Ventricular Septal Defect
Atrial septal defect
Coarctation of the aorta
Patent ductus arteriosus
Pulmonary or aortic valve stenosis
Patent foramen ovale
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Ventricular Septal Defect
Opening between the left and right ventricle
Interventricular septum
(Due to pressure of blood going into left ventricle)
Most common type of congenital heart disease
(Perimembranous or Type 2 is most common type of VSD)
➔ Causes a left to right shunt (due to pressure difference)
➔ Often don’t appear until several days/weeks after birth
➔ Associated with a systolic murmur
➔ May resolve on its own or may require surgery
◆ Depends on size and other factors
➔ Left to right shunt is present unless pulmonary hypertension is present
Most Common pathologic murmur in childhood
– The heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries can increase
(pulmonary hypertension) due to the increase in blood
flow
– High pitched holosystolic murmur (left sternal border)
– Present with: Dyspnea and respiratory distress
– Small vsds close spontaneously
– Echocardiogram is choice of diagnostic tool
– Larger may require surgery
Atrial Septal Defect (ASD)
Hole in the septum between the atria
Secundum ASD is the most common type of ASD. It occurs in the middle of the wall between the upper heart chambers (atrial septum).
– Symptoms: often asymptomatic
– Left to right shunt but less severe than VSD because of lower pressure in atria
– Moderately loud systolic ejection murmur Crescendo – Decrescendo in left upper sternum border
– Widely fixed, split s2 (doesn’t vary with respirations)
– Right atrium enlarges and may result in atrial fibrilliation
– Larger defects may present with failure to thrive, recurrent lung infections, or symptoms of heart failure
– Echocardiogram is choice of diagnostic tool
– Observation is treatment of choice unless it is large enough to caution surgery as a last resort
Coarctation of Aorta
- More common in makes
- In adults, Bicuspid aortic valve instead of normally 3 leaflets
- Turners’ syndrome mostly linked to this (A chromosomal disorder in which a female is born with only one X chromosome)
- Strong arterial pulsations in neck/sternal notch
- Classic finding
- Hypertension in higher extremities and Hypotension in the lower extremities
- Systolic murmur
- Echocardiogram is diagnostic tool of choice
- X-ray findings
1) Posterior rib notching
2) Figure “3” sign indentation around aorta
- Can use prostaglandins prior to ultimate solution of surgery for ease of comfort for patients
Patent Ductus Arteriosus
Common in premature infants
– Characterized by wide bounding pulse pressure, a continuous “machinery” like murmur and a suprasternal notch thrill
– Often due to congenital rubella -exam question
– Shunts blood from right ventricle to bypass fetus non-functioning lungs in utero
– In PDA- ductus fails to close after birth
– Treatment is NSAID –> Indomethacin or Ibuprofen used for up to 48 hours to close. If closer does not occur, then surgery is definitive
Patent Foramen Ovale
A patent foramen ovale (PFO) is a hole in the heart that didn’t close the way it should after birth. The small flaplike opening is between the right and left upper chambers of the heart (atria).
As a baby grows in the womb, the foramen ovale is present in between the right and left top chambers of the heart (atria). It normally closes during infancy. When the foramen ovale doesn’t close, it’s called a patent foramen ovale.
Most people never need treatment for patent foramen ovale.
PFO is not an ASD because no septal tissue is missing – It is due to failed septal fusion
