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• Insidence
20 % of all CHD
No sex influenced
• Anatomy
Subarterial defect : below pulmonary and
aortic valve
Perimembranous defect: below aortic valve at pars
membranous septum
Muscular defect
VSD
VSD
LA LV
Lungs
PA AO
RV RA Systemic
Qp > Qs
VSD
RA
LA
RA LA
RV LV RV LV
VSD
VSD
• Clinical findings
Day 1st after birth: murmur (-)
After 2-6 weeks : murmur (+)
Murmur : pansystolic grade 3/6 or higher
at LSB 3
Small muscular defect: early systolic murmur
Significant defect: Mid diastolic murmur at apex
VSD
Murmur: pansystolic
grade 3/6 or higher at
LSB 3 Small VSD
Large VSD
VSD
Cardiomegaly
Apex down ward
Prominence pulmonary
artery segment
Increased pulmonary vascular
marking
VSD
Diagnosis Differential
PDA with PH
Tetralogy Fallot non cyanotic
Inoscent murmur
Management:
Anti failure
Aortic valve Infundibular PH Spontaneous Smaller
prolaps stenosis closure
Conservative
Surgical closure/Transcatheter closure
VSD after occluded
VSD before occlusion
using ASO
Atrial Septal Defect ( ASD )
• Insidence : + 10 %
• : ratio = 1,5 to 2 : 1
• Anatomy :
Defect on foramen ovale : Secundum ASD
Defect at SVC and RA junction: sinus
venosus ASD
Defect at ostium primum: primum ASD
ASD
ASD
Clinical findings
Asymptomatic
Auscultation :
Normal 1st HS or loud
Widely split and fixed
2nd HS
Ejection systolic murmur
ASD
Management
Surgery : Preschool age
Recent treatment: transcatheter closure using
ASO (Amplatzer septal occluder)
ASD
Infants Children/Adults
Observation
Heart Heart PH (-) PH (+)
Evaluation Failure (-) Failure (+)
At age 5-8 yrs PVD PVD
Anti failure (-) (+)
Cath Hyperoxia
Success Fail
Insidence
+ 10%
Female : Male = 1.2 to 1.5 : 1
Premature and LBW higher
Anatomy
Fetus: ductus arteriosus connects PA and aorta.
If ductus does not closs Patent Ductus arteriosus
PDA
PDA
LA LV
Lungs
PA AO
Systemic
RV RA
Qp > Qs
PDA
• Clinical findings
Small defect:
Symptom (-)
Growth and development normal
Significant defect:
Decreased exercise tolerant
Weigh gained not good
Frequent URTI
Specific case: pulsus seler at 4th extremities
PDA
Diagnosis
Pulsus seler and continuous murmur heard
Diagnosis Differential
AP-window
Arterio-venous fistulae
Management
premature: indometasin
PDA closure : surgery
transcatheter closure
(ADO and coil)
PDA
Neonates/Infants Children/Adults
Fail Success
Success Fail Reactive Non
Age >12wks reactive
W >4kg
• Anatomy:
Pulmonary stenosis valvular :
Bicuspid pulmonary valve
Valve leaflet thickening and adhession
Pulmonary stenosis infundibular :
Hyperthropy infundibulum
PS
• Clinical findings
Valvular stenosis
Mild : Ejection systolic
Wide 2nd HS
ejectiin click
Moderate: ejection systolic, early systolic click
Severe : ejecstion systolic, ejection click (-)
Stenosis infundibular
Ejection click ( - )
1st HS normal, 2nd HS weak, ejection systolic
Pulmonary stenosis periphery
1st & 2nd HS normal, ejection systolic
PS
• Diagnosis
Asymptomatic patient:
click systolic (stenosis valvular)
systolic murmur
wide split 2nd HS vary with respiration
PS
ECG : RAD
Echocardiograhhy : confirmation diagnosis
Catheterization: increased RV pressure without
increased oxygen saturation
PS
• Management
Medicamentosa : useless
Mild stenosis: intervention (-)
Moderate stenosis:
observation
Severe stenosis: balloon
valvuloplasty
Coarctation of Aorta (CoA)
Incidence
• In Western country 5 % of all CHD
• In Asian Country incidence lower
under diagnose?
Anatomy
Stenosis at any where in the aorta
(from aortic valve to abdominalis aorta)
More frequent at ductus arteriosus
Botalli and pulmonary artery junction
CoA
• Clinical findings
Severe coarctation in neonates period can cause
heart failure in 1st weeks of life
• Diagnosis
Clinically : lower extremities pulses are weak
CXR : Mild cardiomegaly
Prominence of aortic knob
Normal pulmonary blood flow
ECG : normal or LVH
Echocardiography: a discrete shelf-like membrane
Cardiac catheterization and angiography: to confime
diagnosis
CoA
• Management
Neonates :
PGE1 to maintain PDA
Diuretic
Correction acid-base imbalance
Prepared to undergo surgery
Big children:
Surgery should be done
as soon as diagnosis made
Balloon angioplasty
CoA