Surgery for Congenital Heart Diseases:

Posted by e-Medical PPT Tuesday, February 14, 2012
Etiologic Basis of Congenital Heart Diseases:
1. Primary genetic factors (10%) 1) Chromosomal ; 5-10% 2) Single mutant gene ; 3% Recessive Dominant 2. Genetic-environmental interaction (90%) 1) Multifactorial inheritance ; majority 2) Risks to offspring of an affected parent 3) Environmental contribution Drugs Infections Maternal conditions

Potential Cardiovascular Teratogens:
1. Drugs Alcohol Amphetamines Anticonvulsants Chemotherapy Sex hormone Thalidomide Retinoic acid 2. Infections Rubella Coxsakie virus 3. Maternal conditions Old age Diabetes Lupus Phenylketonuria 4. Others

Maternal Risk Factors:
Malformation Advanced age Trisomy 21 Maternal CHD Various Diabetes mellitus VSD, TGA, cardiomyopathy SLE Heart block Phenylketonuria TOF, VSD, COA, HLHS Viruses Teratogenic, myocarditis (*cytomegalovirus, herpes, coxsacki B, parvovirus)

Maternal Drug Exposures:
Drug Malformation Diphenylhydantoin PS, AS Trimetadione VSD, TOF, TGA, HLHS Thalidomode TOF, Truncus arteriosus Lithium Ebstein anomalies Alcohol VSD, ASD, PDA, TOF Amphetamine VSD, ASD, PDA, TGA Birth control pills VSD, TOF, TGA

Stages of Heart Formation:
1. Early blood vessel formation 1) Intraembryonic blood vessel at 13 days 2) Extraembryonic blood vessels at 17 days 2. Development of heart 1) Position and cardiac tube at 23 days Heart beating at 26 days. 2) Formation of heart loop at 8 somites 3) Formation of ventricle 4) Development of sinus venosus 3. Formation of cardiac septa 4. Formation of cardiac valves 5. Formation of arterial system 6. Formation of great systemic veins

Evaluation of CHD by History Taking:
1. Infants 1) Murmur 2) Symptoms of CHF poor feeding, low weight gain, tachypnea, tachycardia, sweating, anxiety, irritability, frequent URI 3) Symptoms of hypoxemia cyanosis, hypoxic spell 2. Children 1) Murmur 2) Symptoms of CHF exercise intolerance, dyspnea on exertion, frequent URI, palpitation 3) Syncope, chest pain 4) Symptoms of Hypoxemia cyanosis, hypoxic spell,clubbing

To Be Corrected in Neonate:
Critical AS Hypoplastic left heart syndrome Mitral valve hypoplasia Aortic valve and arch hypoplasia Hypoplastic left ventricle Interrupted aortic arch Symptomatic COA TGA Obstructive TAPVC Truncus Arteriosus PA with IVS PA with VSD Other symptomatic complex heart diseases

To Be Corrected in Infancy(I):
Cardiac anomalies with pulmonary outflow tract obstruction Double inlet ventricle Critical PS Tricuspid atresia DORV DOLV TGA TOF PA with or without VSD Corrected TGA

To Be Corrected in Infancy(II) :
Cardiac anomalies with CHF Large VSD AVSD Double inlet ventricle Tricuspid atresia TAPVC COA DOLV PA with IVS Corrected TGA Cardiac mass TGA Truncus arteriosus Severe AS, AR Severe MS, MR Interrupted aortic arch DORV Aortopulmonary window ALCAPA PDA TAPVR

To Be Corrected in Infancy & Childhood:
ASD AS(LVOTO) Partial AVSD Ebstein ’ s anomaly VSD with PS VSD PS Mitral stenosis Atrial isomerism Coronary artery anomaly (A-V fistula) Anomalous pulmonary venous drainage Valvular heart diseases Complex anomalies with previous palliation Late presenting cardiac anomalies Cardiomyopathy...

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