Over view of Congenital heart Disease

1. BLUE BABIESBLUE BABIES
AND PINK KIDSAND PINK KIDS
Dr Ravi NarayanDr Ravi Narayan
Senior Consultant Ped.Cardiologist,&Senior Consultant Ped.Cardiologist,&
Assoc. Prof. CardiologyAssoc. Prof. Cardiology
RAMAIAH NARAYANA HRUDAYALAYARAMAIAH NARAYANA HRUDAYALAYA

2. OVERVIEW OF MANAGEMENT INOVERVIEW OF MANAGEMENT IN
COMMON CHDCOMMON CHD

3. IntroductionIntroduction
 CongenitalCongenital—means from birth—means from birth
 Congenital heart defects (CHD) canCongenital heart defects (CHD) can
vary fromvary from small holessmall holes in the heart toin the heart to
veryvery serious malformationsserious malformations
 Some defects can manifest in teenageSome defects can manifest in teenage
or adults (GUCH)or adults (GUCH)

4. Cyanosis)—Cyanosis)—note the nails are very bluenote the nails are very blue
because of deoxygenated blood entering thebecause of deoxygenated blood entering the
aortaaorta

5. Pink Kid!!!!Pink Kid!!!!
IS HIS MURMUR INNOCENT???IS HIS MURMUR INNOCENT???

6. CLASSIFICATIONCLASSIFICATION
• ACYANOTIC//CYANOTIC
• SHUNT LESIONS
• ASD,VSD,PDA
• STENOSIS-- AS, PS,
• Narrowing of a pipe -- COA of aorta
• Weak heart muscle Cardiomyopathy

7. CYANOTICCYANOTIC
• TOF,TGA, TAPVC,
• Truncus,Tricuspid Atresia
• E’S –EBSTEIN EISENMENGER
• SINGLE ATRIUM
• SINGLE VENTRICLE

8. How big is theHow big is the
problemproblem ????
 CHD—1/1000 live birthsCHD—1/1000 live births
 India---180,000 babies/yearIndia---180,000 babies/year
 KARNATAKA STATE—5-8,000KARNATAKA STATE—5-8,000
 EstimatedEstimated 5,000/year will have5,000/year will have
shunt lesions(“Holes in heart”)shunt lesions(“Holes in heart”)
 Easy to diagnoseEasy to diagnose
 Reasonably easy to treat unlikeReasonably easy to treat unlike
complex heart diseasecomplex heart disease

9. HISTORY AND EXAMHISTORY AND EXAM
 CYANOSIS PRESENT OR NOTCYANOSIS PRESENT OR NOT
 DYSPNOEA//TACHPNEADYSPNOEA//TACHPNEA
 FAILURE TO THRIVEFAILURE TO THRIVE
 MURMUR, CREPS++MURMUR, CREPS++
 CCFCCF
 CHEST XRAYCHEST XRAY

14. WHAT IS ECHO??WHAT IS ECHO??
 ULTRASOUND OFULTRASOUND OF
HEART.HEART.
 M MODE, 2D,M MODE, 2D,
DOPPLER ANDDOPPLER AND
COLOURCOLOUR
DOPPLERDOPPLER
 3 D3 D
 TEETEE

15. EchocardiographyEchocardiography
 Second
Stethoscope
 ** ExquisiteExquisite
anatomy even inanatomy even in
neonatesneonates
•••Structure and•••Structure and
functionfunction
 More than 95% ofMore than 95% of
cases can be sentcases can be sent
for surgery withoutfor surgery without
cath.cath.

16. MANAGEMENTMANAGEMENT
• MEDICAL
• INTERVENTION
• SURGERY

17. ASD--- left to right shuntASD--- left to right shunt

18. ASD
•TYPES
•Secundum
•Primum
•Sinus venosus
•SIZE
•PAH

19. ASD –ManagementASD –Management
• >> 10mm
• Volume overload
• 3-5 years—Device//surgery
• 12-15 kg
• Moderate ASD or large with good
rims >> Device

20. ASD—SPECIALASD—SPECIAL
CIRCUMSTANCESCIRCUMSTANCES
SPECIAL CIRCUMSTANCES
•SYMPTOMATIC IN INFANCY
•PFO AND STROKE
•AGE MORE THAN 50 YEARS

21. Pinhole surgery—another term forPinhole surgery—another term for
cardiac interventionscardiac interventions
• Key hole—laparoscopic surgery
• Pin hole surgery--- like doing
angioplasty AND STENT in adults
• Small tubes called catheters are passed
through the leg veins
• A Device is then put into the catheter and
released in the heart to block the
hole(ASD,VSD,PDA)

22. ASD Device PDA Device
© 2012 Vascular Innovations 22

23. ASD DEVICEASD DEVICE
Clockwise from above:
Transcatheter delivery
of Amplatzer device,
which is positioned
across the atrial septal
defect
Left: Amplatzer device
in place

