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A Lecture on Congenital Heart Defects Arranged by HART Welfare Society Presented by H/Dr.Muhammad Abid Khan on 15/02/2009 HUMAN HEART Location of Heart in Human Body. EXTERIOR VIEW OF HEART INTERIOR VIEW OF HEART CROSS SECTION OF HEART CIRCULATORY SYSTEM • Pulmonary Circulation • Systemic Circulation • Fetal Circulation FETAL CIRCULATION • Ductus Arteriosus • Foramen Ovale • Ductus Venosus HEART DEFECTS •Congenital Heart Defect (CHD) •Other Defects CONGENITAL HEART DEFECTS Congenital Heart Defect (CHD) is a defect in the structure of the heart and great vessels of a newborn. CONGENITAL HEART DEFECTS 1 Patent ductus arteriosus 2 Hypoplasia 3 Obstruction defects 4 Septal defects 5 Cyanotic defects PATENT DUCTUS ARTERIOSUS The ductus arteriosus is a temporary pathway in the fetal heart between the pulmonary artery and aorta, which allows blood to bypass the fetus's nonfunctioning lungs until birth. Normally, the ductus closes within a few hours or days of birth; when it does not, the result is patent ductus arteriosus. This defect is common in premature infants but rare in full-term infants. Ligamentum arteriosum The ligamentum arteriosum (or arterial ligament) is a small ligament attached to the superior surface of the pulmonary trunk and the inferior surface of the aortic arch. It is a nonfunctional vestige of the ductus arteriosus, and is formed within three weeks of birth HYPOPLASIA Hypoplasia is a rare congenital heart defect in which left side or right side of the heart is underdeveloped. •Hypoplastic left heart syndrome Is a condition in which the left side of the heart is severely underdeveloped. •Hypoplastic right heart syndrome is a condition where the right atrium and right ventricle are underdeveloped. Hypoplastic left heart syndrome OBSTRUCTION DEFECTS Obstruction defects occur when heart valves, arteries, or veins are abnormally narrow or blocked. Common obstruction defects include pulmonary valve stenosis, aortic valve stenosis, and coarctation of the aorta, with other types such as bicuspid aortic valve stenosis and subaortic stenosis being comparatively rare. Any narrowing or blockage can cause heart enlargement or hypertension. Pulmonary Valve Stenosis Outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. Aortic Valve Stenosis Aortic valve stenosis (AS) is a valvular heart disease caused by the incomplete opening of the aortic valve Coarctation of the Aorta Coarctation of the aorta, or Aortic coarctation, is the name given to a congenital condition whereby the aorta narrows in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. SEPTAL DEFECTS The septum is the wall that separates the chambers on the left side of the heart from those on the right. It prevents mixing of blood between the two sides of the heart. Sometimes, a baby is born with a hole in the septum. When that occurs, blood can mix between the two sides of the heart. SEPTAL DEFECTS • Atrial septal defect (ASD). An ASD is a hole in the part of the septum that separates the atria—the upper chambers of the heart. • Ventricular septal defect (VSD). A VSD is a hole in the part of the septum that separates the ventricles— the lower chambers of the heart. Atrial septal defect (ASD). Ventricular septal defect (VSD). CYNOYTIC DEFECTS Cyanotic heart defects are called such because they result in cyanosis, a bluishgrey discoloration of the skin due to a lack of oxygen in the body. Such defects include : CYNOYTIC DEFECTS • Persistent truncus arteriosus • Total anomalous pulmonary venous connection • Tetralogy of Fallot • Transposition of the great vessels • Tricuspid atresia Persistent truncus arteriosus In this condition, the embryological structure known as the truncu arteriosus never properly divides into the pulmonary artery and aorta. Anatomical changes due to Persistent truncus arteriosus • single artery arising from the two ventricles which gives rise to both the aortic and pulmonary vessels • abnormal truncal valve • right sided aortic arch in about 30% of cases (not shown) • large ventricular septal defect • pulmonary hypertension • complete mixing occurring at level of the great vessel Total anomalous pulmonary venous connection (TAPVC) In this condition all four pulmonary veins are malpositioned and make anomalous connections to the systemic venous circulation Tetralogy of Fallot This condition involves four anatomical abnormalities : •Pulmonary stenosis •Overriding aorta •Ventricular septal defect (VSD) •Right ventricular hypertrophy Tetralogy of Fallot A. Pulmonary stenosis A narrowing of the right ventricular outflow. B. Overriding aorta An aortic valve with biventricular connection C. Ventricular septal defect (VSD) A hole between the two bottom chambers (ventricles) of the heart. D. Right ventricular hypertrophy The right ventricle is more muscular than normal, causing a characteristic boot-shaped appearance. Transposition of the great vessels Involving an abnormal special arrangement of any of the primary blood vessels: superior and/or inferior vena cavae (SVC, IVC), pulmonary artery, pulmonary veins, and aorta. TRICUSPID ATRESIA there is a complete absence of the tricuspid valve. Therefore, there is an absence of right atrioventricular connection. In such a case ASD and VSD are compulsory to complete the blood circulation. Tricuspid atresia Thank you very much The End