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BAWAAN
PADA DEWASA
Pulmonary-
veins
Left"
atrium
Right"
atrium
Left"
ventricle
Right"
ventricle
PHYSICAL EXAMINATION
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Echocardiography :
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Devices for percutaneous atrial septal closure
procedure (Amplatzs Septal Occluder)
Devices for percutaneous atrial septal closure procedure
Devices for percutaneous atrial
septal closure procedure
Ventricular Septal Defect
Ventricular Septal Defect is the most common congenital
cardiac abnormality in infants and children.
It occurs with similar frequency in boys and girls.
25 to 40 percent of such defects close spontaneously by the
time the child is 2 years old; 90 percent of those that eventually
close do so by the time the child is 10.
Anatomically, located are
70 percent in the membranous portion of the interventricular
septum,
20 percent in the muscular portion of the septum,
5 percent just below the aortic valve (thereby undermining the
valve annulus and causing regurgitation), and
5 percent near the junction of the mitral and tricuspid valves (so-
called atrioventricular canal defects).
Pulmonary artery
Pulmonary-
veins
Left"
atrium
Right"
atrium
Left"
ventricle
Right"
ventricle
Ventricle
Septal
Defect
A view of the ventricular septal defect (VSD)
from the left side. The VSD lies immediately
beneath the aortic valve.
Hemodynamic VSD
Two-dimensional echocardiographywith
Doppler flow can confirm the presence
and location of the ventricular septal
defect,
Color-flow mapping provides information
about the magnitude and direction of
shunting.
Echocardiography examination
Kateterisasi VSD
Aortic valve
Int
erv
ent
ric
le
sep
tu m
Natural history and treatment :
Aortic valve
Aortic valve
Int
erv
en
tric
le
sep
tu m
Patent Ductus Arteriosus
The ductus arteriosus connects the descending aorta (just
distal to the left subclavian artery) to the left pulmonary
artery.
In the fetus, it permits pulmonary arterial blood to bypass
the unexpanded lungs and enter the descending aorta for
oxygenation in the placenta.
It normally closes soon after birth, but in some infants it
does not close spontaneously. PDA accounts for about 10
percent of cases of congenital heart disease.
Its incidence is higher than average in pregnancies
complicated by persistent perinatal hypoxemia or maternal
rubella infection and among infants born at high altitude or
prematurely.
Causes
The cause of patent ductus arteriosus (PDA) is
not known.
Genetics may play a role. A defect in one or
Pharmacological :
Medical management such as diuretics and fluid restriction
Adequate calories and minerals with fluid restriction
Indomethacin (0.1- 0.2 mg/kg IV) is a potent stimulator of
ductal closure. It blocks the enzyme cyclooxygenase
inhibiting prostaglandin synthesis thereby facilitating ductal
closure (for infants)
Ibuprofen, another non-selective cyclooxygenase inhibitor,
given on the third day of postnatal life appears to be as
effective as indomethacin for PDA closure but less likely to
induce oliguria (for infants)
Non Pharmacological :
Surgical ligation
Trans-catheter closure
Surgical ligation :
The classical approach via a
left lateral sternotomy with
ligation can be performed in
an operating room or at the
bedside with low mortality.
Trans-catheter closure :
• Coil
• ADO = Amplatz Ductal
Occluder
Closure of a PDA by coil catheterization. (A) Injection into the aorta reveals a
large PDA at baseline. (B) Following placement of a coil the angiographic dye
no longer crosses into the pulmonary artery confirming ductal closure.
(MPA = main pulmonary artery, PDA = patent ductus arteriosus, DA = descen
ding aorta)
TERIMA KASIH