Acyanotic Congenital Heart Disease (CHD)

Group Etio. Epid. Clinical Man. Imaging Treatment Comments

LTR VSD 25% Most Pansystolic murmur (LLSB), split S2 ECG: LAH, LVH ⅓ close spontaneously Perimembranous VSD most
shunts common common (67%)
CHD Small VSD: Asymptomatic, loud murmur CXR: Cardiomegaly, Small: no closure required
(P.P) Moderate-to-large VSD: fatigue, diaphoresis LVH Moderate-to-large: Diuretics, Asymptomatic at birth ( PVR)
with feedings, poor growth  HF. Pulmonary HT  RVH digoxin, afterload reduction
Large shunts: Mid-diastolic murmur at apex, Poor growth, pulmonary HT, or
large VSD: surgical closure.
ASD 10% Rarely symptomatic ECG: RAD, RVH R/I unless significant defect by 3y Secundum (foramen ovale)
Systolic ejection murmur (I-II), fixed split S2, RV CXR: Cardiomegaly, Secundum: closure device (cath.) defect most common
impulse (LLSB) RAH, prominent PA Primum, sinus venosus: surgical c.
PDA 10% Widened pulse pressure, continuous machine- CXR: full PA silhouette, Diuretics initially, but requires Imaging may be normal
like murmur (left infraclavicular area, left back, increases pulmonary closure (indomethacin?) Premature infants excluded in
radiates along PA), splitting of S2, thrill vascularity Cath lab: Coil embolization, incidence (occurs more)
Large shunts: Mid-diastolic murmur at apex, ECG: LVH, RVH (P.HT) closure device. Uncorrected PDA results in
hyperdynamic pericordium cyanosis in lower extremities
AVCD - Complete defect: primum ASD + posterior VSD, Dx: Echocardiography Initially: diuretics ± digoxin, Some Down syndrome
leaflet clefts in mitral & tricuspid valves ± AV CXR: cardiomegamly, afterload reduction (for HF) children have complete
valve insufficiency enlargement of all Ultimately surgical repair required endocardial cushion defect
HF in first 6-8 w, P.HT, poor growth chambers
Large VSD component: single S2 ECG: LAX, combined VH
Ob. Les. PS 10% Mild: asymptomatic ECG: RAD, RVH Balloon valvuloplasty Newborn with severe stenosis
may be cyanotic due to atrial
(n P.P) Mod-to-Sev: Exertional dyspn., easy fatigability CXR: prominent main PA Surgical repair: if unsuccessful or right-to-left shunt
SEM (left 2nd intercostal, radiates to back), thrill, Echo: site of stenosis, subvalvular (muscular) stenosis
widely split S2 with quite pulmonary degree of hypertrophy, Valvular PS does not progress
component, impulse at LLSB (RVH), Click pressure gradient
(valvular stenosis, varies with respiration)
AS 5% Mild-to-moderate: Asymptomatic ECG: LVH Serial follow up with Echo Degree of aortic stenosis
Severe: easy fatigability, exertional chest pain, CXR: Poststenotic Balloon valvuloplasty 1st interv. progresses with growth and
syncope, infants can present with HF dilation of ascending (less successful than PSBV) age
SEM (Rt 2nd ICS along sternum, radiating to aorta or aortic knob Surgical repair: failed BV, Aortic insufficiency often
neck), systolic ejection click (valvular Echo: same as PS development of valve develops
stenosis), thrill (RUSB, suprasternal notch) insufficiency ( risk with BV)
COA 10% Infant: Poor feeding, respiratory distress, shock Infant ECG, CXR: RVH, Infant presenting with cardiac Almost always juxtaductal
before 2 w, femoral pulse/BP/timing < radial cardiomegaly, decompensation: IV (preductal)
Older children: asymptomatic, hx of leg pulmonary edema prostaglandin E1, inotropic Symptoms develop after PDA
discomfort with exercise, headache, epistaxis, Older children ECG, agents, diuretics, balloon closes
HT in upper extremity. CXR: LVH, mildly angioplasty, surgical repair (m/c) Most commonly associated
Murmur (left interscapular area of back), enlarged heart, rib Older children: ballooning, with bicuspid aortic valve
collaterals present continuous mumur notching (>8yr with stenting, surgical repair (m/c) Associated with Turner
 throughout chest large collaterals) syndrome
Abnormal aortic valve (50%): SEM, SEC
LTR. Left-to-right shunt; P.P, pulmonary pressure; CHD: congenital heart disease; LLSB, Left Lower Sternal Border; A/VH, atrial/ventricular hypertrophy, PVR, pulmonary vascular resistance; SEM/C, systolic ejection murmur/click, AVCD, atrioventricular canal defect