femoral pulses
  • soft systolic murmur mid LSE
  • and/or mid left back
  • ? ECG RVH in 1st few months of life,
  • LVH if older

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27
Coarctation of the Aorta
  • ? CXR cardiomegaly
  • evidence of CHF
  • rib notching (older child)
  • ? Treatment
  • surgery for native CoA
  • balloon angioplasty for re-CoA
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