Critical congenital heart disease (CCHD) refers to severe heart defects that require intervention, such as surgery or catheter procedures, in the first year of life. CCHD accounts for about 25% of all congenital heart disease cases. Common types include those dependent on ductal flow, such as hypoplastic left heart syndrome, as well as defects affecting the right ventricle outflow tract like pulmonary atresia. Diagnosis is based on symptoms like cyanosis and screening involves pulse oximetry of the right hand and foot in newborns. Treatment options include pharmacological therapy with prostaglandin E1 to keep the ductus arteriosus open, as well as surgical or catheter-based procedures.
2. CONTENTS
1. Definition
2. Fetal circulation
3. Classification
4. Clinical features
5. Diagnosis
6. Treatment
7. Screening
Sources – Cloherty , UpToDate, Article on Screening- link
attached
3. What is Critical CHD?
• Lesions requiring surgery or catheter based
intervention in the first year of life.
Critical CHD= ~25% of all CHD.
https://www.uptodate.com/contents/newborn-screening-for-critical-congenital-heart-disease-using-
pulse-
oximetry?search=newborn%20screening%20for%20cyanotic%20congenital%20heart%20disease&sourc
e=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
4.
5. Concepts
Streaming Mixing
High Pressure to Low Pressure
Uni-Directional
LV to RV Sys to Pul Aor to Pul Art
Near Equal Pressures
Bi-directional
LA & RA Large VSD
6. Start from the beginning – Fetal Circulation
o Heart
Pumping
Separation of circulation
Fetal Circulation
Source of O2
High oxygen and glucose demand for brain and
cardiac structures
Slow growing structures
32. • PROSTAGLANDIN E1:
• Indication: ductal-dependent congenital heart
defect.
• Always given as continuous IV infusion.
• Start at 0.05-0.1 mcg/kg/min, can be reduced
to 0.005-0.01 mcg/kg/min once duct is
opened. (^SaO2).
• Trade name: Alpostin/ Prostin
• One vial will last 2-3 days for a 3 kg baby.
33. • Start PGE1 infusion: 1 ml vial of 500 mcg/ml
• Reconstitute in 50 ml 10% Dextrose
• 0.6*wt= _ml/hr drip rate for a dose of 0.1
mcg/kg/min
• Cost: 5820
34. Adverse effects of PGE1:
•Apnea
•Hypotension and tachycardia
•Necrotizing enterocolitis (NEC)
40. Screening is recommended in the right hand (preductal) and either foot (postductal).
Screening at both locations can occur simultaneously or in direct sequence.
41.
42. Dhoni’s Records – 2004 - 2019
Only captain to win three ICC tournaments
WT20 – 2007, ICC WC – 2011, Champions
Trophy - 2013
Most international matches as a captain
332 Total ( 200 ODI, 60 Tests, 72 T20)
Most final wins as a captain (ODIs)
4/6 multinational ODI
Most Not Outs in ODIs
Unbeaten in 84 ODIs
Most stumpings in international cricket
123 stumping in 350 matches