Acyanotic Congenital Heart Disease

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Acyanotic Congenital Heart Disease
Dr David Coleman Consultant Paediatric
Cardiologist Our Ladys Childrens Hospital,
Crumlin Dublin
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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
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Common Stenotic Lesions

• ? Pulmonary stenosis (PS)
• ? Aortic stenosis (AS)
• ? Coarctation of the aorta (CoA)

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VSDs

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

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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

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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)

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VSDs

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

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VSDs

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

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ASDs

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

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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

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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

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Amplatzer ASD Occluder
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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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PDA

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

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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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Pulmonary Stenosis

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

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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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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

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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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Coarctation of the Aorta

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