24. ASD CASEASD CASE
 10 YEAR OLD BOY10 YEAR OLD BOY
 16 MM SECUNDUM ASD16 MM SECUNDUM ASD
 ALL RIMS (EXCEPT AORTICALL RIMS (EXCEPT AORTIC
RIM ) MORE THAN 5 MMRIM ) MORE THAN 5 MM
 POST. AND INF RIMSPOST. AND INF RIMS
SLIGHTLY FLOPPYSLIGHTLY FLOPPY
 PLAN– 20 MM ASD DEVICEPLAN– 20 MM ASD DEVICE

29. ASD Device closureASD Device closure

30. Fluoroscopy showing ASDFluoroscopy showing ASD
devicedevice

32. Atrial
Septal
Defect
Patch
Repair

33. VSDVSD

34. Large VSD

35. VSD --Doppler

36. VSD—ManagementVSD—Management
• Small to moderate VSD and no PAH
• Wait upto 5-6 years
• Moderate VSD, Mod PAH
• Operate 1-2 years of age
• Large VSD, severe PAH, preferably
4-5 kg. weight

39. VSD deviceVSD device

41. Ventricular Septal Defect RepairVentricular Septal Defect Repair

42. Patent DuctusPatent Ductus
Arteriosus (PDA)Arteriosus (PDA)
PDA(connectionPDA(connection
between the 2 greatbetween the 2 great
arteries—aorta andarteries—aorta and
pulmonary artery)pulmonary artery)

43. PDA -- ManagementPDA -- Management
• PDA preterm,Indomethacin//Ibugesic
• Term neonate
• Large << 5 Kg -- surgery,
• >> 5 Kg -- device
• Small and moderate –1-2 years,
• Device// coil

44. COILING OF PDACOILING OF PDA
Left, top: Catheter crosses the PDA
from the aortic side and delivers a coil.
Left, bottom: Withdrawal of catheter,
leaving coil in PDA

45. Amplatzer Ductal OccludersAmplatzer Ductal Occluders
Amplatzer ductal occluder
Illustration courtesy AGA Medical Group
Aorta angiogram with device
occlusion of PDA, lateral view

46. Note—dumbell device closingNote—dumbell device closing
the PDAthe PDA

47. Cable has been detached—Cable has been detached—
device in good positiondevice in good position

49. Hypertensive PDA –
Closed with 16/18 Device
49© 2012 Vascular Innovations

50. 50© 2012 Vascular Innovations

52. PS (pulmonary stenosis—narrowing ofPS (pulmonary stenosis—narrowing of
pulmonary valve)pulmonary valve)

53. Valvuloplasty
Pulmonary Balloon Valvuloplasty
Lateral angiograms

54. Aortic stenosis(AS– narrowing of aorticAortic stenosis(AS– narrowing of aortic
valve)valve)

58. Coarctation(narrowing of aorta)Coarctation(narrowing of aorta)

59. Angioplasty
Aortic Coarctation Angioplasty
Angiograms showing (left) post-surgical coarctation of the aorta
and (right) angioplasty balloon inflated across coarctation site

60. Intravascular Stents
Coarctation of the Aorta
Left: uninflated angioplasty balloon and stent within coarctation
Middle: expansion of balloon and stent
Right: deflation of balloon leaving stent wide open

61. Advantages of InterventionsAdvantages of Interventions
• Short hospital stay
• Child can start walking sam day or the
next day
• Almost 95-99% success can be achieved
by interventions

62. Cardiac Surgery

63. Breakthroughs in CardiacBreakthroughs in Cardiac
SurgerySurgery
• Heart lung machine
• Cardioplegia
• Deep Hypothermia
• Circulatory arrest

64. Tetralogy of FallotTetralogy of Fallot
1 – ventricular septal defect (VSD), 2 –pulmonary stenosis
2a – infundibular stenosis, 3 – enlarged aorta overriding VSD
4 – right ventricular hypertrophy

65. Tetralogy of Fallot Repair
(Above) With Transannular Patch
(Right) With Pulmonary annulus retained

66. In the “pink of health”In the “pink of health”

67. TGA “Switch operation”TGA “Switch operation”

68. How do we reach theHow do we reach the
common man?common man?

69. Take Diagnosis to the door stepTake Diagnosis to the door step
Mobile Cardiac ClinicMobile Cardiac Clinic

71. INFECTIVE ENDOCARDITISINFECTIVE ENDOCARDITIS
PROPHYLAXISPROPHYLAXIS
• REQUIRED
• CHD---VSD/PDA
• VALVE—BICUSPID AV AND AS
• RHD—MR
• OPERATED AND DEVICE CLOSURE OF
ASD AND PDA ,
• FIRST 6 MTHS
• PROSTHETIC VALVE

72. IE PROPHYLAXIS NOT REQDIE PROPHYLAXIS NOT REQD
• ASD/ PS
• MVP WITH NO MR
• POST CABG OR STENTING
• PACEMAKER

73. REGIMEREGIME
• AMPICILLIN OR AMOXYCILLIN
• WITH OR WITHOUT GENTA
• CEFATOXIME
• 1 HR BEFOR PROCEDURE
• 2 DOSES AFTER PROCEDURE

74. CONCLUSIONS
•Early diagnosis
•Intervention//surgery
•Hybrid//minimally invasive

75. Team Effort

76. A parent’s dream---A parent’s dream---