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DISEASE
R Rukma Juslim,SpJP,FIHA
Subdep Jantung & Pembuluh
Darah
RSAL DR. Ramelan
Surabaya
EPIDEMIOLOGY
1. 8 in 1000 live births
2. Cyanotic & Acyanotic
3. Grown-up Congenital Heart Disease
(GUCH) :
a. < 20% before surgical
correction
b. Now : 85%
CYANOTIC
Neonate :
1.TGA (Transposition of the Great Arteries)
2.Tricuspid atresia
3.Obstructed TAPVD ( Total Anomalous
Pulmonary Venous Drainage )
4.Severe PS
5.Pulmonary atresia
6.Severe Ebsteins anomaly with ASD
7.Hypoplastic left heart
CYANOTIC
Infant and Older Child :
1.TGA
2.TOF
ACYANOTIC
Neonate :
1.Congenital Aortic Stenosis
2.Coarctation + VSD/PDA
Infant & Older child :
VSD, ASD, PDA, Congenital AS,
Coartaction, PS.
ASD
Secundum
ASD
Primum ASD
AV canal
Presentation
Child or Adult
childhood
Infancy
Appearance
Normal
Normal
Down syndrome
Color
Normal
Normal
Cyanosis
Signs
Secundum ASD
As ASD II MR
As VSD
Ventricular
Septum
Intact
Intact
VSD component
ECG
RBBB + RAD
RBBB + LAD
RBBB, LAD,
Long PR or
worse
Pulmonary
Hypertension
Mitral Valve
No
Usually normal
No
Yes
ASD Secundum
Clinical manifestation :
Right Heart dominant
RV failure sign
Auscultation :
Pulmonary systolic ejection murmur
Fixed splitting S2 & P2 on any phase
respiration
Grades of VSD
1.
2.
3.
4.
5.
Very small
Small
Moderate
Large
Eisenmenger syndrome
CLINICAL MANIFESTATION
VERY
SMALL
SMALL
MODERATE
LARGE
EISENME
NGER
Loud
Pansystoli
c. LSE to
Apex & PA
=Small +
diastolic
murmur
at apex
Pansystoli
c
decresend
o to S2.
Pulmonar
y ejection
systolic
None at
LSE.
Ejection
systolic
PA & PR
Apex
Normal
N / LV >
slight
ECG
Normal
Normal
LA&LV >
LAD
LA,LV,RV
>
RA& RV >
RAD
Thorax
foto
Normal
Normal
Slight
cardiome
galy
Cardiome
galy,
Large PA
Large PA
VSD Treatment
1. Very small & small : Spontaneous
closure
2. Moderate : Surgery
3. Large : Surgery
4. Eisenmenger syndrome : Medical
treatment.
PATENT DUCTUS
ARTERIOSUS
Moderate PDA : Collapsing pulse with
wide pulse pressure; Thrill systolic
and or diastolic at ICS II.
The S2 sound is usually Inaudible
TETRALOGY FALLOT
Anatomy :
1. Non restrictive VSD
2. Overriding Aorta (>50%)
3. Right Ventricular Hypertrophy
4. Right Ventricular Outflow Tract
(RVOT) obstruction (+ PS )
TETRALOGY FALLOT
Clinical Manifestation :
1. Unoperated :
a. Severe RVOT obstruction : central
cyanosis & clubbing ; Hypoxic spells
b. S1 normal, S2 inaudible
2. Palliated : Pulmonal hypertension
3. Complete/Total Repaired :
Asymptomatic patients, late symptom :
DOE, RV failure.
TETRALOGY FALLOT
Diagnostic testing :
ECG
1. Unoperated : RVH,RAD, RBBB.
2. Palliated : LVH
3. Repaired : CRBBB after repair
TETRALOGY FALLOT
Thorax Photo :
1. Unoperated :Boot shaped heart
2. Palliated : Blalock Taussig
(increased pulmonary blood flow);
Waterston (unilateral pulmonary
hypertension)
3. Repaired : cardiomegaly from RV
dilatation
TETRALOGY FALLOT
Interventional Options :
Surgery
Resection infundibular stenosis,
Transannular patch
Interventional
Balloon dilatation, stent insertion
Thank you
for your kind
attention