CONGENITAL HEART

DISEASE

Pembimbing: dr. Pulung M. Silalahi, Sp.A

Disusun oleh: Abraham Fatah (07120100096)

Definition
Congenital Heart Disease is a broad spectrum
entity of heart defects; defined by malformation of
the heart or great vessels. Which occurs during
intrauterine development

Epidemiology
General population 6 13 /1000 birth
Indonesia 7 8 / 1000 birth
Acyanotic VSD (2,7/1000), ASD (1/1000)
Cyanotic TOF (0,5/1000)

Anatomy

Anatomy

Embryology

Embryology

Fetal Circulation

Classification

Diagnostic Approach
History taking

Pregnancy, labor, delivery

Infants Feeding history
Older children fatigue during exercise
Growth delayed
Family history of genetics; e.g. Trisomy 21

Diagnostic Approach
Physical examination
Inspection: Cyanosis, work of
breathing
Palpation: Situs solitus, RV
impulse with S2 split,
comparing upper and lower
extremities pulses
Auscultation: S1 S2 heart
sound single or splitting,
murmur (location, grades,
phase during cardiac cycle,
quality), gallop, breath sound

Classification

 Types
Perimembranous
Muscular
AV defect

Clinical Manifestation

congestive heart failure

tachypnea
poor feeding
failure to thrive
frequent lower respiratory
tract infection
Holosystolic murmur @left
sternal border

VSD

 Types
Ostium primum
Ostium secundum (most
common)
Coronary sinus assc.
With TAPVR

Clinical Manifestation
Dyspnea on exertion
Fatigue
Recurrent pulmonary
infection
Murmur @upper left
sternal border
Fixed S2 splitting
RV impulse

ASD

Amplatzer Septal
Occluder

 Machinary continuous
murmur @ left
subclavicular region

PDA
Treatment by administration of Indometachin
Surgical ligation or coil placement

Coarctation of Aorta
Difference pressure
between upper and lower
extremities
Murmur @left interscapular
region

Coarctation of Aorta

 Tet spell
Relieved by squating in
older children

Tetralogy of Fallot

Tetralogy of Fallot

 Very critical
Patent
foramen ovale
allows blood
shunt
Generalized
cyanosis
gradually
worsen after
birth

Transposition of the Great

Arteries

Etiologies
Genetic and maternal factors

Etiologies
Maternal disease
Phenylketonuria TOF, VSD, PDA, CoA
Rubella Congenital Rubella Syndrome
Congenital cataract, sensorineural deafness, CHD;
especially PDA

Febrile illness RV defect; tricuspid or pulmonary

atresia
Obesity ASD, VSD

Drugs
Alcohol Fetal alcohol syndrome; VSD
Cigarette smoking VSD, ASD, TOF

Complications
Pulmonary vascular disease
Anatomical compression tracheobronchomalacia
Pulmonary hypertension
Recurrent infection RSV, metapneumovirus,
influenza, P. aeurginosa, Klebsiella.

The cause is multifactorial

Complications
Neurodevelopmental
growth

Complications
Malnutrition
Increased metabolic demand
Lung infection
Palliative drugs nausea, vomiting; e.g.
indometachin diarrhea

Complications
Eisenmenger Synrdrome

Thank You